Cardiovascular Medicine Case Study

There will be a need for additional catheterization labs, surgical suites and expanded cardiac rehabilitation programs. There needs to be better coordination of care to ensure timely scheduling of procedures. Education programs need to be developed emphasizing cardiac risk factors, healthy living and lifestyle modifications.

The work of Burke, et al (2011) reports that a study with the objective of comparing the "efficacy of intradermal bacteriostatic normal saline with that of intradermal buffered lidocaine in providing local anesthesia to adult patients prior to IV catheterization." (p.1) The study concluded that intradermal buffered lidocaine was superior to intradermal bacteriostatic normal saline in providing local anesthesia prior to IV catheterization in this group of predominately white adults and should be the solution of choice for venipuncture pretreatment." (Burke, et al, 2011, p.1) Burke et al reports that surgery is something that most people fear with the fear of the unknown is combined with "apprehension about such anticipated procedures as insertion of an IV line." (2011, p.1) Burke additionally reports that patients admitted for same-day surgery "require IV access. Any venipuncture, including peripheral IV catheterization with a medium-to-large-gauge catheter, can cause some degree of pain. Using local anesthesia prior to IV catheterization has

The blood vessel that Dr. Eltahawy was concerned about was thin and looked as though it would collapse in on itself. First, Dr. Eltahawy tried a balloon catheter. At the top of the catheter was a small balloon that could inflate to maintain a shape or structure of a blood vessel. However, because the blood vessel was so thin, the balloon catheter was not very effective. Instead, Dr. Eltahawy installed a stent. A stent is a wire mesh tube. It is placed in a blood vessel permanently to maintain the shape of the vessel and to allow for the free flow of blood. Throughout this entire independent study, I realize that shadowing in the medical field is less about learning about medicine and more about discovering about whether becoming a doctor is the right step. This independent study has been a step in the right

The procedure was done emergently because of the patient’s critical condition. His right IJ area was prepped in the usual fashion. It was very difficult to visualize his right IJ vein, even though his habitus should have allowed us to do so, but the patient was, I believe, severely intravascularly volume depleted, and his vein was collapsing. I have attempted to access the right internal jugular vein multiple times, both under real-time ultrasound guidance and even later on blindly. I was able to get blood return and hit the vein; however, I was not able to advance the guidewire. I was able to advance it one time and put the catheter in, and it was nonfunctioning. I had to take the catheter out and tried multiple other times on the right IJ vein without success. That procedure was terminated. Pressure was applied. There was no cervical hematoma whatsoever. The patient was uncomfortable because of the length of the procedure but did well otherwise. Hemodynamically, he was unchanged, and his oxygen saturations remained stable.I prepped the IJ vein area in the usual fashion. One percent lidocaine was used for local anesthesia. Again, the left IJ vein was collapsing. With deep inspiration, the vein could be well visualized on the real-time and ultrasound guidance, after which I could get access to the left IJ vein. A wire was advanced without difficulty while the

Mr. Howard, a 57-year-old man, had a 3-month history of progressive typical anginal chest pain. He reported that the symptoms first occurred with heavy exertion and involved what he described as“heaviness” in his chest. The symptoms were promptly relieved with rest. Over the past weeks, he had been experiencing increasingly frequent episodes of chest pain and diaphoresis. The episodes had become more prolonged, and he had experienced one episode of pain occurring at rest after a heavy meal. Mr. Howard was moderately obese and had a 20-year history of hypertension, which was being treated. Other risk factors in Mr. Howard’s history include hypercholesterolemia (350 mg/dL), which he was attempting to treat with dietary modifications, and a 30-year two-pack-a-day smoking history which continued up to the present time. Mr. Howard previously had surgery for a bilateral inguinal hernia repair, cholecystectomy, and arthroscopic surgery on his left knew. He also gave a history of problems with gastric reflux and was currently taking cimetidine (Tagamet).

Unfortunately, “VTE comprised of DVT and/or PE represent a serious public health challenge, affecting up to 600,000 Americans annually. The consequences can be deadly; VTE has been identified as the most common cause of preventable mortality in hospitalized patients, accounting for up to 10% of hospital deaths” (Shermock et al., 2013, p. 1) It is imperative that all patients admitted to the ICU should be assessed for VTE. The assessment should be done frequently. It is important to assess both subjective and objective data. Past medical history is very important. It is essential to find out if the patient has any predisposition to a VTE including any trauma to veins, any varicosities, obesity, COPD, HF. Certain medications can also put a patient at risk for VTE such as oral contraceptives, hormone therapy, tamoxifen, or raloxifene. Also, any recent surgeries such as orthopedic, gynecologic, gastric, or urologic and past surgeries involving veins or a central venous catheter can put a patient at risk. Objective data includes fear, anxiety, and pain. Monitor vital signs frequently. Check the integumentary system for symmetry; taut, shiny, warm skin, erythematous, tender to palpation. Not every patient

As the qualitative research has demonstrated, the beta-blocker use post-acute coronary syndrome various greatly, and are underused (Bradley et al., 2001). The conclusion of that qualitative study shared four goals for improvement of organization when it compared the hospital with greater improvement of beta blocker use over time (Bradley et al., 2001). The implementation of the change can by best achieved by the four factors. Frist, strong unified drive with goals for improvement (Bradley et al., 2001). According to Lewin’s change theory, in order for change to be successful, the unfreeze-change-refreeze process must occur (Grossman & Valiga, 2013). The unfreeze step of the theory is that inner motivation that comes from within in the organization. Second, the substantial amount of administrative support to implement the beta blocker use according to best evidence based guidelines (Bradley et al., 2001). Third, strong provider leadership advocating for beta-blocker use based on evidence (Bradley et al., 2001). To implement changes that are based on evidence and guidelines are more than likely to be successful (Grossman & Valiga, 2013). lastly, and use of credible data (quality assessment) feedback (Bradley et al., 2001). The last step is when all the process refreezes and the changes become the new norm (Grossman & Valiga,

Evaluation is the final and often the most critical step in evidence based research and practice. Evaluation of evidence based practice follows a pathway beginning with the selection of the area for improvement, synthesizing the research into a process improvement activity and evaluating both the implementation of the process improvement as well and the outcomes of the intervention (Titler, 2008). To measure the results of process change in the management of heart failure patients a retrospective analysis will be conducted comparing the readmission rates of a pilot and control population over a 6-month period. The pilot population will be evaluated with the LACE index readmission risk assessment upon admission and subsequently receive the recommended interventions based on the risk stratification. In comparison, the control group will receive the current process of telephonic contact only. The pilot group will include patients over the age of 18 residing in zip-codes 45402 and 45403,

1). Chest X-ray was normal. Initial laboratory studies were remarkable for white blood cells count of 12.1K, a creatine kinase MB fraction of < 3 mm was associated with significant reductions in restenosis and the rate of target vessel revascularization19. In SES-SMART trial patients were randomly assigned to receive a Sirolimus-eluting or bare-metal stent in small coronary artery. Sirolimus stent was associated with significant reductions in the rates of angiographic restenosis (primary outcome), target lesion revascularization and MI at 8 months20. The composite clinical endpoint ( death, non-fatal MI, ischemia- driven target lesion revascularization, and cerebrovascular accidents) was significantly lower with the sirolimus-eluting stent21. In the TAXUS V trial, in the subset of patients with small coronary arteries, the paclitaxel stent was associated with significant reductions in angiographic restenosis and target lesion revascularization at nine months compared to bare metal stents22. Although DES improves target lesion revascularization rates compared to bare-metal stents in small vessels, the absolute rates are still higher in small vessels than large

A coronary angiography provides information about the hearts blood pressure and functioning. This procedure can identify whether the coronary arteries are blocked or narrowing. A tube/camera is passed through an artery in the groin or arm; it is guided using x-rays up to the heart. A coronary angiogram is a safe procedure, but there are some small side affect. You may feel a slightly strange sensation when the dye is put down the catheter, a small amount of bleeding when the catheter is removed, a bruise in your groin or arm.

The ICUs are associated with over 15 million catheter days while there is indication that only 24.4% of CVC use occurs outside the ICUs (Chopra, Krein, Olmsted, Safdar & Saint, 2013). This implies that millions of patients in the ICUs are at a high likelihood of developing CLABSI

Peripheral IV catheterization is a painful and potentially anxiety-provoking procedure for the patients. The interventions to reduce the pain caused by venipuncture were explored in the past decades (Oman, 2014). The majority of the studies reviewed in this summary included one level 1 evidence of meta-analyses (Oman, 2014), three level 2 evidences of randomized controlled trials (Beck, 2011; Deguzman, 2012; Kahre, 2011) and one level 3 evidence of controlled trials without randomization (Levitt , 2013). Many studies have demonstrated that 1% lidocaine intradermal injection before IV insertion can reduce the pain significantly (Oman, 2014). Kahre and his colleagues’ study indicated bacteriostatic normal saline (BNS) group had lower pain score

In the medical industry today, surgery takes a wide variety of forms and is often performed using minimally invasive techniques, which has evolved greatly since even the 19th century from the first blood transfusion in 1818, that took place in Germany. New,

Measures to reduce central venous pressure (CVP) and cerebral metabolic rate for oxygen (CMRO2) can effectively allow to increase SVC clamping time [4,6,7]. To maintain mean arterial pressure, fluid administration and vasopressor use plays important role. However fluid infusion through cannula placed in upper limbs would cause further rise in cerebral venous pressure. Femoral venous or right atrial cannula would be effective in fluid resuscitation. Neuroprotective methods like use of thiopentone and mild hypothermia can be used. BIS monitoring is essential during such surgery. As brain metabolism is decreased, bispectral index also decreases. SVC decompression can be done by creating temporary veno atrial shunt or cavo pulmonary anastomosis for drainage of the SVC. (5,8) J.Y. Perentes et al described a new temporary SVC bypass technique -preoperative jugulo-femoral bypass or intraoperative innominate-femoral bypass using standard perfusion tubing. SVC clamping induced jugulo-femoral pressure gradient drives blood from jugular to femoral vein without any need of a pumping device or additional heparinization beyond that required for SVC reconstruction.(9) Hemodynamic imbalance and neurological effects of SVC clamping can be life threatening. Anaesthesiologist must be aware of different options to manage such challenging

There are countless scenarios throughout this series that are similar to what takes place every day in a hospital and what the doctors and nurses see on a daily basis. Grey’s Anatomy benefits its viewers through realistic portrayals. Multiple surgeries have performed on the show that are consistent with literature. This could be a medium for medication students to review their content of interest or for those who are considering joining the medical field. Coronary bypass is one of many surgeries that is often completed on this show. During this procedure blood is diverted around a section of a blocked artery in the heart to restores blood flow to a patient’s heart muscle. Coronary bypass surgeries are just as common on Grey’s Anatomy as they