Embolism In Hospital Setting

Nearing the end of my shift in the Emergency Department, I was requested to accompany a patient while the nurse readied the discharge papers. Upon entering the bay, I met a very small and fragile patient who was anxious to go home. Conflicted between my primary duties and responsibilities to complete training for two inexperienced volunteers, I decided to put forth my interests in teaching by demonstrating compassionate care to my trainees. Although the patient repeatedly refused my assistance, I gave my best effort to calm her as I cloaked a warm blanket around her. As I listened to her confide in me of all of her hospital anxieties, I was shocked from the lack of quality care she had received which made her feel more sick after the first

2. An 56-year-old established patient presents to her doctor's office with chest pain and shortness of breath. The doctor orders an ambulance to take the patient to the ED to be checked out. From the ED the patient is admitted for some

DVTs usually occur within the deep veins of the lower leg. The DVTs that remain in the lower leg and calf tend to be asymptomatic and do not become clinically significant. A DVT is most likely to present symptoms when the proximal leg veins are involved and also when the DVT obstructs venous outflow resulting in inflammation of the vein wall (Bonner and Johnson, 2014). Warmth, redness, pain and swelling in the affected limb are common symptoms of a DVT. If a patient presents with these symptoms, a physical examination of the whole limb should be undertaken by a nurse or physician to observe for signs suggestive of a DVT. Suggestive symptoms of DVTs include superficial venous dilation, tenderness along the course of the vein, unilateral leg oedema, cyanosis, warmth and erythema (Bonner and Johnson, 2014). On examination of the limb, these are the symptoms that the nurse or physician should be looking out for, however, diagnosis on clinical presentation alone is extremely difficult as these symptoms are not specific to DVT and can be present in numerous other conditions. To improve accuracy when determining the probability of a DVT, nurses are advised to use the two level DVT Wells score. Each clinical feature is accompanied with a score. If a patient presents with a score that is two points or higher, it is likely that a DVT is present and

Clipboard and stethoscope in hand, I walked toward the double doors that flashed emergency in bright red letters above. It was my first clinical shift as an EMT student, and first day jitters fluttered around in my stomach. I had no idea what lay ahead of me. However, I was not expecting to witness the fragility of life. About a half an hour into my shift the rapid response alarm blared through the emergency room. I turned to my preceptor and quizzically asked what this meant. “A rapid response is a patient who is in need of immediate medical care and intervention. As an EMT who is part of the rapid response team you will be expected to assist with vitals and chest compressions. Let’s head toward the recess room, and I’ll explain more there.”

Six... seven... eight. “You’re going to have to push harder than that! What’s her oxygen reading? Alright, let’s give her another dose of Epi.” Sweat was dripping down my face and adrenaline was rushing through my system. I was out of breath, but I pressed harder like the doctor asked. Twenty-eight... twenty-nine... thirty. “Okay, she’s tired, have someone switch off with her. Let’s keep going. I’ll go update the husband.” It had been forty minutes since the patient coded. Everyone had been exhausted from taking turns doing CPR. The patient’s face was pale and hands were ice cold. I wiped my sweat off and took a quick look at the patient’s face as I stepped down for the next person to do CPR. She looked like every other person that I probably could have met on the street, at the mall, or at a random restaurant. She was young. I watched silently as the EMT performed the compressions. The patient’s arms were hanging off the gurney, bobbing up and down

Aneurysm Embolization is done in Interventional Radiology, by an Interventional Neuroradiologist. The radiologist uses guide wires, known as catheters to locate the aneurysm. Through the catheter a small coil can be placed into the aneurysm. With these coils the body will develop blood clots around them which prevent blood from entering the aneurysm. This eliminates the risk of rupturing aneurysms. There are many different types of stents that can be used for aneurysm embolization. Many of these stents depend on the type of aneurysm. A stent that’s commonly used is the Solitaire AB Stent. This stent is used for the treatment of wide-necked aneurysms in the brain as well as small intracranial aneurysms. Another type of embolization device that’s used is pipeline; this device is used for dissecting cerebral aneurysms.

Deep vein thrombosis (DVT) is a type of cardiovascular disease. DVT is a blood clot that forms in the large deep veins in the leg or pelvis area and grows toward the heart. Including the veins in the calf and thighs, the femoral, popliteal, and iliofemoral vein are also the sites of DVT development. It is a mainly common and dangerous condition (Kesieme et al., 2011). Some DVTs may cause no pain or swelling, whereas others might be quite painful and result in a lot of swelling. Mortality is not high with prompt diagnoses and treatment for most DVTs. However some can be a threat to your life, especially the ones that develop in the deep veins as compared to the clots that develop in the visible superficial veins. Clot which forms in the deep veins is more likely to break free and travel through the veins, which is then called an embolus. When an embolus travels from the legs or pelvis area and lodges into the lung artery, the condition is known as a pulmonary embolism or PE. This is a potentially fatal condition if it is not treated immediately and can lead to death. As high as 50% of the time a DVT can progress to pulmonary embolism. Collectively, DVT and PE are known as venous thromboembolism (VTE). DVT and PE are highly preventable (Kesieme et al., 2011).

Working as a scribe in the San Bernardino Emergency Room has provided me with many different types of medical experiences, from seeing gunshot wounds and various lacerations to strokes and ST elevated myocardial infarctions to hypoglycemia and hyperkalemia. Observing the treatment process from triage to disposition has been an exciting experience, in which every patient encounter has only taught me more about the field of medicine and spiked my interests in learning more about the human body. It is truly an amazing experience watching people come in scared and worried, but in the matter of a few hours after various medications, diagnostic studies and procedures they are more comfortable than when they came in. Through this experience, I have

1. Define Disease process: blockage of an artery usually by a blood clot however can be a fat, or air embolism in the lungs. In this paragraph I will be discussing each type. However, for this SIM our patient will have a blood clot (DVT- deep vein thrombosis) that breaks off and travels to the lungs where it is lodged causes a rapid onset of problems. First I will talk about a fat embolism

Compression stockings and brief walks to promote blood circulation can aid in resolving and also preventing DVTs. Findings from clinical trials have shown the effectiveness and safety of pharmacological prevention with low, fixed doses of anticoagulant drugs (Goldhaber). “Although approximately half of venous thrombotic events treated with traditional anticoagulant blood thinners resolve during a 3 to 6 month conventional duration, the risk of Post Thrombotic syndrome (PTS) persists, possibly due to acute valvular damage from complete venous obstruction (Greene). Anticoagulants have been recommended for at least 3 months, though duration of this therapy should be based on the risk of recurrence as well as whether the blood clot has

Air embolism is a rare but recognized complication of endovascular procedures, and can involve both the venous and arterial systems. However, in the case of the venous system, low or negative intravascular pressure creates the potential for air to enter the vascular system. Conversely, the higher pressure in the arterial system affords some degree of protection, because bleeding is more likely to occur, decreasing the risk of air entry. When air becomes endovascular, ischemia or infarction may occur if the air embolus reaches an organ with limited or no collateral supply.

Research has pointed to a combination of treatments for people with chronic venous insufficiency. Abstaining from long periods of standing and/or sitting. Taking a break as often as possible. Walking is specifically beneficial. If overweight, reducing your weight is important. Elevation of the legs above you when you’re sitting or lying down. Compression socks are excellent. Good hygiene is important too. The objective with chronic venous insufficiency is to reduce the pooling of blood and prevention of leg ulcers. Prevention includes eating healthy, don’t smoke, exercise, avoid wearing tight clothing, and avoid extended periods of standing and/or sitting.

Pulmonary embolus is when solid, liquid or air particles collects in the lungs and cause a blockage. This blockage obstruct blood flow to the lungs depriving the tissue in the lungs of adequate oxygen which leads to tissue death if not corrected. Pulmonary embolus is often cause by blood clot from venous thromboembolism (VTE), mostly a deep vein thrombosis (DVT) and is frequent among hospitalized patients, with many death few minutes of the onset of symptoms. When a patient has DVT in pelvic or legs, blood clot from the vein might detached and travel to the right side of the settling in the pulmonary artery which then become a site for platelets to collect. The collections of platelets on the blood clot triggers a substance release that

“Time of death: 05:42.” you have just lost the patient you have been trying to save for the past five hours. Defeated and exhausted, you discard your gloves and begin preparing the body for the morgue. “You can’t save ‘em all!” a colleague utters in a vain effort to cheer you up, and smiling politely, you continue with your work. While the Emergency Room is not always so bleak, this can be the outcome of even the hardest days work.

Compression stockings are specially designed to apply pressure to your legs to improve your circulation. They work by encouraging the blood to flow upwards towards your heart by being tighter at the ankle and progressively looser towards the