We conducted an analysis of national inpatient sample, the largest all-payer inpatient database of the United States, to estimate the incidence of in-patient mortality after pericardiocentesis in all comers, and in subgroup of patients with coexisting cardiac procedures associated with iatrogenic pericardial effusion. Furthermore, we also studied the relationship between the hospital procedure volume and inpatient mortality after pericardiocentesis. To our knowledge, this is the first analysis of its kind of a nationally representative data of the United States. We found the estimated in-patient mortality of patients undergoing pericardiocentesis is higher than previously reported single center studies (2-6, 8-9). Approximately, one in …show more content…
Thirdly, our patient population has differences compared to prior studies. Our patient population was older and higher proportion of patients were unstable compared to previous studies (2,6,8). Similar to prior studies about one third of patients had malignancy, however, the prevalence of percutaneous cardiac procedures in patients undergoing pericardiocentesis have increased significantly (2-3,8).
With continued increase in the use as well as complexity of the percutaneous cardiac procedures, iatrogenic pericardial effusion will likely to remain one of the common reasons for pericardiocentesis (11). The rapid increase in pericardial pressure due to acute onset, in patients who are usually anticoagulated, is more likely to be associated with hemodynamic collapse and death in the absence of urgent intervention compared to chronic large effusion. Catheter based percutaneous cardiac procedures were performed during the same hospitalization in about 17.77% of patients undergoing pericardiocentesis in our analysis, and most of these procedures were electrophysiologic consistent with prior studies (5,11). As expected the subgroup of pericardiocentesis patients who underwent PCI and structural heart interventions had significantly higher inpatient mortality compared to controls. About one in four such patients died during the hospitalization (Figure 1).
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Fibrinolytic therapy uses drugs to break up blood clots. This therapy is used with heart attack patients to remove the blockage that caused the myocardial infarction. Another treatment option is percutaneous coronary intervention (PCI). PCI involves the placement of a catheter into the blocked artery to allow blood to flow. The purpose of this paper is to examine the outcomes of these two procedures and to suggest that percutaneous coronary intervention is superior to fibrinolytic therapy.
The purpose of this paper is to discuss a new best practice, the necessary steps for implementing the new practice, and support this change in practice with current literature. Heart disease is the leading cause of death in the United States. Evidence-based clinical practice guidelines regarding patients with ST-segment elevation myocardial infarction (STEMI) seek to reduce variation in practice and improve outcomes for this patient population (O 'Gara et al., 2013). Current evidence-based practice includes immediate reperfusion therapy to the involved coronary artery in this patient population. However, it is often challenging for emergency department nurses to implement the initial steps of this evidence-based practice, which includes obtaining a 12-lead electrocardiogram within ten minutes of arrival, as some patients present with symptoms other than chest pain, or atypical symptoms. For instance, atypical presentations include shortness of breath, altered mental status, upper extremity pain, upper back pain, generalized weakness, and abdominal pain (Glickman et al., 2012). Ultimately, this results in delays of reperfusion therapy.
The purpose of this paper is to analyze if there is any improvement, post-operative complications, mortality and related factors of elderly undergoing cardiac surgery. The debate whether or not we are pushing the limits is still questionable because of the complications associated with these invasive surgeries and whether or not if it’s a money game. The growing numbers of the elderly patients enjoy a prescription drug benefit, access to artificial knee and hip surgery, and life-saving cardiovascular interventions that were undreamed of a half-century ago.
This paper describes in detail considering one of the possible post- procedural complications of Mrs. Elizabeth Green, who has undergone the coronary angioplasty procedure to relieve chest pain caused due to blood vessel occlusion. Mrs. Green, a 78-year-old Caucasian woman, lives independently at home with her pet dog. She has a son and daughter, who occasionally visit her and provide some support (School of Nursing & Midwifery 2014). ). Mrs Green has a past medical history of gastro oesophageal reflux disease, hypertension, hypercholesterolemia, osteoarthritis and diet controlled type two diabetes mellitus (School of Nursing & Midwifery 2014). There are certain complication arises as a result of the procedure
The characteristics of pain from myocardial infarction and pericarditis can help to differ both the conditions, and rule out the actual problem of the patient. The characteristics of myocardial infarction include pain duration- 30 minutes to 1 hour; pain intensity and type- severe, crushing, occurs on exertion; and pain does not relieve by the rest or taking nitroglycerine. However, pericarditis, the inflammation of pericardium causes pain that lasts for hours to days; pain intensity and type- mild to severe, asymptomatic, sharp or cutting; pain increases with breathing, swallowing, belching, neck or trunk movement; and relieved by leaning forward, kneeling, sitting upright, or breath holding (Goodman & Snyder, 2013). Therefore, the therapist should ask the patient questions about his or her pain duration, type, intensity, aggravating factors, and relieving factors to rule out whether it is MI or an acute onset of
Primary percutaneous coronary intervention (PCI) and PCI with fibrinolysis are current therapy options used for patients who have had an acute ST elevation myocardial infarction (STEMI). These six article discuss multiple elements involved in the discussion comparing the many factors that affect which forms of therapy is preferred to which patients. Concerns regarding the safety and effectiveness of primary PCI have risen. Factors include the optimal time for therapy, the important of hospital staff and volume, and the efficiency of PCI after fibrinolysis.
Clinical prediction tools have been developed to estimate the possibility of cardiac surgery–associated AKI (CSA-AKI).8–10 These have recognized female gender, impaired left ventricular function, insulin-requiring diabetes, emergency surgery, and abnormal baseline renal function as independent predictors of requirement for dialysis.23 Pathophysiological mechanisms of CSA-AKI include decreased renal perfusion, lack of pulsatile flow, oxidative stress, hypothermia, atheroembolism, and inflammation 23. The main mechanism of injury is thought to be intraoperative ischemia-reperfusion injury (IRI).20 Prolonged duration of cardiopulmonary bypass (CPB) and its inflammatory response, and prolonged aortic cross-clamping are the leading factors associated with an increased likelihood of cardiac ischemia-reperfusion injury.22 Although
Mrs. Moonjeli always refers to American College of Cardiology Guidelines for the care of patients requiring cardiac clearance for any procedures and request additional assistance from attending. She promotes opportunities for improvement in CPRS and in vista Web for better patient care. She uses health informatics to deliver care to the patients through different providers using the same template and order sets for the best care. She endeavors for the top quality and continuous improvement in the service. All records are reviewed and cosigned by attending cardiologists. Specific patient charts are reviewed by the Chief of Cardiology for content and care of and reviewed with Mrs.
perioperative hypotension is a common problem, incidence is largely unknown. There are evidences suggesting that incidence of myocardial adverse events in the postoperative outcome may be linked to the prolonged episodes of perioperative hypotension. There are few comprehensive resources available in the literature regarding diagnosis and management of these common clinical outcomes, especially in non-cardiac surgery. Perioperative myocardial ischemia is associated with significant morbidity and mortality, 50% of postoperative deaths are due to cardiac complications, the ischema is the major problem amongst. It is an emergency crisis which poses a unique challenge for the anaesthetist in its management. We report a case of Intraoperative myocardial ischemia in an elderly patient with multiple comorbidities who underwent orthopaedic hip surgery . Intraoperative myocardial ischemia was diagnosed on time and was managed successfully.
Chest pain syndrome, rule out myocardial infarction. She was admitted to telemetry, where 3 sets of cardiac enzymes and troponins were measured, and she was given supplemental oxygen, nitrates and Coreg were started. After 3 sets of cardiac enzymes were documented to be negative, the patient was discharged and she was instructed to call my office for scheduling of an outpatient stress myocardial perfusion scan, to evaluate for obstructive
5. KoparalS ,Vurol M, Sayen B, PasaogluL, Elverici E, DedeD. Isolated pericardial hydatidcyst in an asymptomatic patient, a remark on its radiologic diagnosis. Clin Imaging 2007 Jan-Feb;31(1):37-9.
The current article critique dissects a research undertaken by Goodridge, Duggleby, Gjevre, and Rennie (2009) and published in the Journal of Nursing in Critical Care. Their research was a mixed method approach centered on exploring the quality of dying of patients with chronic obstructive pulmonary disease in the intensive care unit.
Both Saint Thomas Midtown, Tristar Centennial Medical Center, Tristar Skyline Medical Center, and Vanderbilt University Medical Center both are acute care hospitals. Also, both are accredited by the Behavioral Healthcare Hospital. According to Hospital Care, patient who reported that the nurses always communicate well, Sant Thomas Midtown and Tristar Skyline Medical center are below average on state and national averages, but Tristar Centanial medical Canter and Vanderbilt University Medical Center have 81 percent and both state and national average is 80 percent. Only Tristar Centanial Medical Center has average of state and Nation average in patient who reported that they always received help as soon as they wanted, and others are
As the lady had a pre-existing heart condition an echocardiogram was performed. An echocardiogram is a non-invasive ultrasound test that shows an image of the inside of the heart (Klein et al 2011). Routine pre anaesthetic assessment and a physical examination were carried out prior to ECT to ensure the treatment was still viable. Informed consent was also obtained.