Life Vest Case Studies

A 68 year old male presented to the emergency department at 0800 hours via ambulance after experiencing chest discomfort and intermittent palpitations since 0500 hours. Prior to presentation, the patient stated he

plan, if the more frequent care calls had not helped then the individual may benefit from

The patient is a 72-year-old female who arrived to the emergency department in cardiac arrest. Emergency medical services reports the patient was last seen eating breakfast at her nursing home and was found an hour later face down and unresponsive. After it was determined the patient was in asystole, an intravenous catheter was started and two rounds of Epinephrine was administered. Upon arrival to the emergency department the patient had pulseless electrical activity with sinus tachycardia on the monitor. Airway management was in process with a bag valve mask on 100% oxygen and chest compressions in progress. After intubation and stabilization the

Patient is a 60 year old gentleman with PMH significant for CVA with residual left side weakness and speech difficulties, IDDM2, HFrEF (15% in March 2017 per cardiac Cath, and 32% per TTE 3/23/17 ), and CAD/MI s/p DES X 2 to the LAD (Tampa VA in 2012, 3/2017 at Florida Hospital), presenting initially to OVAMC on 5/19/17 with left hip pain after a mechanical fall at home. He had an MI in late March 2017, at which time he had a DES placed in the proximal-mid LAD (LHC also revealed a LV apical thrombus – 1.6 x 1.4 cm). His EF at that time was reportedly 15% per LHC, and it was suggested he get a Life Vest prior to discharge. Patient subsequently left AMA, without a Life Vest and without prescriptions (including the one

that they dosage is safe. If physicians skip this step, it may lead to more harm then good.

- Taking into account the patient physical, social, psychological and spiritual health allow for allow for a more competent and effective patient care.

(P2) – This approach can be applied in health practice such as a Doctors surgery. For example, if a service user is diagnosed with cancer, their treatment may depend on the ill-strength of the individual and whether or not they are able to fight the cancer mentally.

Service users should be given sufficient information about any treatment they are offered so that they can make an informed decision about whether or not to take it.  Information should include the benefits and possible risks of the treatment, the likely duration of treatment and any financial costs. The service user should also be given information on alternatives to the treatment being offered.

Inability to meet costs of required medication for short-term and prolonged illnesses, and access to health services.

The ethics committee has spoken with other healthcare professionals in the community with regards to case. Several professionals feel that there is an ethical dilemma at this time to turn the pacemaker off. The professionals that feel there is a dilemma are Dr. Vijay, Cardiologist; Jane Robinson, Social Worker; and Cindy Mackin, Rehabilitation Center Administrator. The healthcare professionals on the ethics committee understand the issues presented to them and have personally communicated with the patient in regards to her wishes of the patient. Upon investigating other cases involve similar ethical dilemmas, the ethics committee has considered several cases and consultations before reaching a conclusion. (cbhd.org, 2008).

An example is if someone with high blood pressure gets regular checkups, they are less likely to suffer a stroke or heart attack because they are aware of their condition.

Unnecessary treatments and tests performed on patients in order to make money (or) tests and treatments not performed due to lack of money

Lack of a policy may lead to treatment with a greater risk of care-induced illness for more complete recovery. Additionally, there

Without early intervention on average 360,000 people out of the hospital succumb to cardiac arrest. “ Cardiac arrest and sudden death account for 60 percent of all deaths from coronary artery disease”,(Bledsoe, Porter, & Cherry, 2011,2007,2004, p. 1229)There are several causes of sudden cardiac arrest. Most are caused by ventricular fibrillation. “During ventricular fibrillation, the ventricles do not beat normally. Instead they quiver rapidly and irregularly.” When this occurs, the heart pumps very little and blood does not get circulated throughout the body. “ Most of the cases found with sudden cardiac death are related to undetected cardiovascular disease.("Sudden Cardiac Death," 2015, para. 2)Sudden cardiac arrest are immediate and drastic that includes sudden collapse, no pulse, not breathing, and loss of consciousness. “Four rhythms produce pulseless cardiac arrest: ventricular fibrillation, rapid ventricular tachycardia, pulseless electrical activity and asystole.”("Circulation ," 2005, p. IV-58)Other signs and symptoms that could occur prior to sudden cardiac arrest, include fatigue,

ECG : ventricular rate 54 beats/min, HR varying from 39 to 60 during a 45 minute period of monitoring, infrequent PVCs, ST elevation in leads II, III and avF indicating inferior injury or ischemia secondary to acute MI.