Myocardial Infarction Of An Acute Infarction

This case study and the following questions pertain to Mr. Londborg, who came into the hospital with trouble breathing. Through his health history, they found out that he has a history of seizures, hypertension, and chronic obstructive pulmonary disease (COPD). His stay was extended in the hospital due to a respiratory tract infection, decreased kidney function, a blood clot in his leg, and a fall that could have been fatal. The following questions addressed throughout this paper will discuss what happened, why it happened and how it should now be prevented.

In the UK, reports show that heart failure has been affecting up to 2% of the population, over 900,000 people are living with heart failure, with 63,000 new cases being diagnosed each year (BHF, 2015). It costs the NHS £625 million per year, as a result of the high portion of emergency admissions, readmission and long length of inpatient stay (NHS Improvement, 2010). DH (2000) confirmed that Heart failure accounts for all cardiac admissions and the readmission rate can be as high as 50% within 3 months; also, it further estimated 50% readmission might be preventable. Unfortunately, Heart Failure can’t be cured, but early

Every patient has a right to decide on their own course of treatment and freely consent to that treatment. In order to make an educated decision they must be provided with the proper information to make an informed choice (Opinion 8.08 - Informed Consent, 2006). It is the physician’s legal and ethical obligation to provide this information when making their recommendation on treatment. The choices given must be in accordance with good medical practice (Opinion 8.08 - Informed Consent, 2006). The informed consent is the legal policy, either written or verbal, that gives full disclosure of all the information including potential risks that is applicable to the patient’s condition and treatment being offered (Kazmier, 2008).

John was a 34 year old gentleman who presented himself to the Accident and Emergency Department (A & E) with swelling to his left leg. He was admitted on to the ward for investigations into a suspected deep vein thrombosis (DVT) which is the formation of a blood clot (Hinchliff et al, 1996). My first communication with John was on his admission to the ward. Initially, I carried out some admission forms, which involved gathering

It's Rose Ann. I just want to let you know that Mr. Bogue, James in room 564, MRN 291222300018 fell yesterday around 4pm. He was Amanda's patient and she completed the voice. I notified our risk management Jodi Palmer about the incident. Apparently the patient was instructed by Amanda not to get up because he was hypotensive, but he didn't listen and grabbed the walker and fell forward. We ended up calling RRT because he was hypotensive and developed a big hematoma on his right groin surgical post angiogram from previous day. The patient was transferred in ICU12. We were short staff from 7a-7p, I called everyone with no luck. Our nurses and PCA were overwhelmed, because we kept on getting multiple admissions, including 2 cath lab patients

The Human Rights Act 1998 upholds the person/patient rights to make decisions on whether to accept or decline treatment ("UKCEN: Ethical Issues - Consent", 2016).

In the emergency room, Rudd was connected to the cardiac monitor, labs were drawn and a 20-guage peripheral IV was started in the right arm. An IV infusion of nitroprusside was started and vital signs were recorded periodically. The Pain was assessed using a PQRST pain assessment method and Rudd rates throbbing pain bilaterally in the head with a pain score of 8 that aggravates with moving and does not radiate to elsewhere other than the head. The orthostatic BP shows no changes. The E.D physician decides to admit Rudd in CCU to further monitor his blood pressure and watch for any signs of organ damage. The E.D physician writes an order for pain management and transfer to CCU. The ER nurse

Early recognition of signs and symptoms and taking the right steps to identify, distinguish, and manage subtypes (STEMI and NSTEMI/UA) will improve Mr James outcomes (Bradley E.H., 2006)Recognizing the signs and symptoms such as chest pain or shortness of breath suggestive of an MI and obtaining an ECG as soon as possible (goal of less than 10 minutes following presentation of a patient) should be the standard of practice to manage this patient It has been demonstrated that reperfusion of the infarct-related artery in the very first hour (golden hour) of MI reduces mortality rates (Ayrik et al. 2006, Van de Werf et al. 2008). fact, every 30 minutes of delay time, the 1-year mortality risk increases by (DeLuca et al. 2004).According to triage and first assessment guidelines (Wrightet. al. 2011) Patients who complain of chest pain , pressure , tightness or heaviness require immediate assessment by the triage nurse and should be referred for further evaluation.

There are an estimated 250,000 sudden cardiac deaths occurring each year in the united states, that translates into 680 per day, half of this is in persons younger than 65 and in addition half of these have no prior warning symptoms (Heart,2013). Looking at these statistics it is imperative that having POC testing to rule out benign conditions and reserve resources for true life threating cardiac issues.

The importance of informed consent and physician-patient communication was highlighted. The procedure to be performed or other treatment options must be well-explained, and the implication and possible conflicts that may arise should be discussed in order to minimize the occurrence of difficult situations like the cases presented in this session. With the current healthcare system, however, where physicians are severely limited in how much they can spend time with the patient

The chronic disease burden has increased the need for a statewide and national approach in its detection, prevention, and treatment of heart failure. In the state of Indiana heart disease is shown to be leading the way with a total of 13,394 individuals who have died in 2013 (Indiana State, 2013). The health indicators show that although the mortality rate has decreased from 42.3 per 100,000 in 2001 to 37.3 per 100,000 hospitalization rates have increased (Center for Disease, 2011). Heart failure rehospitalization rate has increased from 2007-2011 especially in those who are over the age of 85. In 2011, there were a total of 41.9 per 1,000 hospitalizations due to heart failure. This is gradually increasing from the Healthy People 2020

For the hospital, there is a lower risk than the reference population. The indicator measures in-hospital deaths per every 1000 hospital discharges with a principal diagnosis of acute myocardial infarction for patients above 18 year of age. This measure excludes all obstetric discharges and any transfers to other hospitals. The numerator is the number of deaths and the denominator is the number of discharges with a ICD-9 code for AMI.

“Time is muscle” when it comes to cardiac. Heart attack patients are either non-STEMI or STEMI. STEMI stands for ST-Segment Elevation Myocardial Infarction. In patients who are non-STEMI’s, aggressive antiplatelet therapy is the primary treatment due to a soft clot or platelet plug. In patients that are a STEMI, reperfusion is the primary treatment due to a stable clot. There are two methods of reperfusion that are used: fibrinolytic’s or PCI (Percutaneous Coronary Intervention). For either STEMI or non-STEMI there is supportive medical therapy is used which includes Oxygen, Nitroglycerin, Morphine, Beta Blockers and ACE inhibitors.

A STEMI is caused by an acute interruption of blood supply to an area of the heart that develops into full thickness cardiac muscle damage to the area that the vessel supplies blood to (Wadud, A; 2014). It is defined by having ST-segment elevation with pathological Q-wave formation and is condition under the umbrella term Acute Coronary Syndrome (ACS) (Wadud, A; 2014). The lack of oxygenation to the myocardium also causes the cardiac markers troponin T, troponin I and creatinine kinase myocardial brand (CK-MB) start to rise in the blood. Troponin rises within 4-6 hours and remains raised for up to two weeks whilst CK-MB starts to rise within 4-6 hours and returns to normal within 48-72 hours (Wadud, A; 2014). Nice guidance identifies that “nearly half of potentially salvageable myocardium is lost within 1 hour of the coronary artery being occluded and two thirds are lost within 3 hours” (NICE; 2013). The end of the 20th century showed the best way to re-perfuse and improve oxygenation was using a fibrinolytic drug however in recent years the use of Coronary Angioplasty, thrombus extraction catheters and stenting which are under the umbrella term Percutaneous Coronary Intervention (primary PCI) (NICE; 2013). The National Infarct Angioplasty Project (NIAP) interim report found that primary PCI will be feasible in a variety of geographical settings, will be most effective and cost-effective if delivered within 120-150 minutes from a patient’s initial call for

long-term survival in patients with initially unexplained cardiomyopathy. N Engl J Med 2000 Apr 13;342(15):1077–84.