Non Research Evidence Study

The overall process of discharging a patient from a hospital and the transition back home or to a care facility are critical advancements in the overall course of both acute and long-term care. It is important that the hospitals releasing these patients have ensured the proper overall course of care from beginning to end. The lack of consistency with both the discharge process and the quality of discharge planning has led to many avoidable readmissions. To reduce the amount of hospital readmissions, it is imperative that hospitals recognize the need for focused patient care and that programs are being implemented to assist in the care transition.

✽ Note: Most HF admissions are R/T fl uid volume overload. Patients who do not require intensive

Pulling off the ramp, we turned onto Church Hill Road responding on a priority one for the cardiac arrest. I tried to review my field guide en-route to the call, but all I could see were flashing lights reflecting off the guide’s pages and crowds of cars moving over for our wailing sirens. Within three minutes we had arrived on-scene and it was clear that our patient was not in cardiac arrest; however, his 12-Lead EKG and oxygen saturation were marginally reassuring and pointed to an active heart attack. At this point in my EMS training I was a BLS provider, but had adequate knowledge to assist Kathy. Instinctively, I went right to work and loved every second of it. The concept of formulating a differential diagnosis in the field and testing that theory is one of the principle factors that kept drawing my back to EMS. In addition, I developed an unparalleled appetite for knowledge, stemming from my desire to get every differential diagnoses right. Coming to this realization early in my EMS career, we [healthcare providers] frequently forget that patients often lack the medical knowledge provided to us through years of training. Behind CT Scans and MRIs are patients with questions. Having the ability to provide compassion, sympathy and reassurance to a patient is a central part to their recovery and survival; therefore, we [healthcare providers] need to be able to care for our patients on a holistic level, focusing less on the disease and more on the

Have you ever thought about what you would do if a family member suddenly stopped breathing? Imagine that you grow up in a small town, the population is 700 people, and one morning you wake up and everyone in the town is dead. On any given day 670 people die of sudden cardiac arrest. Could it be a loved one, someone you care deeply for, or just a complete stranger? The chances are that someone in your family is going to die of sudden cardiac arrest in your lifetime. On average it takes an ambulance no less than seven minutes to reach someone in need, therefore, every adult should know how to administer CPR.

For an electronic search to be successful it is important to find the right key words or concepts required to retrieve the journal articles as journal articles are indexed and entered onto the databases using keywords (Aveyard, 2014). The keywords for this literature review derived from the research question and synonyms words (Schneider, Elliott, LoBiondo-Wood and Haber, 2004). The keywords identified and retrieved used a combination of the following keywords; CPR, cardiac arrest, cardiopulmonary resuscitat*, famil* and family carer*. The keywords 'family ', 'witnessed

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 flittered around in my stomach, I had no idea what to expect. 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.” Eventually, we reached the recess room, and the rapid response team was already there preparing for the arrival of the patient. A nurse was on the phone with the firefighters that were bringing the patient in. Seconds later she announced “It’s a STEMI”. Then fright ran through my veins. A STEMI is medical jargon for a segment elevation on an EKG. In other words the patient’s coronary artery is completely occluded. The patient is suffering from a heart attack. Prior to this, I had never seen someone who was having a heart attack. However, the thing that terrified me the most was that I knew I would be expected to perform chest compressions. I had only ever performed chest compressions on a dummy.

Immediately life threatening A patient with chest pain, severe blood loss, MVA, sepsis. These types of patient are prompt to deteriorate, and their life could be at risk if not treated within 10 min of arrival in ED. (Basnet, Bhandari and Moore, 2012)

The RUC will be able to provide treatment to patients suffering from non-life threatening conditions and the most common illness, including pneumonia and flu, fevers, upper respiratory infections, sprains and strains, lacerations, contusion, and also necessary screening test, such as High Blood Pressure, mammogram, diabetes. Since the late 1980s and early 1990s, hospitals have looked to facilities such as RUCs as a means to reduce rate of inappropriate ED utilizations by triaging patients to less acute settings. The ED is not the most appropriate care setting for many patients, such as elderly patients and young children. Non-urgent patients account for well over 10 percent of the average ED’s caseload, and semi-urgent cases account for another

DNACPR orders are of considerable concern to ambulance staff, the patient and their families in tackling requests at the end of life (NHS End Of Life Care Programme 2007). A study by Stone et al. (2009) showed nearly all participants had questioned whether interventions performed were correct for the patient when using cardiac life support on patients they thought were terminal. When a patient requires resuscitation and a DNACPR is in place immediate sharing of information is critical. At certain points in the patient care pathway incompatible systems may mean DNACPR requests are not being followed and inappropriate resuscitation being attempted.

This paper will be going over a scenario involving a real patient and what things could have been different with EMS care. It will also be covering what exactly cardiac arrest is and what rhythms produce it. And for every cardiac rhythm in cardiac arrest, there is a specific treatment plan paramedics can follow.

As a result of delayed treatment, patients are more likely to experience unanticipated intensive care (ICU) admissions as well as increased lengths of stay, cardiac arrest, and death (McGaughey et al., 2007).

Most people believe that it is their right to be present during a loved-one’s resuscitation, should they so desire. Contrary to the fears of the medical community, family members who have been present during a resuscitation report that the experience was not traumatic for them and would in fact opt to witness it again. Also, being present seems to provide a sense of closure and security in knowing that everything possible was done to save their loved one’s life (Critchell et al 2007).

| Lesson Outline: Allocated teacher-NExplaining legal requirements : Duty of care: A duty of care is implied when the person who is requiring your assistance is in your workplace. E.g. patient, co-worker or visitor. Consent of an unresponsive patient is assumed in an emergency situation. (Crouchman, 2009; Milne & Mellman-Jones, 2010).Cultural awareness/sensitivity: We need to mindful of varying cultures when assisting patients, as different cultures prefer to be unexposed which is necessary when defibrillation is required. Eg, Muslims (Hattersley & Keogh, 2009). Confidentiality: Following an emergency situation it is vital to refrain from speaking to others outside the workplace about the patient to ensure the patient’s privacy and dignity. Think about how you would feel if you where in the patient’s situation. (Maeder, Martin-Sanchez, Croll, & Ambrosoli, 2012)?Limitations: Remember that once you start you can’t stop until you’re physically unable to or help arrivesDebriefing: Participating in the debriefing process is vital due to the enormity of the situation, enabling the nurse to express

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,

A Do not resuscitate (DNR) order is a legal document written by a licensed physician, which is developed in consultation with the patient, surrogate decision maker, and attending physician. This document indicates whether the patient will receive resuscitative care, cardiopulmonary resuscitation (CPR), or advanced medical directives, in the setting of cardiac and/or respiratory arrest. A DNR can also be referred as a no code when identifying a patient’s resuscitation status. If a patient has an existing DNR it allows the resuscitation team, taking care of the patient, to either withhold or stop any resuscitation measures, and therefore respect the patient’s wishes. Historically, DNR orders did not become active in the care of patients until 1974, when it was identified that patients who received CPR, and survived, had significant morbidities (Braddock & Derbenwick-Clark, 2014). Braddock and Derbenwick-Clark further noted, the American Heart Association (AHA) recommended that physicians, in consultation with the patient, family, and or surrogate, place on the patients chart when CPR was not indicated. This documentation is now what we refer to as the DNR order and has become the standard to allow autonomous respect for patients, and their families, to make informed medical decisions. Therefore, the purpose of this paper is to discuss the legal aspects, ethical issues, and the application surrounding the DNR order.