Category archives for Blog

MEDICAL MANAGEMENT OF AORTIC DISSECTIONS

Aortic dissections are a medical emergency.  They can be treated either medically or surgically.  Generally the treatment of choice for ascending aortic dissections is surgical intervention.  Surgical intervention is also used for complicated descending dissections.  Various issues determine whether an aortic dissection will be treated medically or surgically.  We will be addressing the medical management […]

IMPORTANCE OF ST-SEGMENT MONITORING POST AMI

Patients that have had a myocardial infarction should have continuous ST-segment monitoring post MI/cath.   Following are the indications for ST-Segment monitoring post AMI. Evaluating post-MI ischemia Evaluating reocclusion after angioplasty or atherectomy.   Evaluating reperfusion after thrombolytic therapy. The expected practice, as put forth by the AACN (American Association of Critical Care Nurses) is […]

JOINT COMMISSION: ACUTE MI CORE MEASURES

heart

The Joint Commissions Core Measures serve as a standardized assessment measure for care given in specific areas.  Despite widespread dissemination of the core measures, safety goals, and related quality guidelines, there is significant variation in their application across hospitals.  The reasons for this are varied but include differences in guideline familiarity, provider training, and tools […]

SURVIVING SEPSIS, PART 3

As mentioned in my previous blog posts sepsis is a significant problem in the hospital settings of the world, costing countries billions of dollars a year in health care costs.  In order to combat this problem, countries from around the world came together in the fall of 2002 and launched the Surviving Sepsis Campaign.  In […]

SURVIVING SEPSIS, PART 2

As mentioned in my previous blog post sepsis is a huge problem in the hospital setting in the world, costing countries billions of dollars a year in health care costs.  In order to combat this problem, countries from around the world came together in the fall of 2002 and launched the Surviving Sepsis Campaign.  In […]

SURVIVING SEPSIS

There are more than 750,000 cases of sepsis each year in the United States.  The mortality rate of sepsis is 20% and economic cost of sepsis is $17 billion a year.  The incidence of sepsis is projected to increase by 1.5% a year.  Although the prognosis of sepsis has improved the death rate will increase […]

Brain Dysfunction in Sepsis

Delirium is one of the symptoms of sepsis.  The brain has an important role in sepsis.  One of the ways is as a target for the pathologic processes involved in sepsis.  Sepsis causes brain dysfunction, or sepsis-associated  (SAE).  Delirium is a major component of SAE.  It is associated with a change in cognition or perceptual […]

What are the True Objective Diagnostic Findings to Support Whiplash?

The differences between subjective and objective findings are clear and necessary when sorting out the pertinent aspects of a case. The definition of Subjective per Medline Plus:  “1 a: relating to or determined by the mind as the subject of experience <subjective reality> b: characteristic of or belonging to reality as perceived rather than as […]

Changes needed to improve in-hospital cardiac arrest care, survival

The American Heart Association put out a statement in March of this year (2013) stating that improvements needed to be made in the way hospitals deal with in-hospital cardiac arrests.  Two main points were made: Improvements in the readiness of hospitals and the health care providers in giving evidence based quality care during cardiac arrests, […]

THE LNC and HIPPA

A new modification to the Health Insurance Portability and Accountability Act (HIPAA) took effect on March 26, 2013 with compliance by all effected parties required by September 23, 2013.  The modifications are sweeping and all nurses should be aware of these changes for their practice, whether they are LNC’s, management, or clinical nurses. The entire […]

“NEVER EVENTS”—LIABILITY for the HEALTHCARE PROVIDER?

The National Quality Forum (NQF), an advocacy group focused on developing a national strategy for healthcare quality measurement, identified 28 adverse events in 2002 now commonly referred to as “never events.” Such events are considered preventable and as such should never occur in any healthcare setting. Some examples of never events are decubitus, urinary tract […]

How to get information about a motor vehicle accident

How to get information about a motor vehicle accident Consider hidden sources of information about an accident, particularly when there is a question of when it happened.  The cardiac monitor/defibrillator electrocardiogram (ECG) equipment used by an ambulance crew has an internal clock, which documents the time on the ECG rhythm strip. This equipment is typically […]

CERTIFICATION OR CERTIFICATE: WHAT INITIALS WOULD YOU PUT AFTER YOUR NAME?

There are many different types of educations available for nurses that are interested in pursuing a career as a Legal Nurse Consultant.  You have the online courses, the University based courses, the courses made available by different organizations, and then the courses advertised by the big marketing companies.  The focus of these different courses is […]

NURSING DOCUMENTATION: PATIENT CARE AND LEGAL RAMIFICATIONS

The quality of nursing documentation is an important issue for both patients and nurses.  Obviously quality nursing documentation enhances patient care as this leads to better communication of the issues. “No matter how skilled or experienced you are, inaccurate or incomplete nursing documentation can mean serious trouble for your patients—and for you if you’re ever […]

Electronic Medical Records: How to Navigate Your Way Through the Paper Printouts

  The patient’s healthcare record has evolved into the most reliable source of data available to fulfill multiple purposes and functions.  As many as 150 end users seek access to a standard medical record.  With ever increasing numbers of individuals needing the information in a medical record, the physical condition and location of the record […]

ICU MONITORS: IMPROPER SETTINGS/MUTED

Untreated respiratory arrest and DEATH.  Patient found asystolic with resulting DEATH.    ST elevation goes unnoticed in a post anterior MI patient that had received a LAD stent.  The patient infarcts, goes into v-fib and is unable to be resuscitated.  These are all examples of what happens when monitor alarms are turned off, muted, or […]