Malignant Hyperthermia free essay sample

Clinical signs are; Increased end tidal CO2 production which is an early sign, tachycardia, tachypnea, trunk or total body rigidity, masseter (jaw) muscle rigidity after succinylcholine which occurs commonly in children, marked temperature elevation (maybe a late sign), respiratory and metabolic acidosis, myoglobinuria(MHAUS, 2011). If left untreated the patient will experience cardiac arrest, kidney failure, blood coagulation problems, internal hemorrhage, and possibly death (slideshare, 2010) Nursing Assessment Nurses taking care of surgical patients must be knowledgeable regarding MH so they can identify clinical signs and symptoms early on, its emergent treatment, and be able to respond promptly and appropriately. Preoperative assessment by nurses are crucial in identifying the patient, who could be at high risk for Malignant Hyperthermia, so MH triggering agents can be avoided during anesthesia. Example of questions to ask to help screen for MH susceptibility are (AORN 2012): 1. Has anyone ever told you that you had a â€Å"bad† reaction to anesthesia? 2. We will write a custom essay sample on Malignant Hyperthermia or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Has anyone ever told you that you or your family member had a problem with anesthesia? . Have you or a family member experienced a high fever while under anesthesia? 4. Has anyone ever told you or a family member they had a difficult time opening your jaw during general anesthetic? 5. Has anyone in your family died unexpectedly in the operating room? 6. Have you or anyone in your family experienced sunstroke or heat stroke resulting in hospitalization? 7. Have you ever noticed dark â€Å"cola-colored† urine after a general anesthetic or after experiencing a heat-related illness? Treating MH Dantrolene IV is the only drug available in the market to treat Malignant Hyperthermia. It is difficult to mix and is time consuming to reconstitute. It comes in yellowish colored powder that when fully mix with non-bacteriostatic sterile water, the color stays the same. The new brand Dantrium IV (dantrolene sodium for injection) mixes in just 20 seconds (MHAUS, 2011). However, this is not what we have stocked in our cart. According to MHAUS (2011), dantrolene suppresses the exaggerated rise in muscle cell calcium that seems to trigger MH by binding to the calcium channel site in muscle that is responsible both for calcium release and, likely, calcium entry into the cell. Dantrolene may cause significant muscle weakness in patients with preexisting muscle disease and should be used with extreme caution in those patients. When used with calcium channel blockers (verapamil or diltiazem), dantrolene may produce life-threatening hyperkalemia and myocardial depression. Once a patient has been successfully treated for 36 hours with intravenous dantrolene, he/she may be switched to oral dantrolene until the CK or Creatine Kinase level is trending down and there is no further evidence of acidosis or hypermetabolism and temperature spikes. A recommended 36 vials be stocked. Treating Malignant Hyperthermia crisis is a complex nature, and it involves several staff members. The first thing to do in the event of suspected MH crisis is to recruit extra staff. The following steps are outline by role (MHAUS, 2011): The surgeon should stop or complete the procedure as soon as possible. The anesthesia provider stops inhalation agents; stops warming blanket; increase minute ventilation; inserts esophageal temp probe; inserts NG tube for lavage as needed; administers dantrolene IV; inserts an arterial line; draws blood for chemistry, ck, coagulation, ABG. If peaked T waves on ECG, administers calcium then glucose and insulin. If T waves are not peaked and arrhythmia present, injects bicarbonate. The circulating nurse brings in MH cart; mixes dantrolene based on 2. 5 mg/kg with 60 ml of non-bacteriostatic sterile water, repeat dose until the signs are controlled. The circulating nurse should document the event. A second nurse assist in mixing dantrolene and hands syringe to anesthesia provider. A third nurse brings in emergency crash cart; places urinary catheter; assist in drawing blood or with other task. A fourth nurse brings in plastic bags with ice and cold IV fluids; places ice bags on exposed parts like groin, axilla, and neck (without compromising sterility); iced saline lavage of any open body cavities such as the stomach, bladder, or rectum. Cold I. V. fluids are administered using 0. 9% sodium chloride, but Lactated Ringer’s is avoided so that acidosis is not worsened (Martin, 2009). Stop cooling measures when temperature falls to 38 °C (MHAUS, 2011). A laminated copy of MHAUS dantrolene dosage chart is located on top of MH cart to minimize precious time wasted in calculating dosage per kilogram. As soon as patient is stabilized, transfer patient to ICU or call transfer center for an emergent transfer to UH Case SICU or ED. Knowing your Role All staff involved in the MH crisis response should conduct a debriefing meeting as early as possible. Points to consider including (AORN, 2012): 8. Was the MH cart adequately stocked and immediately available? 9. Were enough staff members available to manage the crisis effectively? 10. When staff members responded, were they familiar with task expected in MH crisis? 11. Was MHAUS appropriately notified? 12. Do staff members have other ideas about planning care for a future MH crisis? 3. Has a root-cause analysis been done (MH is considered a sentinel event)? Staff Competency By using the mannequin as our patient, and mixing the expired dantrolene from MHAUS, perioperative staff did fairly well during the MH mock drill simulation by following thru with the expected roles. MH drill should be held at least quarterly to help perioperative st aff practice early recognition of MH crisis and how to act accordingly. MH drill also improve OR (operating room) team coordination and provides opportunities to serve in each of the four roles mentioned (Martin, 2009). Prevention Early detection of clinical signs and symptoms of MH, knowing your role and a prompt response to this emergent crisis can save your patient’s life. MH crisis prevention is the key and the best treatment you can provide to your patient. Knowledge about MH is a must for nurses taking care of a patient before, during and after operative care. Armed with this knowledge, you can make a difference in your patient’s lives.

indias earthquake essays

indias earthquake essays Residents in the Gujarat State of western India spent the night outside Friday, too fearful to go back into their damaged homes after India's most powerful earthquake in half a century. The 7.9 magnitude earthquake killed as many as 2,000, injured at least 2,000, and left 4,000 missing. Most of the missing are thought to be buried under rubble, and rescue workers dug frantically with bulldozers, shovels, sticks even bare hands trying to find them. "The earthquake is a calamity of national magnitude," said Indian Prime Minister Atal Bihari Vajpayee, who planned a trip to the area to survey damage. "We have decided to meet the emergency on a war footing," he said. "This is the time for people to rally around." The temblor shook high-rise towers 600 miles away in the capital, New Delhi. The quake could be felt as far as 1,200 miles away in Calcutta and coastal Bangladesh. The quake struck at 8:46 a.m. as many cities were beginning celebrations for India's 51st Republic Day, which commemorates the adoption of the country's constitution. In Ahmadabad, Gujarat's commercial capital and a sprawling city of 4.5 million, helmeted rescue workers used iron rods to pry slabs of concrete and metal, searching for survivors. Women wept and rocked back and forth, watching as the few available bulldozers and cranes pushed through the piles of stone that once had housed families and shops. Beds, children's toys and clothes lay abandoned in the debris, lamp posts and electric pylons were twisted and many buildings were left leaning precariously. After night fell, with temperatures at 55 degrees, survivors spread blankets and huddled around campfires. "There is a great panic among the people and they have spilled out onto the streets," said Haren Panya, home minister of Gujarat. Because of the aftershocks, "We have asked people to move out of old buildings." Corpses were piled up on the verandah of the N.S. Hospital,...

Policy of Hong Kong in Healthcare System Essay Example | Topics and Well Written Essays - 3000 words

Policy of Hong Kong in Healthcare System - Essay Example The paper presents that in the era of globalization and advanced technical knowhow countries are making significant reforms in their various sectors. In such a respect Hong Kong is also not left behind. The country has made a number of alterations within the healthcare sector. The reforms have been directed towards providing better health care services to the country’s citizens. The Department of Health is entrusted with framing policies for country’s healthcare care services and also to facilitate efficient allocation of resources. It has implemented new policies and modified existing policies. Several modifications have been made in healthcare practices and management. New pricing policy has been introduced in Hong Kong healthcare sector. The country in 2002 has introduced charges for patients who are admitted in hospitals under emergency situation or after meeting with an accident. The reforms have lead to noticeable reduction in death rates and increased life expect ancies. Better treatment is available from efficient health care professionals at a considerably low cost. Keeping this at the backdrop the current paper tends to present a critical review of the pricing policy that has been implemented for the health care system of Hong Kong. The public hospitals and clinics in Hong Kong receive a good amount of subsidies from the government so as to provide medical treatment to the citizens at the lowest possible cost. The government despite such high quality medical care has imposed low rates of taxes. However government is expected to bear the burden of expensive medical facilities which is likely to increase in the upcoming years. The estimates have shown a continuous increase in governmental expenditure for health care (Development and Financing of Hong Kong’s Future Health Care, 2007). Pricing Policy of Hong Kong Healthcare System Health care services in Hong Kong are considered to be a mixed one. The public sector has taken up the res ponsibility to give 92 percent of the hospital services. About 85 percent of primary care is provided by the private sector. Most people approach public hospitals for complex diseases in Hong Kong mainly due to the low cost of treatment (Fitzner, Coughlin, Timori and Bennett, 2000). The fees charged by public health care institutions in Hong Kong are very much less compared to other countries. Government has imposed strict regulations on these public sector fees. However patients have a hard time trying to get to the physician. The healthcare system is very time consuming. Patients have to pay a high cost in terms of inconvenience and time consuming treatment. Physicians often send their patients to emergency department in order to get a simple diagnostic test done. The emergency department remains filled with such patients depriving the actual needy ones from proper treatment (Hay, 1992, pp.35-36). However medical treatment for diseases like tuberculosis is performed free of cost. However to make such a low cost medical system sustainable for the country is a major challenge before the government (Hong Kong (China), 2010). It is becoming increasingly difficult for the government to meet the expenses of such low cost medical treatment. Recent economic predictions have shown increase in tax rates to finance healthcare needs. Such a pricing policy under health care system have made even the richer sections rush to public hospitals for treatment. The demand for such health care facilities has been continuously growing (Hay, 1992, p.51). Clearly Hong Kong has adopted a non- interventional for its public healthcare system. The pricing policy was aimed at providing medical facilities to those sections of population that cannot afford medical treatment elsewhere. Reforms have also been made in the structure of funds in Hong Kong to adopt such