Vegan Neuro ICU Nurse

Anyone that has dealt with a cardiac patient or taken a ACLS class will know their H’s & T’s. Some of us find it to be just another long list of things to remember out in the field, but when it comes down to it, these are what doctors want medical professionals to know to look for when a pt is having a cardiac emergency.

Hypovolemia Hypothermia Hypoxia H+ Ions Hyper/hypokalemia or glycemia Tension pneumothorax Tamponade, cardiac Toxins Thrombosis, pulmonary Thrombosis, coronary.

These ten disorders can easily through the human body out of whack and it’s that simple to cause the person’s heart to disagree with the situation and begin to act up. With that being said, most of these are pretty quick fixes.

Hypovolemia - a loss of fluid, making cardiac output drop. Usually if the pt is CAOx3 and you get a BP of 70/36, you might find them to be running a bit tachy. Some normal saline is a quick fix for people and might help correct the issue.

Hypothermia - pretty self explanatory, but to keep it simple: Warm the person up and you’ll see them kicking

Hypoxia - What makes the heart happy? A good supply of wonderful O2! So, if you are hypoxic the best thing to do is put them on a NRB at 15 lpm (if airway and breath on own), or start bagging them with 15 lpm O2 going.

H+ ions - might seem weird, but it just means acidosis. pH balance is monumental for the body and any shift too far one way or the other and you’re going to have issues. If the pt is acidotic, the two major forms of treatment are bicarb and O2, which varies upon what kind of acidosis they have. (maybe I’ll talk about his in a future lecture)

Hypo/hyperkalemia or glycemia - The major one I will discuss is the K+ levels. Hypokalemia is considered <3.5 mmol/L but you won’t see changes really until about <2.7 mmol/L. Prolong PRi may occure, flat or inverse T waves, ST depression, U waves may occur. You may find SVT or ventricular ectopic beats. A-fib, A-flutter, atrial Tach are all possible as well.

(source: LIFEINTHEFASTLANE)

Tension pneumothorax: Air trapped into the chest cavity. An open chest wound can become a sucking chest wound. People naturally prone to closed Tension pneumos or trauma may cause it. Absent lung sounds on one side, tracheal deviations and JVD may be present for this. Common treatment will be a Needle Chest Decompression in the field and then a chest tube in the hospital.

Tamponade, cardiac: If the pt is unconscious, you probably won’t know this until you get a ultrasound of the pt’s heart. If they are awake, you might find beck’s triad with the pt. For field paramedics, this just means you need to load and go. For hospital the procedure of removing the fluids from the pericardial sac becomes important. This is done by placing a needle catheter into the pleural space and removing the fluid.

JEMS STORY

Toxins: Such a wide variety of toxins can cause cardiac arrest. The major thing to do in this situation is hope that you know what they took and hope even more that you have a reversal agent for it.

Thrombosis: A blockage in the lungs or the coronary arteries is deadly! For the field you won’t know to much other then a possible STEMI on your EKG strip. The cath lab is probably your best chance of find it though.

The major thing to remember is that knowing how to reverse these different issues are key in helping your pts. This means knowing your H’s and T’s will help you narrow down treatments options when you have a cardiac issue. Pay attention not only to the patient but the information you get from them or the family. There just might be some clues hidden in their words.

1. Instinct will save your patient, it will save your coworker’s you’re covering for, and it will save your own ass.

2. If a doctor asks you to do something and it feels wrong, it probably is. See #1.

3. Patients lie, families lie, everybody lies.. sniff out the truth with your detective nose.

4. If you even mention you hate taking one type of case to a charge nurse you don’t get along with, guaranteed you will see nothing but those cases once word gets out.

5. Some of the strongest nurses, the people you would inherently trust with your patients, your family, your loved ones, yourself with - aren’t preceptors, they aren’t charge nurses, they are likely the neighboring nurse who never gets the unit award, but everyone wishes silently would be the nurse if they were to ever look up frightened from a stretcher.

6. Half the shit you do in Nursing school isn’t reality, and you won’t always have time to do it in the same way; but that doesn’t mean you’re compromising care, quality or integrity of your profession. It just means you’ve found a more proficient, effective, and just as safe way to do it that textbook authors won’t admit to.

7. You do actually have a choice to speak up when someone is intensely rude to you, despite what surveyors, management, and all the circus of politically correct people will tell you - there isn’t a law or standard of practice in nursing that says take all the crap from people and stay silent. Setting boundaries with patients, families, and coworkers doesn’t mean you’re disrespectful, it means you respect yourself and your place in this profession.

8. Protect your patients, but protect your license just as hard - you can’t protect anyone if you’re not protecting yourself.

9. Nursing management often complains the loudest about things they’ve forgotten how to do themselves.

10. You can make mistakes, have a snitty day, be off point, miss all the IV’s, miss a subtle sign in diagnosis,  and wish you’d chosen another career - but it doesn’t take away from the days that you’re the one to catch someone’s error before it harms their patient, or their license, it doesn’t take away from the days when you sort of think in the back of your mind, I simply love what I do,  it doesn’t take away from the all the times you snagged an impossible IV, but no one really needed to see it for it to feel good, it doesn’t take away from all the moments you caught subtleties that made you remember why nursing is a vital piece of hospital function, and it doesn’t take away from the moments you reminded yourself that hey, it’s a good thing to stick with this profession that you never quite know what to expect of next.

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A 25-year-old student has just come up with a way to fight drug-resistant superbugs without antibiotics.

The new approach has so far only been tested in the lab and on mice, but it could offer a potential solution to antibiotic resistance, which is now getting so bad that the United Nations recently declared it a “fundamental threat” to global health.

Antibiotic-resistant bacteria already kill around 700,000 people each year, but a recent study suggests that number could rise to around 10 million by 2050.

In addition to common hospital superbug, methicillin-resistant Staphylococcus aureus (MRSA), scientists are now also concerned that gonorrhoea is about tobecome resistant to all remaining drugs.

But Shu Lam, a 25-year-old PhD student at the University of Melbourne in Australia, has developed a star-shaped polymer that can kill six different superbug strains without antibiotics, simply by ripping apart their cell walls.

“We’ve discovered that [the polymers] actually target the bacteria and kill it in multiple ways,” Lam told Nicola Smith from The Telegraph. “One method is by physically disrupting or breaking apart the cell wall of the bacteria. This creates a lot of stress on the bacteria and causes it to start killing itself.”

The research has been published in Nature Microbiology, and according to Smith, it’s already being hailed by scientists in the field as “a breakthrough that could change the face of modern medicine”.

Before we get too carried away, it’s still very early days. So far, Lam has only tested her star-shaped polymers on six strains of drug-resistant bacteria in the lab, and on one superbug in live mice.

But in all experiments, they’ve been able to kill their targeted bacteria - and generation after generation don’t seem to develop resistance to the polymers.