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Clinical Update
Summer 2016 Clinical Update We are pleased to offer this archive of our award-winning newsletter Clinical Update. There are 75 issues in this document. Each issue has a feature article, summaries of articles in the nursing literature, and Web sites of interest. By downloading and using this archive, you agree that older medical articles may no longer describe appropriate practice. The issues are organized in date order from most recent to oldest. The following pages offer tips on how to navigate the issues and search the archive in Adobe Acrobat Reader. In 2006, we were honored to receive the Will Solimine Award of Excellence in Medical Writing from the American Medical Writers Association, New England Chapter. Issues that received the most positive response over the years include: • Nurses Removing Chest Tubes, a discussion of state boards of nursing’s approaches to this extended practice for registered nurses • Medical Adhesive Safety, a review of guidelines published by the Wound, Ostomy and Continence Nurses Society, complete with original tables identifying characteristics of each type of medical tape and how tape components contribute to medical adhesive- related skin injury (MARSI) • Autotransfusion for Jehovah’s Witness Patients, an explanation of the Biblical origins of the reasons for refusing blood transfusion and how continuous autotransfusion may offer an option that is acceptable to members of the faith • Air Transport for Patients with Chest Tubes and Pneumothorax and Chest Drainage and Hyperbaric Medicine, in which each issue provides a thorough analysis of how pressure changes with altitude and with increased atmospheric pressure affect chest drainage and untreated pneumothorax • Age Appropriate Competencies: Caring for Children that describes developmental stages and strategies to deal with a child’s fears at each stage Creative Commons License This work is licensed under a Creative Author: Patricia Carroll RN-BC, RRT, MS Commons Attribution-NonCommercial- ShareAlike 4.0 International License. -
Nitrox CONFIRME
Formation théorique NITROX Patrick Baptiste MF1 n° 22108 Formation théorique Nitrox confirmé Sommaire de la formation • Rappels • La réglementation • La crise Hyperoxique l’effet Paul Bert l’effet Lorrain Smith • La table NOAA • Le compteur SNC • Les UPDT ou OTU • Les autres effets physiologiques La syncope Hypoxique Effet vasoconstricteur de l’O2 • La fabrication des mélanges Patrick Baptiste MF1 n° 22108 Formation théorique Nitrox confirmé Composition de l’air L'air sec au voisinage du sol est approximativement composé de: • 78,08 % d’azote, • 20,95 % d’oxygène, • moins de 1 % d'autres gaz dont : • argon 0,93%, • néon 0,0018%, • krypton 0,00011%, • xénon 0,00009% • dioxyde de carbone 0,033 %. Il contient aussi des traces d'hydrogène 0,000072%, mais aussi d'ozone et de radon. Patrick Baptiste MF1 n° 22108 Formation théorique Nitrox confirmé Composition de l’air Nous considérons que la composition de l’air est la suivante : - Oxygène (O²) 21 % - Azote (N²) 79 % Convention d’appellation Par convention, on désigne ce mélange en citant en premier sa teneur en O² puis sa teneur en N², on obtient une indication du type : O²/N² ou XX / YY . un mélange définit comme suit : 40/60 Désigne un NITROX contenant 40 % d’O² et 60 % de N² Patrick Baptiste MF1 n° 22108 Formation théorique Nitrox confirmé Limites et contraintes Liés à l’augmentation de la pression partielle d’oxygène (PpO²) - Limitation de la profondeur maximum par rapport à l’air( PpO²max = 1,6b .) - Limitation variable de la profondeur en fonction du mélange respiré - Risque d’accident hyperoxique si les profondeurs planchées ou la durée d’utilisation sont dépassés, - Manipulation plus contraignante et plus dangereuse, - Nécessite un matériel spécifique ( compresseur, équipement spécifique si Nitrox > 40/60) - Planification des plongées obligatoires et plus complexes - Prix de revient plus élevé que l’air. -
Hyperbaric Physiology the Rouse Story Arrival at Recompression
Hyperbaric Physiology The Rouse Story • Oct 12, 1992, off the New Jersey coast • father/son team of experienced divers • explore submarine wreck in 230 ft (70 m) • breathing compressed air • trapped in wreck & escaped with no time for decompression Chris and Chrissy Rouse Arrival at recompression Recompression efforts facility • Both divers directly ascend to dive boat • Recompression starts about 3 hrs after • Helicopter arrives at boat in 1 hr 27 min ascent • Bronx Municipal Hospital recompression facility – put on pure O2 and compressed to 60 ft – Chris (39 yrs) pronounced dead • extreme pain as circulation returned – compressed to 165 ft, then over 5.5 hrs – Chrissy (22 yrs) gradually ascended back to 30 ft., lost • coherent and talking consciousness • paralysis from chest down • no pain – back to 60 ft. Heart failure and death • blood sample contained foam • autopsy revealed that the heart contained only foam Medical Debriefing Gas Laws • Boyle’s Law • Doctors conclusions regarding their – P1V1 = P2V2 treatment • Dalton’s Law – nothing short of recompression to extreme – total pressure is the sum of the partial pressures depths - 300 to 400 ft • Henry’s Law – saturation treatment lasting several days – the amt of gas dissolved in liquid at any temp is – complete blood transfusion proportional to it’s partial pressure and solubility – deep helium recompression 1 Scuba tank ~ 64 cf of air Gas problems during diving Henry, 1 ATM=33 ft gas (10 m) dissovled = gas Pp & tissue • Rapture of the deep (Nitrogen narcosis) solubility • Oxygen -
Chapter 23 ENVIRONMENTAL EXTREMES: ALTERNOBARIC
Environmental Extremes: Alternobaric Chapter 23 ENVIRONMENTAL EXTREMES: ALTERNOBARIC RICHARD A. SCHEURING, DO, MS*; WILLIAM RAINEY JOHNSON, MD†; GEOFFREY E. CIARLONE, PhD‡; DAVID KEYSER, PhD§; NAILI CHEN, DO, MPH, MASc¥; and FRANCIS G. O’CONNOR, MD, MPH¶ INTRODUCTION DEFINITIONS MILITARY HISTORY AND EPIDEMIOLOGY Altitude Aviation Undersea Operations MILITARY APPLIED PHYSIOLOGY Altitude Aviation Undersea Operations HUMAN PERFORMANCE OPTIMIZATION STRATEGIES FOR EXTREME ENVIRONMENTS Altitude Aviation Undersea Operations ONLINE RESOURCES FOR ALTERNOBARIC ENVIRONMENTS SUMMARY *Colonel, Medical Corps, US Army Reserve; Associate Professor, Military and Emergency Medicine, Uniformed Services University of the Health Sci- ences, Bethesda, Maryland †Lieutenant, Medical Corps, US Navy; Undersea Medical Officer, Undersea Medicine Department, Naval Medical Research Center, Silver Spring, Maryland ‡Lieutenant, Medical Service Corps, US Navy; Research Physiologist, Undersea Medicine Department, Naval Medical Research Center, Silver Spring, Maryland §Program Director, Traumatic Injury Research Program; Assistant Professor, Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland ¥Colonel, Medical Corps, US Air Force; Assistant Professor, Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland ¶Colonel (Retired), Medical Corps, US Army; Professor and former Department Chair, Military and Emergency Medicine, Uniformed Services University of the Health Sciences, -
Board of Directors Chosen Valley Care Center & Apartments
Views From The Valley Fall and Winter, 2019 2019 Walk N Roll Charlie and his granddaughter Page 2 Board of Directors Chosen Valley Care Center & Apartments Mary Patten Mike Thieke Dan Hollermann Amy Vreeman Gary Bren Pam Holte Angie Bicknese Sheryl Bennett Mary L. Allen Maureen Ruskell Views from the Valley Contributing Writers: Craig Backen, Administrator [email protected] Lisa Vickerman, Director of Clinical & Resident Services [email protected] Ellen Strande, Director of Human Resources [email protected] Carrie Colbenson, Director of Nursing [email protected] Melissa Fenske, Director of Social Services [email protected] Gerry Gathje, Director of Environmental Services [email protected] Kate Glor, Director of the Dept. of Life Enrichment [email protected] Jody Lawstuen, Environmental Services Supervisor [email protected] Barb Weiss, Director of Food and Nutrition Services [email protected] Erin Amdahl, Business Office Manager [email protected] Robert (Bob) Schrupp, Physical Therapist [email protected] Spotlight Writer: Mimi Seamens, MRP Page 3 From The Administrator’s Desk Hi Everyone, We are just weeks away from the Care Center building addition and renovation project. Project planning has been very successful, and we will soon be breaking ground! The project is scheduled to begin in October and be completed in October 2021. The project will begin with an addition between the end of E Wing and D Wing. Next, a new therapy addition and private rooms (suites) on A Wing will be completed. Then, renovations will occur throughout D Wing and E Wing. As noted in my previous article, there are numerous project priorities for what we want to accomplish in the Care Center. -
A Primer for Technical Diving Decompression Theory
SCUBA AA PPRRIIMMEERR FFOORR TECH TTEECCHHNNIICCAALL DDIIVVIINNGG DDEECCOOMMPPRREESSSSIIOONN PHILIPPINES TTHHEEOORRYY 1 | P a g e ©Andy Davis 2015 www.scubatechphilippines.com Sidemount, Technical & Wreck Guide | Andy Davis First Published 2016 All documents compiled in this publication are open-source and freely available on the internet. Copyright Is applicable to the named authors stated within the document. Cover and logo images are copyright to ScubaTechPhilippines/Andy Davis. Not for resale. This publication is not intended to be used as a substitute for appropriate dive training. Diving is a dangerous sport and proper training should only be conducted under the safe supervision of an appropriate, active, diving instructor until you are fully qualified, and then, only in conditions and circumstances which are as good or better than the conditions in which you were trained. Technical scuba diving should be taught by a specialized instructor with training credentials and experience at that level of diving. Careful risk assessment, continuing education and skill practice may reduce your likelihood of an accident, but are in no means a guarantee of complete safety. This publication assumes a basic understanding of diving skills and knowledge. It should be used to complement the undertaking of prerequisite training on the route to enrolling upon technical diving training. 2 | P a g e ©Andy Davis 2015 www.scubatechphilippines.com This primer on decompression theory is designed as a supplement to your technical diving training. Becoming familiar with the concepts and terms outlined in this document will enable you to get the most out of your theory training with me; and subsequently enjoy safer, more refined dive planning and management in your technical diving activities. -
Vacuum in the 17Th Century and Onward the Beginning of Experimental Sciences Donald M
HISTORY CORNER A SHORT HISTORY: VACUUM IN THE 17TH CENTURY AND ONWARD THE BEGINNING OF Experimental SCIENCES Donald M. Mattox, Management Plus Inc., Albuquerque, N.M. acuum as defined as a space with nothing in it (“perfect Early Vacuum Equipment vacuum”) was debated by the early Greek philosophers. The early period of vacuum technology may be taken as the V The saying “Nature abhors a vacuum” (horror vacui) is gener- 1640s to the 1850s. In the 1850s, invention of the platinum- ally attributed to Aristotle (Athens ~350 BC). Aristotle argued to-metal seal and improved vacuum pumping technology al- that vacuum was logically impossible. Plato (Aristotle’s teach- lowed the beginning of widespread studies of glow discharges er) argued against there being such a thing as a vacuum since using “Geissler tubes”[6]. Invention of the incandescent lamp “nothing” cannot be said to exist. Hero (Heron) of Alexandria in the 1850s provided the incentive for development of indus- (Roman Egypt) attempted using experimental techniques to trial scale vacuum technology[7]. create a vacuum (~50 AD) but his attempts failed although he did invent the first steam engine (“Heron’s steam engine”) and Single-stroke Mercury-piston Vacuum Pump “Heron’s fountain,” often used in teaching hydraulics. Hero It was the latter part of 1641 that Gasparo Berti demonstrated wrote extensively about siphons in his book Pneumatica and his water manometer, which consisted of a lead pipe about 10 noted that there was a maximum height to which a siphon can meters tall with a glass flask cemented to the top of the pipe “lift” water. -
Remote Extra Terrestrial Healthcare: a View from India
Editorial 1 Remote Extra Terrestrial Healthcare: A View from India Krishnan Ganapathy* Apollo Telemedicine Networking Foundation & Apollo Telehealth Services, Chennai, India Correspondence to: EJBI 2019; 15(1):01-02 Received: September 10, 2018 Prof. K.Ganapathy M.Ch( Neuro) FACS, FICS, FAMS, Ph.D Accepted: September 29, 2018 Director, Apollo Telemedicine Networking Foundation & Apollo Published: October 06, 2018 Telehealth Services, 21,Greames Lane, Chennai, India. E-mail: [email protected] Breaking with tradition, this editorial from India, in the of unexpected medical emergencies need to be addressed official mouthpiece of the European Federation for Medical and prepared for. Removing the effect of Earth‘s gravitational Informatics, is truly an example of how the world is shrinking. force alters all organic functioning. Space motion sickness, A paradox, the inhabitants of the planet, however are expanding characterized by impairment of performance, nausea, vomiting their reach, albeit slowly. The recent announcement by ISRO and a diffuse malaise, occurs in astronauts and lasts for the first 72 (Indian Space Research Organisation) that India would be hours of a space mission. Normal process of bone formation and embarking on a Human Space Program Gaganyaan, scheduled resorption is disturbed. for launch in December 2021 has excited hard core telehealth Medical challenges and care during space missions include enthusiasts in India. India will now be the fourth country in the attention to space pharmacology, nutrition, immunology, world, after Russia, USA and China, to launch a manned space countermeasures to withstand microgravity and attention to flight. Monitoring in real time, the health parameters of the three aerospace physiology. -
Aerospace Nursing Section
Send information for publication on this page to: Maj. Jana Campbell, USAF, NC 9619 Ridge Heights East St. Louis, IL 62208-2319 AEROSPACE NURSING SECTION stability to the section. We have tentatively A Message from the New President selected our speakers for the next year. My focus for the coming year will be on As I assume the presidency of the Aero- Patricia Ravella; and Executive Board Mem- communication. Communication tends to space Nursing Section I would like to bers-at-large Maj. Betty McCoy and Col. taper off after the annual meeting. I hope to present my vision of the following year for Georgia Hale. Committee chairpersons are see improved communication within the sec- our section and its relation with our parent as follows: Scientific Program--Lt. Col. tion and between the section and the parent organization. Garye Jensen; Nominations--Maj. Anne organization. Through communication I ex- After over 10 years' of flying I find my Hamilton; Editorial/Publicity--Maj. Jana pect to see greater involvement of our chair- role changing. Though I am no longer in an Campbell; Education/Training---Capt. Lee persons with our parent organization com- active flying position I find I can still have Williamson; Long Range Planning--Lt. Col. mittees. an effect on that which I enjoy so much. Sarah Wright; History/Archives--Maj. As we look toward next year's meeting in The prospect of a new role became clear Charles Tupper; Awards--OTC Patricia Pe- San Antonio I anticipate an even better when I realized I had more to contribute ters; Membership/Marketing Lt. -
President's Page
President’s Page Here I am, flying back to Oklahoma City after at- tending the 1-day Summer Executive Committee (ExComm) Meeting at AsMA Headquarters in Alexandria, VA. I just heard the announcement from the flight deck that due to security regulations, for the next 30 minutes of flight all passengers cannot leave our seats. I will remember it this time, because during my previous flight departing Washington, DC, I forgot the warning and left my seat in a hurry to go to the lavatory 28 minutes after take off. Next thing that I re- member is attempting to sit down on the toilet and hearing loud banging on the door and somebody yelling at me to open the door and get back to my seat immediately. I pulled up my pants in record time, Melchor J. Antuñano, M.D., M.S. opened the door, and while apologizing to the flight at- tendant for my transgression I noticed the many pas- sengers who were looking at me in disbelief (at least it a. AsMA Vice-Presidents' Roles and was not a Federal Air Marshall waiting for me outside Responsibilities: David Schroeder, Ph.D. (AsMA Past- the lavatory). Two minutes later the flight attendant President) submitted a proposal defining the specific came back to my seat to tell me that I could now use roles and responsibilities for the Vice-Presidents and the lavatory. However, I did not feel the need to go to identifying guidelines for their selection. This proposal the lavatory for remaining duration of the flight. This will be revised by the ExComm and the final draft will experience makes me wonder what triggers a Federal be presented to AsMA Council. -
Here Were a Number of Sources of Introductory Information Giving the Basics of Decompression Theory
Contents Introduction .....................................................................................................................................1 Chapter 1 Historical Perspective .....................................................................................................7 Robert Boyle (1627 - 1691)................................................................................................................7 Rediscovery .......................................................................................................................................8 Caissons Disease ...............................................................................................................................8 Paul Bert (1833-1886) .....................................................................................................................10 John Scott Haldane (1860-1936) .....................................................................................................12 US Navy ...........................................................................................................................................15 Robert Workman ..............................................................................................................................17 Professor Albert Bühlmann (1923–1994)..........................................................................................17 Chapter 2 Decompression Principles ............................................................................................21 Overview -
Metabolism of Oxygen - Mika Venojärvi
PHYSIOLOGY AND MAINTENANCE – Vol. II – Metabolism of Oxygen - Mika Venojärvi METABOLISM OF OXYGEN Mika Venojärvi Department of Physiology, Institute of Biomedicine University of Kuopio, Kuopio, Finland and Medical Laboratory Technology, Turku University of Applied Sciences, Turku, Finland. Keywords: oxygen, superoxide, hydrogen peroxide, hydroxyl ion, singlet oxygen, reactive oxygen species, Fenton reaction, Haber-Weiss reaction. Contents 1. Introduction 2. Oxygen chemistry 2.1. Oxygen molecule 2.2. Singlet oxygen 2.3. Superoxide, hydrogen peroxide and hydroxyl radical 2.4. Carbon dioxide and monoxide 2.5. Sulfuric acid-sulfurdioxide 2.6. Nitrogen and its oxides 3. Mitochondria and oxygen 3.1. Oxidative phosphorylation 3.2. Mitochondrial superoxide synthesis and its elimination 4. Oxygen activation by cytochrome P450 5. Peroxisomes 6. Vascular endothelium and xanthine oxidase 7. Reactive metabolites as bullets of phagocytes 7.1. NADPH oxidase 7.2. Hypochloric acid 8. Oxygen damages of Biomolecules 8.1. Protein oxidation 8.2. Lipid peroxidation 8.3. DNA oxidation 8.4. Tissue anoxia 8.5. Anoxic necrosis 9. SensingUNESCO oxygen levels – EOLSS 9.1. Chemoreceptors 9.2. Glutathione cycle 10. Oxygen andSAMPLE genome regulation CHAPTERS Glossary Bibliography Biographical Sketch Summary Oxygen is highly toxic at too high concentrations and dangerous due to fires. Oxygen on the other hand is a vitally critical element for animals and even plants which themselves generate oxygen in their photosynthesis. ATP is required in most energy- ©Encyclopedia of Life Support Systems (EOLSS) PHYSIOLOGY AND MAINTENANCE – Vol. II – Metabolism of Oxygen - Mika Venojärvi consuming steps in intermediary metabolism as well as in maintaining proper ion gradients in cells and extracellular fluids.