Myocardial Infarction (Heart Attack)
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Internal Bleeding
Internal bleeding What is internal bleeding? It is a leakage of blood from the blood vessels of the surrounding tissues because of an injury affect the vessels and lead to rupture. Internal bleeding occurs inside the body cavities such as the head, chest, abdomen, or eye, and it is difficult to detect, because the leaked blood cannot be seen, and the person may not feel its occurrence till the symptoms associated with that bleeding start to appear. Note: It should be noted that people who take anticoagulant drugs are more likely to have this bleeding than others. What are symptoms of abdominal internal bleeding? There are many symptoms developed by the patients of internal bleeding in the abdomen or chest as below: • Feeling of pain in the abdomen. • Shortness of breath. • Feeling of chest pain. • Dizziness upon standing. • Bruises around the navel or on both sides of the abdomen. • Nausea, Vomiting. • Blood in urine. • Dark color stool. What are the symptoms of abdominal internal bleeding? Sometimes, internal bleeding may lead to loss of large amounts of blood, and in this case, the patient will have many symptoms, as below: • Accelerated heart beats • Low blood pressure • Skin sweating • General weakness • Feeling lethargic or feeling sleepy When should I go to seek medical care? Internal bleeding is very dangerous and life threatening and you should visit the doctor when experience one of the following cases:: ✓ After exposure to a severe injury, to ensure that there is no internal bleeding. ✓ Feeling severe pain in the abdomen ✓ Feeling acute shortness of breath ✓ feeling dizzy ✓ Seeing a change in vision Note: When these symptoms are noticed, you should go immediately to medical care or you must call the emergency services to avoid death. -
The European Guideline on Management Of
Rossaint et al. Critical Care (2016) 20:100 DOI 10.1186/s13054-016-1265-x RESEARCH Open Access The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition Rolf Rossaint1, Bertil Bouillon2, Vladimir Cerny3,4,5,6, Timothy J. Coats7, Jacques Duranteau8, Enrique Fernández-Mondéjar9, Daniela Filipescu10, Beverley J. Hunt11, Radko Komadina12, Giuseppe Nardi13, Edmund A. M. Neugebauer14, Yves Ozier15, Louis Riddez16, Arthur Schultz17, Jean-Louis Vincent18 and Donat R. Spahn19* Abstract Background: Severe trauma continues to represent a global public health issue and mortality and morbidity in trauma patients remains substantial. A number of initiatives have aimed to provide guidance on the management of trauma patients. This document focuses on the management of major bleeding and coagulopathy following trauma and encourages adaptation of the guiding principles to each local situation and implementation within each institution. Methods: The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004 and included representatives of six relevant European professional societies. The group used a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were reconsidered and revised based on new scientific evidence and observed shifts in clinical practice; new recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. This guideline represents the fourth edition of a document first published in 2007 and updated in 2010 and 2013. -
Symptomatic Intracranial Hemorrhage (Sich) and Activase® (Alteplase) Treatment: Data from Pivotal Clinical Trials and Real-World Analyses
Symptomatic intracranial hemorrhage (sICH) and Activase® (alteplase) treatment: Data from pivotal clinical trials and real-world analyses Indication Activase (alteplase) is indicated for the treatment of acute ischemic stroke. Exclude intracranial hemorrhage as the primary cause of stroke signs and symptoms prior to initiation of treatment. Initiate treatment as soon as possible but within 3 hours after symptom onset. Important Safety Information Contraindications Do not administer Activase to treat acute ischemic stroke in the following situations in which the risk of bleeding is greater than the potential benefit: current intracranial hemorrhage (ICH); subarachnoid hemorrhage; active internal bleeding; recent (within 3 months) intracranial or intraspinal surgery or serious head trauma; presence of intracranial conditions that may increase the risk of bleeding (e.g., some neoplasms, arteriovenous malformations, or aneurysms); bleeding diathesis; and current severe uncontrolled hypertension. Please see select Important Safety Information throughout and the attached full Prescribing Information. Data from parts 1 and 2 of the pivotal NINDS trial NINDS was a 2-part randomized trial of Activase® (alteplase) vs placebo for the treatment of acute ischemic stroke. Part 1 (n=291) assessed changes in neurological deficits 24 hours after the onset of stroke. Part 2 (n=333) assessed if treatment with Activase resulted in clinical benefit at 3 months, defined as minimal or no disability using 4 stroke assessments.1 In part 1, median baseline NIHSS score was 14 (min: 1; max: 37) for Activase- and 14 (min: 1; max: 32) for placebo-treated patients. In part 2, median baseline NIHSS score was 14 (min: 2; max: 37) for Activase- and 15 (min: 2; max: 33) for placebo-treated patients. -
Cardiovascular Disease and Rehab
EXERCISE AND CARDIOVASCULAR ! CARDIOVASCULAR DISEASE Exercise plays a significant role in the prevention and rehabilitation of cardiovascular diseases. High blood pressure, high cholesterol, diabetes and obesity can all be positively affected by an appropriate and regular exercise program which in turn benefits cardiovascular health. Cardiovascular disease can come in many forms including: Acute coronary syndromes (coronary artery disease), myocardial ischemia, myocardial infarction (MI), Peripheral artery disease and more. Exercise can improve cardiovascular endurance and can improve overall quality of life. If you have had a cardiac event and are ready to start an appropriate exercise plan, Cardiac Rehabilitation may be the best option for you. Please call 317-745-3580 (Danville Hospital campus), 317-718-2454 (YMCA Avon campus) or 317-456-9058 (Brownsburg Hospital campus) for more information. SAFETY PRECAUTIONS • Ask your healthcare team which activities are most appropriate for you. • If prescribed nitroglycerine, always carry it with you especially during exercise and take all other medications as prescribed. • Start slow and gradually progress. If active before event, fitness levels may be significantly lower – listen to your body. A longer cool down may reduce complications. • Stop exercising immediately if you experience chest pain, fatigue, or labored breathing. • Avoid exercising in extreme weather conditions. • Drink plenty of water before, during, and after exercise. • Wear a medical identification bracelet, necklace, or ID tag in case of emergency. • Wear proper fitting shoes and socks, and check feet after exercise. STANDARD GUIDELINES F – 3-5 days a week. Include low weight resistance training 2 days/week I – 40-80% of exercise capacity using the heart rate reserve (HRR) (220-age=HRmax; HRmax-HRrest = HRR) T – 20-60mins/session, may start with sessions of 5-15 mins if necessary T – Large rhythmic muscle group activities that are low impact (walking, swimming, biking) Get wellness tips to keep YOU healthy at HENDRICKS.ORG/SOCIAL.. -
Complications from COVID-19 – Not for the Faint of Heart Jeannette Guerrasio, MD
Complications from COVID-19 – Not for the faint of heart Jeannette Guerrasio, MD Anytime a person suffers a health event there is always the risk for complications. For example, if you are walking through the living room and bump your leg into the coffee table, you will get a superficial bruise. You may not have any complications at all. But, if you also get a tiny cut on your shin from the corner of the coffee table and bacteria that normally live on the skin get into the cut, you will develop a complication in the form of a skin infection (cellulitis). If you are on blood thinners, you may bleed more than the average person and develop the complication of a deeper, lumpy, more painful bruise called a hematoma. The same is true for COVID-19. When an individual gets the virus, they may or may not go on to develop complications. Some of the complications are more likely than others and some of them are temporary while others may become permanent. The most common complications of COVID-19 are the development of blood clots and low oxygen levels. Patients can form blood clots in the veins or arteries anywhere in the body. The most common locations are in their legs (deep vein thrombosis or DVT) and lungs (pulmonary embolism or PE.) Some patients who get blood clots need to be on blood thinners, like Warfarin, Xarelto or Eliquis, for months while others need them for the rest of their lives. COVID-19 disrupts the iron in patient’s red blood cells, making it harder for their blood to carry oxygen from their lungs to the organs of their body, resulting in low oxygen levels. -
The Internal Treatment of Traumatic Injury
THE INTERNAL TREATMENT OF TRAUMATIC INJURY The focus of this paper is the treatment of traumatic injury with internally ingested Chinese herbal formulas. Whereas the strategy for external treatment of traumatic injury is governed by clinical manifestation, internal treatment strategies are governed by proper identification of progressive stages. GENERAL SIGNS/SYMPTOMS OF ACUTE INJURY There are three distinct stages of traumatic injury, which are expressed by a limited number of clinical manifest- ations. The three primary manifestations of the early stages of trauma are heat, swelling, and pain. Western medicine, since the time of the great Roman physician, Galen, has specified five signs, but the differences, from our point of view, is negligible. The five signs discussed by Western medicine are: pain, swelling, redness, heat, and loss of function. Oriental medicine combines heat and redness into one sign, since both a sensation of warmth and the visible sign of redness are classified as heat. The “loss of function” sign is seen by Oriental medicine as a mechanical consequence of significant qi and blood stasis, and cannot be addressed separately from qi and blood stasis by internal treatments. Thus, both East and West are in basic agreement about the signs of early stage injury. If acute injury develops into a chronic issue, other signs can come into play, such as numbness/tingling, localized weakness, and aggravation by external evils such as cold. A WORD ABOUT BLEEDING Bleeding is a special manifestation of traumatic injury, and is a pattern unto itself. In most injuries where there is bleeding, it must be stopped before further assessment is made. -
The Management of Acute Coronary Syndromes in Patients Presenting
CONCISE GUIDANCE Clinical Medicine 2021 Vol 21, No 2: e206–11 The management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: key points from the ESC 2020 Clinical Practice Guidelines for the general and emergency physician Authors: Ramesh NadarajahA and Chris GaleB There have been significant advances in the diagnosis and international decline in mortality rates.2,3 In September 2020, management of non-ST-segment elevation myocardial the European Society of Cardiology (ESC) published updated infarction over recent years, which has been reflected in an Clinical Practice Guidelines for the management of ACS in patients international decline in mortality rates. This article provides an presenting without persistent ST-segment elevation,4 5 years after overview of the 2020 European Society of Cardiology Clinical the last iteration. ABSTRACT Practice Guidelines for the topic, concentrating on areas relevant The guidelines stipulate a number of updated recommendations to the general or emergency physician. The recommendations (supplementary material S1). The strength of a recommendation and underlying evidence basis are analysed in three key and level of evidence used to justify it are weighted and graded areas: diagnosis (the recommendation to use high sensitivity according to predefined scales (Table 1). This focused review troponin and how to apply it), pathways (the recommendation provides learning points derived from the guidelines in areas to facilitate early invasive coronary angiography to improve relevant to general and emergency physicians, including diagnosis outcomes and shorten hospital stays) and treatment (a (recommendation to use high sensitivity troponin), pathways paradigm shift in the use of early intensive platelet inhibition). -
Management of Hypovolaemic Shock in the Trauma Patient HYPOVOLAEMIC SHOCK GUIDELINE
HypovaolaemicShock_FullRCvR.qxd 3/2/07 3:03 PM Page 1 ADULT TRAUMA CLINICAL PRACTICE GUIDELINES :: Management of Hypovolaemic Shock in the Trauma Patient HYPOVOLAEMIC SHOCK GUIDELINE blood O-neg HypovaolaemicShock_FullRCvR.qxd 3/2/07 3:03 PM Page 2 Suggested citation: Ms Sharene Pascoe, Ms Joan Lynch 2007, Adult Trauma Clinical Practice Guidelines, Management of Hypovolaemic Shock in the Trauma Patient, NSW Institute of Trauma and Injury Management. Authors Ms Sharene Pascoe (RN), Rural Critical Care Clinical Nurse Consultant Ms Joan Lynch (RN), Project Manager, Trauma Service, Liverpool Hospital Editorial team NSW ITIM Clinical Practice Guidelines Committee Mr Glenn Sisson (RN), Trauma Clinical Education Manager, NSW ITIM Dr Michael Parr, Intensivist, Liverpool Hospital Assoc. Prof. Michael Sugrue, Trauma Director, Trauma Service, Liverpool Hospital This work is copyright. It may be reproduced in whole or in part for study training purposes subject to the inclusion of an acknowledgement of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above requires written permission from the NSW Insititute of Trauma and Injury Management. © NSW Institute of Trauma and Injury Management SHPN (TI) 070024 ISBN 978-1-74187-102-9 For further copies contact: NSW Institute of Trauma and Injury Management PO Box 6314, North Ryde, NSW 2113 Ph: (02) 9887 5726 or can be downloaded from the NSW ITIM website http://www.itim.nsw.gov.au or the NSW Health website http://www.health.nsw.gov.au January 2007 HypovolaemicShock_FullRep.qxd 3/2/07 12:36 PM Page i blood O-neg Important notice! 'Management of Hypovolaemic Shock in the Trauma Patient’ clinical practice guidelines are aimed at assisting clinicians in informed medical decision-making. -
Management of Hypovolaemic Shock in the Trauma Patient (Full Guideline)
HypovaolaemicShock_FullRCvR.qxd 3/2/07 3:03 PM Page 1 ADULT TRAUMA CLINICAL PRACTICE GUIDELINES :: Management of Hypovolaemic Shock in the Trauma Patient HYPOVOLAEMIC SHOCK GUIDELINE blood O-neg HypovaolaemicShock_FullRCvR.qxd 3/2/07 3:03 PM Page 2 Suggested citation: Ms Sharene Pascoe, Ms Joan Lynch 2007, Adult Trauma Clinical Practice Guidelines, Management of Hypovolaemic Shock in the Trauma Patient, NSW Institute of Trauma and Injury Management. Authors Ms Sharene Pascoe (RN), Rural Critical Care Clinical Nurse Consultant Ms Joan Lynch (RN), Project Manager, Trauma Service, Liverpool Hospital Editorial team NSW ITIM Clinical Practice Guidelines Committee Mr Glenn Sisson (RN), Trauma Clinical Education Manager, NSW ITIM Dr Michael Parr, Intensivist, Liverpool Hospital Assoc. Prof. Michael Sugrue, Trauma Director, Trauma Service, Liverpool Hospital This work is copyright. It may be reproduced in whole or in part for study training purposes subject to the inclusion of an acknowledgement of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above requires written permission from the NSW Insititute of Trauma and Injury Management. © NSW Institute of Trauma and Injury Management SHPN (TI) 070024 ISBN 978-1-74187-102-9 For further copies contact: NSW Institute of Trauma and Injury Management PO Box 6314, North Ryde, NSW 2113 Ph: (02) 9887 5726 or can be downloaded from the NSW ITIM website http://www.itim.nsw.gov.au or the NSW Health website http://www.health.nsw.gov.au January 2007 HypovolaemicShock_FullRep.qxd 3/2/07 12:36 PM Page i blood O-neg Important notice! 'Management of Hypovolaemic Shock in the Trauma Patient’ clinical practice guidelines are aimed at assisting clinicians in informed medical decision-making. -
Chapter 24 Abdomen Injuries
44093_CH024_0001_0021.qxd 1/18/07 4:35 PM Page 1 SECTION 4TRAUMA Chapter 24 Abdomen Injuries Objectives Cognitive 4-8.17 Describe the epidemiology, including the morbidity/mortality and prevention strategies 4-8.1 Describe the epidemiology, including the for hollow organ injuries. (p 24.11) morbidity/mortality and prevention strategies for a patient with abdominal trauma. 4-8.18 Explain the pathophysiology of hollow organ (p 24.6, 24.7) injuries. (p 24.11) 4-8.2 Describe the anatomy and physiology of organs 4-8.19 Describe the assessment findings associated and structures related to abdominal injuries. with hollow organ injuries. (p 24.11) (p 24.6) 4-8.20 Describe the treatment plan and management of 4-8.3 Predict abdominal injuries based on blunt and hollow organ injuries. (p 24.15) penetrating mechanisms of injury. 4-8.21 Describe the epidemiology, including the (p 24.5, 24.8) morbidity/mortality and prevention strategies 4-8.4 Describe open and closed abdominal injuries. for abdominal vascular injuries. (p 24.12) (p 24.7, 24.8) 4-8.22 Explain the pathophysiology of abdominal 4-8.5 Explain the pathophysiology of abdominal vascular injuries. (p 24.12) injuries. (p 24.10) 4-8.23 Describe the assessment findings associated 4-8.6 Describe the assessment findings associated with abdominal vascular injuries. (p 24.12) with abdominal injuries. (p 24.10) 4-8.24 Describe the treatment plan and management of 4-8.7 Identify the need for rapid intervention and abdominal vascular injuries. (p 24.15) transport of the patient with abdominal injuries 4-8.25 Describe the epidemiology, including the based on assessment findings. -
Treatment of Acute Coronary Syndrome
Acute Coronary Syndrome: Current Treatment TIMOTHY L. SWITAJ, MD, U.S. Army Medical Department Center and School, Fort Sam Houston, Texas SCOTT R. CHRISTENSEN, MD, Martin Army Community Hospital Family Medicine Residency Program, Fort Benning, Georgia DEAN M. BREWER, DO, Guthrie Ambulatory Health Care Clinic, Fort Drum, New York Acute coronary syndrome continues to be a significant cause of morbidity and mortality in the United States. Family physicians need to identify and mitigate risk factors early, as well as recognize and respond to acute coronary syn- drome events quickly in any clinical setting. Diagnosis can be made based on patient history, symptoms, electrocardi- ography findings, and cardiac biomarkers, which delineate between ST elevation myocardial infarction and non–ST elevation acute coronary syndrome. Rapid reperfusion with primary percutaneous coronary intervention is the goal with either clinical presentation. Coupled with appropriate medical management, percutaneous coronary interven- tion can improve short- and long-term outcomes following myocardial infarction. If percutaneous coronary interven- tion cannot be performed rapidly, patients with ST elevation myocardial infarction can be treated with fibrinolytic therapy. Fibrinolysis is not recommended in patients with non–ST elevation acute coronary syndrome; therefore, these patients should be treated with medical management if they are at low risk of coronary events or if percutaneous coronary intervention cannot be performed. Post–myocardial infarction care should -
Head to Toe Critical Care Assessment for the Trauma Patient
Head to Toe Assessment for the Trauma Patient St. Joseph Medical Center – Tacoma General Hospital – Trauma Trust Objectives 1. Learn Focused Trauma Assessment 2. Learn Frequently Seen Trauma Injuries 3. Appropriate Nursing Care for Trauma Patients St. Joseph Medical Center – Tacoma General Hospital – Trauma Trust Prior to Arrival • Ensure staff have received available details of the case • Notify the entire responding Trauma team • Assign tasks as appropriate for Trauma resuscitation • Gather, check and prepare equipment • Prepare Trauma room • Don PPE (personal protective equipment) • MIVT way to obtain history: Mechanism of injury Injuries sustained Vital signs Treatment given Trauma Trust St. Joseph Medical Center – Tacoma General Hospital – Trauma Trust Primary Survey • Begins immediately on patient’s arrival • Collection of information of injury event and past medical history depend on severity of condition • Conducted in Emergency Room simultaneously with resuscitation • Focuses on detecting life threatening injuries • Assessment of ABC’s Trauma Trust St. Joseph Medical Center – Tacoma General Hospital – Trauma Trust Primary Survey Components Airway with simultaneous c-spine protection and Alertness Breathing and ventilation Circulation and Control of hemorrhage Disability – Neurological: Glasgow Coma Scale [GCS] or Alert, Voice, Pain, Unresponsive [AVPU] Exposure and Environmental Controls Full set of vital signs and Family presence Get resuscitation adjuncts (labs, monitoring, naso/oro gastric tube, oxygenation and pain)