China
Africa
Explore chapters and articles related to this topic
Cardiovascular system
Published in David A Lisle, Imaging for Students, 2012
Postprocedure care following PTA consists of haemostasis and bed rest as for angiography. Patients may be maintained on low-dose aspirin or heparin following a complicated procedure. Complications are uncommon and include arterial occlusion, arterial rupture, haemorrhage and distal embolization.
A ripple effect in prehospital stroke patient care
Published in International Journal of Production Research, 2021
Brandon W. Lee, Jiho Yoon, Seung Jun Lee
Stroke is ‘a sudden interruption in the blood supply of the brain’ (American Stroke Association 2020). According to the Centres for Disease Control and Prevention (CDC), stroke is the fifth leading cause of death in the U.S. (National Center for Health Statistics 2017, 49). There are two types of stroke: ischemic stroke (i.e. an obstruction in the blood vessel of the brain) and hemorrhagic stroke (i.e. a ruptured blood vessel) (American Stroke Association 2020). Once a patient has a stroke, an average of 1.9 million brain cells die per minute. Thus, faster transport to a hospital for early treatment leads to improved therapeutic outcomes (Saver 2006; Emberson et al. 2014). Because of the importance of faster treatment for a stroke patient, the expression ‘Time lost is brain lost’ is popular in the stroke care community. To ensure early treatment for a patient, care providers should first identify a stroke promptly and precisely. The dispatch centre identifies a stroke using a conversation-based protocol called the ‘Stroke Diagnostic Tool (SDxT),’ which is composed of a set of questions that the dispatcher asks the patient (Ramanujam et al. 2008; Gardett et al. 2017). On the other hand, the field provider identifies a stroke using on-scene assessment tools such as the Cincinnati Prehospital Stroke Severity Scale (CPSSS), Los Angeles Motor Scale (LAMS), and Rapid Arterial oCclusion Evaluation (RACE) (Nazliel etal. 2008; Pérez de la Ossa et al. 2014; Katz et al. 2015). These field provider assessment tools not only identify a stroke, but also measure its severity.
Blood flow restriction does not augment low force contractions taken to or near task failure
Published in European Journal of Sport Science, 2020
Samuel L. Buckner, Matthew B. Jessee, Scott J. Dankel, Kevin T. Mattocks, J. Grant Mouser, Zachary W. Bell, Takashi Abe, John P. Bentley, Jeremy P. Loenneke
Participants exercised with either a high-load (70% 1RM) or a very low-load (15% 1RM) with and without blood flow restriction. Exercise consisted of unilateral elbow flexion exercise completed to volitional failure or 90 reps per set, whichever occurred first. Ninety repetitions represents 3 min of continuous exercise which would equal the time-frame used by Holm et al. (2008), and it would minimise participant strain. Further, if the contractions were not generating a sufficient amount of fatigue, the stimulus would likely become more aerobic (i.e. mitochondrial protein synthesis > myofibrillar protein synthesis) with time (Burd et al., 2012). Each set for the high-load condition was separated by 90s of rest and the very low-load conditions were separated by 30s of rest. Exercise was performed to the beat of a metronome, with the concentric and eccentric portions of the lift each lasting for 1s (total of a 2s per repetition). For the BFR conditions, the same protocol used for very low-load training was employed with the addition of a 5 cm wide nylon cuff (SC5, Hokanson Inc., Belleville, WA, USA), at the top of the limb which was inflated to 40% or 80% of the individual’s resting AOP. This led to an average applied pressure of 57 mmHg for the 1540 condition and 110 mmHg for the 1580 condition (Mattocks et al., 2019). The standing arterial occlusion pressure was determined by placing an MD6 Doppler probe (Hokanson, Bellevue, WA, USA) at the radial or artery to detect a pulse. The pressure cuff was then inflated and was increased by 1 mmHg increments until a pulse was no longer present. The cuff remained inflated for the duration of the protocol including rest periods and was deflated and removed upon completion of the final set. The AOP was determined prior to exercise each visit.
Task, usability, and error analyses of ambulance-based telemedicine for stroke care
Published in IISE Transactions on Healthcare Systems Engineering, 2021
Hunter Rogers, Kapil Chalil Madathil, Anjali Joseph, Nathan McNeese, Christine Holmstedt, Richard Holden, James T. McElligott
The results from the HTA answer RQ1. The overall process of care for a stroke patient was described by the clinicians. When a person potentially experiencing a stroke calls 911, the local EMS sends one of their ambulances with an Emergency Medical Technician (EMT) and paramedic team to assess the patient. On arrival, they typically conduct a Rapid Arterial oCclusion Evaluation (RACE), a simple 5-item scale used to help identify a possible stroke. Based on the RACE score and the overall evaluation of the patient, the EMT and paramedic move the patient into the ambulance, call the receiving secondary hospital to begin a stroke consult and log on to the REACH program from a laptop in the ambulance. The nurse at the receiving Emergency Department (ED) creates the patient encounter, and the telemedicine alerts the neurologist on call at the tertiary care hospital of the awaiting consult. The paramedic gathers vital information and stabilizes the patient until the neurologist and nurse can be connected. The neurologist obtains more health history and information about the patient and begins an assessment using the National Institutes of Health Stroke Scale (NIHSS). When the ambulance arrives at the secondary hospital, the patient is taken directly for a Computed Tomography (CT) brain scan, which is immediately uploaded to the telemedicine interface such that the neurologist can make a treatment decision that may include transfer to the tertiary hospital for more intensive care. However, to evaluate the ambulance-based assessment the start and endpoints of the telemedicine platform use were used to scope the HTA. The HTA was developed first by role and then as an overall process conducted by a team. Overall, the goal of the team process is to care for the patient; however, individually for the nurse and neurologist, this goal takes different forms. The main goal of the nurse is to prepare for the arrival of the patient at the ED, while the neurologist determines the patient care plan. In the overall HTA, the subgoals for the process are distributed among clinician roles as described below.