Psychological Management of Burns
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Did you know that around a third of patients that present with a severe burn, also have a pre-existing mental health condition? Furthermore, around 80% of patients report having had a major life event or severe stress prior to the burn. This talk will help you discover if all burns are traumatic, how and why a trauma-related disorder may evolve and increase your understanding of how trauma responses can interfere with many aspects of physical and psychological recovery.
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Health/illness and adaptation/maladaptation (nursing world view) are two distinct continuums.
The model includes the primary, secondary, and tertiary levels of prevention by describing four discrete stages of psychiatric treatment: crisis, acute, maintenance, and health promotion.
Nursing care is based on the use of the nursing process and the standards of care and professional performance for psychiatric nurses.
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Appraisal of stressor - an evaluation of the significance of a stressor.
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Autoimmune rheumatic diseases are due to a compromised immune response against the self. Physicians have commonly observed that stress adversely affects patient’s disease and many studies have demonstrated that a high percentage of patients have reported unusual emotional stress before disease onset. Stress is now days an important risk factor for the pathogenesis of autoimmune disease.
Research among veterans showed that those diagnosed with PTSD had higher risk for diagnosis with an autoimmune disorder like rheumatoid arthritis, systemic lupus erythematosus autoimmune thyroiditis, multiple sclerosis, alone or in combination, compared to veterans with no psychiatric disorder.
A large longitudinal study of civilian women, demonstrated that exposure to trauma and PTSD were associated with increased risk of SLE occurrence. A group of patients with fibromyalgia and PTSD reported significantly greater levels of avoidance, hyperarousal, anxiety, and depression than did the patients without PTSD symptoms.
Conclusion. Rheumatic diseases are common chronic disorders. Several risk factors contribute to their pathophysiology like genetic factors, sex hormones, infections and stress. Research has showed that psychological stress and stress-related hormones are involved in immune modulation, which may result in autoimmune disease. Further studies are needed to clarify the pathophysiological implications of stress and trauma on the onset and activity of rheumatic autoimmune diseases and to determine whether treatment of PTSD and lifestyle changes can decrease the risk for developing autoimmune disorders in patients with this severe psychological disorder.
WOMEN IN MIND KEYNOTE: Everybody Hurts: The personal and political ramificati...
WOMEN IN MIND KEYNOTE: Everybody Hurts: The personal and political ramificati...The Royal Mental Health Centre
The keynote speech at our 2013 Women in Mind Conference on Women's Mental Health.
"Everybody Hurts: The personal and political ramifications of trauma and its treatment for women."
By Catherine Classen, Associate Professor in the Department of Psychiatry at the University of Toronto. She is the Director of the Women’s Mental Health Research Program at the Women’s College Research Institute at Women’s College Hospital, and the academic leader of the Trauma Therapy Program at Women’s College Hospital.Critical incident-stress-managment-update386
The document provides an overview of a presentation on Critical Incident Stress Management (CISM). It discusses updates from the International Critical Incident Stress Foundation (ICISF), including new courses. It also reviews the CAP CISM program, stress responses, and signs of distress and dysfunction. The goal is to provide information on CISM topics to help attendees.
Critical incident-stress-managment-update386
The document provides an overview of Critical Incident Stress Management (CISM) topics including updates from the International Critical Incident Stress Foundation (ICISF) and their courses. It discusses signs and symptoms of distress and dysfunction from critical incidents. It also covers peritraumatic stress, effects of hyperarousal, and ways to mitigate operational stress and critical incident stress through preparedness training and support during responses.
Simple And Complex Trauma
The document discusses simple and complex trauma, including definitions, prevalence, risk factors, common reactions and diagnoses like Acute Stress Disorder and Post-Traumatic Stress Disorder. It also outlines stages of trauma treatment from safety and stabilization to resolution, and principles of trauma-informed care like reducing retraumatization and understanding the impacts of trauma.
Crisis intervention
This document discusses crisis, crisis intervention, and the role of nurses. It defines crisis as a sudden event that disturbs one's homeostasis and usual coping mechanisms. Crises are personal, acute, and have potential for growth or deterioration. The document outlines phases of crisis and types according to Baldwin. It discusses balancing factors like perception, support, and coping that determine if a problem is resolved or becomes a crisis. Nursing roles include assessment, defining the event, developing an action plan, and helping individuals understand and cope with feelings to attain mastery over the crisis.
Stress and adaptation
This document discusses stress, its causes and effects. It defines stress as a state of imbalance resulting from a disparity between situational demands and an individual's ability to meet those demands. Stress can be caused by external factors like the environment or internal factors like lifestyle choices. The general adaptation syndrome describes the body's three stage response to stress. When a person experiences stress, they may exhibit physical or emotional symptoms. Managing stress involves identifying stressors, selecting coping strategies like exercise, nutrition, and social support. The document also examines stress among students and nurses, finding that academic factors are a primary stressor for students while long hours and lack of support contribute to stress in nurses.
7 posttraumatic stress disorder
This document provides an overview of post-traumatic stress disorder (PTSD), including its history, diagnostic criteria, prevalence in children and adults, common symptoms, and treatment approaches. Key events in the recognition of PTSD include railway accidents in the 19th century, Freud's work with traumatized women, and combat veterans experiencing shell shock. The diagnostic criteria for PTSD were established in the DSM-III in 1980. Common treatments include cognitive behavioral therapy, EMDR, and medication.
Child Psychiatric Emergencies McGill University - 4.09.2019
This is a presentation to the Emergency Medicine Teaching Programme in the Faculty of Medicine at McGill University, Montreal, Quebec, Canada
Educational Objectives:
After this presentation, the audience should be able to define, clarify and better appreciate the following topics:
* The Burden of Care (epidemiology)
* Principles of Crisis Intervention
* The Emergency Physician’s Task
DOI 10.13140/RG.2.2.20724.30080
Trauma informed addiction utilizing car model
The document discusses traumatic events, PTSD, and substance abuse disorders. It notes that around two-thirds of the global population experiences a traumatic event that could meet criteria for PTSD. Around 8% of those who experience trauma receive a PTSD diagnosis. The document then discusses what can cause trauma, prevalence of PTSD and substance use disorders occurring together, and poorer treatment outcomes when PTSD and SUDs co-occur. It also discusses the proposed DSM-V criteria for PTSD and explores concepts like containment and autonomic regulation therapy, memory systems, and how trauma impacts the autonomic nervous system.
Health and Safety on Mission - Stress and Substance Abuse final-1
Health and Safety on Mission - Stress and Substance Abuse final-1Program on Humanitarian Policy and Conflict Research at Harvard University
This document provides an overview of a webcast series on health and safety for humanitarian workers produced by Harvard University. The series addresses topics like stress, substance abuse, and burnout. The June 23, 2010 session focuses on stress and substance abuse, with guest speakers including Dr. Stephen Morris, Dr. Donald Bosch, and Dr. John Ehrenreich. They will discuss the causes and impacts of stress, as well as strategies for managing stress on a personal, organizational, and professional level. The document provides background on the guest speakers and outlines from the presentations.Aahpm3.10 mindfulness
This document provides an introduction to mindfulness and its role in caring for dying patients. It defines mindfulness as regulating attention to bring non-judgemental awareness to current experiences. Mindfulness can help cultivate empathy, self-awareness, and the ability to hold contradictory truths. Practicing mindfulness can help clinicians address burnout, errors, and lack of presence by learning to stay present with discomfort. Formal mindfulness practices like meditation as well as informal practices like mindful moments can promote mindfulness. Mindfulness may improve physician well-being, quality of care, and quality of caring.
Similar to Psychological Management of Burns (20)
The Psychological Impact Of Disaster On Emergency Response
The Psychological Impact Of Disaster On Emergency Response
Stress, Stress Adaptation Model & Crisis intervention
Stress, Stress Adaptation Model & Crisis intervention
MHCC & ASCA co-presentation THEMHS 2011. Trauma Informed Care & Practice: Usi...
MHCC & ASCA co-presentation THEMHS 2011. Trauma Informed Care & Practice: Usi...
WOMEN IN MIND KEYNOTE: Everybody Hurts: The personal and political ramificati...
WOMEN IN MIND KEYNOTE: Everybody Hurts: The personal and political ramificati...
Child Psychiatric Emergencies McGill University - 4.09.2019
Child Psychiatric Emergencies McGill University - 4.09.2019
Health and Safety on Mission - Stress and Substance Abuse final-1
Health and Safety on Mission - Stress and Substance Abuse final-1
More from Coda Change
0830 CODA-McGain.pptx
This document discusses the environmental impacts of reusable versus single-use medical equipment from a life cycle assessment perspective. It notes that reusable anaesthetic equipment can save a hospital around $100,000 per year compared to single-use equipment. While reusable equipment reduces waste, most medical plastics are still made from fossil fuels like propylene gas. The document advocates transitioning to renewable electricity to power hospitals and manufacturing medical plastics, which could further reduce the carbon footprint of reusable equipment.
0815 Roslyn CODA 22 landscape.pptx
Roslyn Morgan from the Australian Nursing and Midwifery Federation (Vic Branch) spoke on September 12th about decarbonisation in clinical settings. She acknowledged the traditional custodians of the lands and paid respects to Elders past, present, and emerging. Her presentation focused on reviewing processes to reduce waste and encourage reuse in clinical settings in order to lower carbon emissions by millions of tonnes per year through small changes. She provided tools and resources from the ANMF to aid in these efforts.
Nick Watts 1.pptx
In today's #Coda22 podcast, Nick Watts - chief sustainability officer at the NHS - talks about the NHS's response to climate change.
Nick Watts 1.pptx
Nick Watts
In today’s podcast, Nick Watts - chief sustainability officer at the NHS speaks about the NHS's response to climate change.
A Research Perspective with Simon Finfer
As with everything else, ICU management of sepsis should ideally the evidence based. Evidence based practice combines the best scientific knowledge (evidence) with patient preferences and clinical assessment and judgement.
While the pursuit of specific pharmaceutical agents to treat Sepsis has resulted in the expenditure of billions of dollars without producing a single effective agent, much of what we do in the treatment of patience with Sepsis can be evidence based. Clinicians make literally hundreds of decisions day on the management of an individual patient in the ICU, often these decisions are made routinely without a great deal of thought about the reasoning behind them. Every decision made about the treatment of a critically ill patient should be based on evidence or the belief that the action resulting from that decision will improve a patient centred outcome for that particular patient. A patient centred outcome is an outcome that affects how the patient feels, functions or survives meaning we should question every decision we make to ask whether it is going to improve one of those outcomes.
The best evidence on which to base of such decisions comes from large robust randomised controlled trials conducted by unbiased investigators. The last 20 years has seen the emergence and maturing of regional and national clinical trials groups who conduct such studies and increasingly collaborate with each other. (2) Such collaboration is often essential to perform studies large enough to provide evidence to guide clinical practice such collaboration is often essential to perform studies large enough to provide evidence to guide clinical practice. As someone who designs and contacts clinical trials I am well aware that they provide evidence on a population basis. Each trial result is the net of harm and benefit resulting from the treatment being studied and even when a treatment is proven to have a net benefit there may be some patients who are harmed by the use of that treatment. A graphic example of this is someone who suffers a massive intracranial haemorrhage when treated with thrombolysis. Causing visible harm to a patient may shake a clinician's faith in an effective treatment making it important that we accept such tragic events without changing our practice to deny that effective treatment to future patients.
Research, like clinical practice, has inherent imperfections. Researchers, like clinicians, need to recognise this and be prepared to put their hand up and admit when they have been wrong. Conducting robust studies of appropriate size in an effective collaborative research group is the best way to avoid being wrong too often!
For more head to our podcast page #CodaPodcast
Early management of sepsis with Emergency Department Nurse Gladis Kabil
Sepsis in other words ‘life-threatening organ dysfunction’ in response to infection is a leading cause of death worldwide and a global health priority recognised by the World Health Organisation. In Australia, for adults with sepsis admitted to the intensive care unit, the in-hospital mortality is estimated as 18–27%. Early recognition of sepsis, prompt administration of antibiotics and resuscitation with intravenous fluids for those with features of hypoperfusion or shock are the mainstays of initial treatment. Emergency departments often being the first point of contact for patients presenting with sepsis, are required to prioritise sepsis as a medical emergency. The “Sepsis Kills” program implemented across the nation aims to reduce unwarranted clinical practice variation in management of sepsis.
In a recent Australian based study conducted across four emergency departments in Western Sydney Local Health District, among 7533 patients with suspected infection, a reduction in risk of in-hospital mortality was observed for each 1000 mL increase in intravenous fluids administered in patients with septic shock or admitted to ICU. However, despite evidence showing mortality benefits, not all aspects of sepsis care have been given the needed attention. In the same setting, out of 4146 patients with sepsis, 45% of them did not receive intravenous fluids in the emergency departments within the first 24 hours. Younger patients with greater severity of illness and presented to smaller hospitals were more likely to receive fluids.
The unanswered questions regarding the facilitators and barriers influencing intravenous fluid administration in sepsis are being explored using qualitative methods. Several emergency physicians and nurses have provided insight into aspects that influence their ability to provide appropriate fluid resuscitation such as constantly overcrowded emergency departments with chronic staff shortages of skilled health professional, failure to recognise sepsis early, the complexity of the presentations and lack of resources. Awareness of these challenges among stakeholders is the need of the hour. Leaving no one behind and not disregarding the critical aspects of sepsis care are crucial. Recognition of these factors and sustainable interventions are necessary to improve clinical outcomes for patients.
For more head to our podcast page #CodaPodcast
Derick_Adigbli.pptx
Introduction to the Sepsis Workshop
"Effective care of critically ill patients with sepsis requires much more than good medical care. In this trans-disciplinary workshop we pay homage to the many specialists involved in caring for patients with sepsis, from pre-ICU admission to post-sepsis recovery.
We will hear from experts from diverse backgrounds and settings including nursing, physiotherapy, speech pathology, medicine and academia. In addition, we are privileged to be joined by a sepsis survivor who will provide us with their own perspective and lived experience.
This workshop will expose evidence and equity gaps across the spectrum of specialists involved in providing sepsis care. We will improve your knowledge and ability to provide holistic patient centred care, with a focus on ensuring no patient or aspect of care is left behind."
For more head to our podcast page #CodaPodcast
Michelle_Paton.pptx
A Physiotherapist Perspective with Michelle Paton
Physiotherapists form a key part of the multi-disciplinary team in the Intensive Care, focusing on both respiratory care and optimisation of function. This talk will discuss the role of physiotherapy across the continuum specifically in the management of an acutely unwell septic patient. I will discuss the focus of a physiotherapy assessment, main treatment aims, some of the barriers for the implementation of physiotherapy in ICU, while identifying strategies to enable appropriate application of physiotherapy techniques.
A Pre-hospital Physician Perspective with David Anderson
Sepsis is a common presentation in the prehospital and retrieval environment, with most cases having a respiratory, urinary or soft tissue origin. However the best practice for identifying and management sepsis in the prehospital environment remains unclear. Despite sepsis having been a priority for in hospital guidelines and protocols for decades now, relatively little attention has been paid to prehospital sepsis management. Traditional teaching is that early antibiotics in sepsis save lives, however trials examining this are observational and confounded by outdated ICU care. An appropriately sensitive and specific tool for the prehospital identification of sepsis remains elusive. NEWS2 is common and lactate-modified QSOFA emerging (although prehospital lactate measurement remains difficult). The role of prehospital antibiotics, and the most appropriate one are also unclear. Most ambulance services that carry antibiotics use ceftriaxone. The retrieval environment is similar, with sepsis probably being the single commonest reason to call a retrieval service.
For more head to our podcast page #CodaPodcast
Amy_Freeman_Sanderson.pptx
A Speech Pathology Perspective with Amy Freeman-Sanderson
Sepsis causes organ and tissue dysfunction in response to severe infection, resulting in significant physical and cognitive morbidities. For patients diagnosed with severe sepsis, admission to an intensive care unit and use of an artificial airway are often required. The sequalae of severe sepsis necessitating critical care can result in significant changes to a patient’s swallowing and communication function. These negative changes and impacts to function can occur during and after a diagnosis of sepsis, and ultimately impact a patient’s health and functional status. The nature and long-term recovery of swallowing and communication function is still to be completely understood; however evidence affirms recovery continues well beyond hospital discharge.
This presentation will focus on tasks we do daily – eating, drinking and speaking. Specifically, the nature of swallow impairments will be described, and the impact of this new disability will be explored from the perspective of the patient’s body structure, function and activities. Core components of swallowing safety and efficiency will be described, alongside the role of assessment and management within and beyond the ICU. Changes to communication including altered voice, speech and language function will be described. Outcomes of altered communication function over the continuum of care during, and after hospital will be explored. The evidence base and the lived experience of sepsis and patient stories will underpin the content delivered in this presentation.
The final aim of the presentation will be to describe and highlight the role of speech pathology, an allied health profession, in the management of swallowing and communication function. Following the workshop attendees will be able to (1) describe the characteristics of swallowing and communication disorders; (2) have knowledge of the impact of these new disabilities; and (3) will be able to describe the role of speech pathology in the healthcare team for the patient with sepsis.
For more head to our podcast page #CodaPodcast
Delivering change now
Healthcare Saves!
Healthcare Pollutes!
Healthcare is responsible for 7% of Australia's carbon emissions, consumes 10% of Australia's GDP, and has numerous other adverse environmental effects.
This talk introduces healthcare's polluting ways, and how clinicians can mitigate their own carbon footprint. Action is the Antidote to Anxiety!
For more head to our podcast page #CodaPodcast
2 weeks: a case from India
2 weeks: a case from India
Ankur Verma opens the podcast by telling his listeners that he’s going to share with them something that happened during the time that Delta was in its dreadful stages in both Australia and India. He goes on to talk about a case that took place during the Delta wave, when minutes matter.
He recounts a patient - Mrs P - who had come in gasping and immediately went into cardiac arrest, and notes that – as is often the case – she immediately became part of the ward’s family. After testing positive for Covid, they then gave her a CT scan to see if she had pneumonia and subsequently put her on various experimental medications, including steroids. She got better over the next four or five days and was weaned off the ventilator and over the next couple of days we removed her TPI (trigger point injection) but then her sugars went up.
Ankur explains that just when he thought she was becoming much better, she started becoming hypoxic again and he then found out her left lung had collapsed. She then went on to improve – and, understandably – her family were thrilled, especially her son. After a two-week rollercoaster ride, she was discharged, much to the joy of everyone involved. At a time of great distress, Ankur explains that Mrs P reminded him and his co-workers of the power of determination and motivation, and it was through a combination of compassion and great determination and motivation that she survived.
He notes that Mrs P gave the hospital staff a ray of hope and a much-needed silver lining during what was an otherwise hellish Covid wave, and notes that he owed her more than she owed him for saving her life.
But, continues Ankur, she had other plans. She had been a ray of hope during the dreadful delta in India and the world and sadly, she died.
But Ankur says that he and his co-workers didn’t lose sight of the vision and the hope that she gave them and that they continued to support each other.
He concludes the podcast with an important lesson learnt: take care of yourself and those around you because when the dark times come, those people will be the ones surrounding you.
1420 Rebecca Szabo.pptx
Bec Szabo – an obstetrician, gynaecologist, and medical educator – begins the podcast by asking the audience to go back to Melbourne with her on a journey through the looking glass. She notes that while taking her listeners to Wonderland might be a bit quirky, but that it’s essential for the point of the story. Bec also wants to preface the talk with a trigger warning; and acknowledges that the subject matter of her talk might be triggering – so please do bear in mind that this talk covers Covid, ICU and pregnancy before listening.
As per the notion of taking her readers through the looking glass, Bec wants to take listeners back to spring 2021 – a time that Melbourne was looking down the barrel of a sixth lockdown. Known as having had one of the longest – and strictest – lockdowns in the world - people in Melbourne were tired and had done a lot. Many were already vaccinated.
Bec then goes on to say that she wants to talk about Covid and pregnancy and, explains to listeners that she wants to paint a picture of inequality and sexism.
She runs through a case of what happened shortly after the Delta strain had arrived in Melbourne – it was a time when things were changing rapidly during covid with delta things came thick and fast. A pregnant woman was admitted to hospital; it was her third child, and her two toddlers, partner and parents were all sick with Covid; and despite concerns over a post-partum haemorrhage, a healthy baby was delivered, and the woman went back to the ICU.
Except, says Bec, this wasn’t what actually happened; what she described was a simulation, carried out in order to ensure they had everything prepared in the case that something similar happened.
She goes on to say that teamwork and communication are everything, but so too is listening to the voice of the patient. And that while we’ve heard that belonging and community and connection are important, having those values and shared goals to keep us doing what we’re doing.
Bec closes the podcast by that we need to remember we’re the captains of our soul. And that if we can be human and kind, we can deal with emotionally fraught situations.
For more head to our podcast page #CodaPodcast
Is Burnout Burning Us Out?
In this week’s podcast Liz Crowe – an advanced clinician social worker who has worked in Brisbane’s major children’s hospitals in intensive care, emergency departments and cancer wards - begins the podcast with the question – is all this talk of burn out, actually making us burnt out?
In this podcast, Liz goes on to address exactly what the term burn out actually means and discusses how the literature on burnout in healthcare workers is prolific. She discusses how healthcare presents as an occupation of high risk, distress, and despair, with an escalation of risk post pandemic. Yet, she says, burnout is not the whole story even though it is the only story being told. Liz speaks about the extensive research into burnout and what it reveals, and the risk factors for burnout, which include excessive workload, lack of control or recognition, mismatch of values, lack of meaning and emotional contagion. However, she notes that none of these are individual deficits and says that it is concerning that ‘wellbeing’ in healthcare is never discussed in terms of meaning making, purpose, contribution, community, stimulating work or growth and development.
Yet, she goes on to say, for many critical care staff these positive factors for wellbeing are found in abundance.
Liz also states that her research shows that people want to believe that the bad stuff happens on one side of life; the good on the other, and people want to know how they get to the other side. Whereas, she says, in reality, life is a crappy mess that sits somewhere in the middle.
The podcast concludes with Liz stating that purpose and community are everything, that life is messy, but some days - despite how awful we feel - we soar because of the opportunities we have. She encourages listeners to savour life, and to remember that even on the worst day of their working life, their patients are doing it tougher.
For more head to our podcast page #CodaPodcast
4 Seconds: A Case from Afghanistan
"Death is not the enemy but occasionally needs help with timing."
Peter Josef Safar (1924 – 2003) 'The Father of Modern CPR'
In this week’s episode of the Coda podcast, former flight paramedic Gary Berkowitz – who previously worked in Afghanistan and now works for Queensland Ambulance Service - explores how when death is inevitable, the way of dying matters.
To open the discussion, he addresses the fact that out of hospital emergency care practitioners are often faced with time critical decisions. He notes that fortunately, most of these situations often have clear guidelines because – generally speaking - they follow pathways with expected outcomes.
When it comes to ethics in healthcare, however, it can be a nuanced topic. For example, the decision to not commence resuscitation, or to withdraw life saving measures in a patient who appears to have no meaningful prospect of recovery, can be a difficult one. Gary goes on to note that in this environment, it’s impossible to design a guideline that could encompass all the elements of such a complex decision.
In this talk Gary examines providing care to patients rather than always trying to fight death. By way of example, Gary tells listeners how he was working closely with the various western military forces, when one day they asked a favour – a young Afghani soldier had been badly burnt fighting against the Taliban, and while his treatment had begun in a military hospital, it was decided it shouldn’t be continued there.
Gary was asked if he could assist transporting the soldier to a hospital in the city, and he goes on to talk about the fact that he had two options – to take the easy choice, which would have involved giving the soldier enough medication that he wouldn’t have to see him suffer; or the brave choice – which would have been to give him enough medication so he wouldn’t be suffering at all.
He discusses the ethics around each alternative – and how he came to sit with his final choice. Gary notes that the decision he made that day has remained with him ever since, and continues to influence his decisions in his everyday practice.
For more head to our podcast page #CodaPodcast
Prehospital resuscitation of TBI
In this podcast, Marty Nichols talks us through managing patients with TBI in a prehospital environment. This involves avoiding hypoxia and hypotension, ensuring a safe transportation and getting to the right treatment centre the first time.
Top 10 Critical Care Papers of 2020
- A cluster crossover RCT of 6 US PICUs found that limiting duration of patient care shifts to <16 hours (versus >24 hours) increased serious medical errors and unintended consequences from increased workload.
- An RCT of 168 ICUs across 15 countries found no difference in mortality or RRT dependence between an accelerated versus standard strategy for initiating RRT in patients with AKI, but the intervention group had more hypotension and adverse events.
- An RCT of early ECMO versus standard ACLS in 30 patients with refractory VF found lower hospital mortality in the intervention group, but the study was conducted at a single highly invested center and may not be generalizable.
Advanced support of Acute Liver Injury
From CodaZero Live, Alex Rowell reviews the available advanced liver supports for patients with acute liver failure.
Artificial supports for the liver are quite complex and difficult. This is largely due to the liver's complex function.
Some of the advanced liver supports include CVVHDF, Molecular Adsorbent Recirculating System (MARS), Single Pass Albumin Dialysis (SPAD) and high volume plasma exchange.
In this podcast, Alex takes us through the research and evidence for these supports and shares some guidance on when they should be used.
CVVHDF is familiar and effective but we need to remember to use it early with acute liver failure patients.
Furthermore, Molecular Adsorbent Recirculating System (MARS) is widely studied but unfortunately not available in all places.
Single Pass Albumin Dialysis (SPAD) is easily implemented. Although there is less evidence on SPAD, it is generally agreed to be an effective support.
Unfortunately, there are no mortality benefits in any of these supports. They are however, useful tools in bridging to transplant.
From #CodaZero tune in to a quick, sharp & informative talk by Alex Rowell on Acute Liver Injury.
Surgical considerations in the injured spine patient
This document discusses the surgical management of a patient with injuries to the spine and chest from a traumatic accident. The patient had a burst fracture at L2 with fragments in the spinal canal, as well as transverse process fractures from L1-L3 and injuries to the right chest including broken ribs and lung damage. The surgical procedures performed included fixing the broken ribs in the chest, removing the bone fragments in the spinal canal from L1-L2, fusing the spine from T11 to L4 with internal fixation, and placing an expandable interbody cage at L2. The patient had a lengthy recovery but was eventually able to walk with a stick after six months.
Echo in Cardiac Arrest
Echo in Cardiac Arrest by Behny Samadi
From #CodaZero Live, Behny explains the importance of Echo and lists some of the ways in which Echo can help us during a cardiac arrest. It is more than we think!
Echo is a quick, easy and simple tool, making it invaluable in many situations including cardiac arrests.
It is a bedside test that is non invasive and painless for the patient. It is easily taught to any doctor or nurse and done in real time at the bedside. It can be used to guide and inform management and treatment... so why isn't everyone embracing Echo?
Behny challenges us to consider another bedside tool which compares to the effectiveness and usefulness of Echo.
Furthermore, in the chaos of cardiac arrests, Echo can help to exclude some of the 4Hs & 4Ts. It can help to check the rhythm, check the quality of compressions and assess for post-resuscitation care.
It is an invaluable tool in managing patients suffering from cardiac arrest.
Behny suggests that the focused 2D echo is our generations stethoscope. We need to open our minds and embrace the capabilities of Echo and challenge each other to learn how to effectively utilise this tool in times that matter.
Tune in to a fascinating podcast by Behny Samadi on the value of Echo in Cardiac Arrest.
As a self-confessed Echo enthusiast - Behny is here to share her knowledge on the benefits of Echo.
For more like this, head to our podcast page. #CodaPodcast
More from Coda Change (20)
Early management of sepsis with Emergency Department Nurse Gladis Kabil
Early management of sepsis with Emergency Department Nurse Gladis Kabil
A Pre-hospital Physician Perspective with David Anderson
A Pre-hospital Physician Perspective with David Anderson
Surgical considerations in the injured spine patient
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This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
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End-tidal carbon dioxide (ETCO2) is the level of carbon dioxide that is released at the end of an exhaled breath. ETCO2 levels reflect the adequacy with which carbon dioxide (CO2) is carried in the blood back to the lungs and exhaled.
Non-invasive methods for ETCO2 measurement include capnometry and capnography. Capnometry provides a numerical value for ETCO2. In contrast, capnography delivers a more comprehensive measurement that is displayed in both graphical (waveform) and numerical form.
Sidestream devices can monitor both intubated and non-intubated patients, while mainstream devices are most often limited to intubated patients.
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TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - ...
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原版定制【微信:bwp0011】《(uofm毕业证书)美国密歇根大学毕业证学位证书》【微信:bwp0011】成绩单 、雅思、外壳、留信学历认证永久存档查询，采用学校原版纸张、特殊工艺完全按照原版一比一制作（包括：隐形水印，阴影底纹，钢印LOGO烫金烫银，LOGO烫金烫银复合重叠，文字图案浮雕，激光镭射，紫外荧光，温感，复印防伪）行业标杆！精益求精，诚心合作，真诚制作！多年品质 ,按需精细制作，24小时接单,全套进口原装设备，十五年致力于帮助留学生解决难题，业务范围有加拿大、英国、澳洲、韩国、美国、新加坡，新西兰等学历材料，包您满意。
【业务选择办理准则】
一、工作未确定，回国需先给父母、亲戚朋友看下文凭的情况，办理一份就读学校的毕业证【微信bwp0011】文凭即可
二、回国进私企、外企、自己做生意的情况，这些单位是不查询毕业证真伪的，而且国内没有渠道去查询国外文凭的真假，也不需要提供真实教育部认证。鉴于此，办理一份毕业证【微信bwp0011】即可
三、进国企，银行，事业单位，考公务员等等，这些单位是必需要提供真实教育部认证的，办理教育部认证所需资料众多且烦琐，所有材料您都必须提供原件，我们凭借丰富的经验，快捷的绿色通道帮您快速整合材料，让您少走弯路。
留信网认证的作用:
1:该专业认证可证明留学生真实身份
2:同时对留学生所学专业登记给予评定
3:国家专业人才认证中心颁发入库证书
4:这个认证书并且可以归档倒地方
5:凡事获得留信网入网的信息将会逐步更新到个人身份内，将在公安局网内查询个人身份证信息后，同步读取人才网入库信息
6:个人职称评审加20分
7:个人信誉贷款加10分
8:在国家人才网主办的国家网络招聘大会中纳入资料，供国家高端企业选择人才
【关于价格问题（保证一手价格）】
我们所定的价格是非常合理的，而且我们现在做得单子大多数都是代理和回头客户介绍的所以一般现在有新的单子 我给客户的都是第一手的代理价格，因为我想坦诚对待大家 不想跟大家在价格方面浪费时间
对于老客户或者被老客户介绍过来的朋友，我们都会适当给一些优惠。
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Psychological Management of Burns
- 1. The University of Sydney Page 1 Psychological Management of Burns A/Prof Caryl Barnes Senior Staff Specialist Consultation Liaison Psychiatry Royal North Shore Hospital, St Leonard's, Sydney Course Coordinator Masters in Medicine (Psychiatry) Brain and Mind Center
- 2. The University of Sydney Page 2 Are Burns Accidents?
- 3. The University of Sydney Page 3 Are all Burns Traumatic? Types of Trauma 1. A single isolated event involving survival/integrity threat to self or witnessed other. 2. Cumulative trauma -An accumulated set of circumstances or events that an individual is exposed to- repeated single events. 3. Complex trauma -trauma is relational and often occurs early in development: (chronic) complex trauma 4. Massive trauma in the form of violence, terrorist acts, wars, deprivation, torture, natural disasters, forced migration, slavery
- 4. The University of Sydney Page 4 Traumatic Stress Pre-Trauma variables How to define trauma ? Subjective experience vs objective reality Perception of threat to self or others Embodied experience of threat Attribution of meaning to events Post Trauma Variables
- 5. The University of Sydney Page 6 Why is identifying mental health condition or trauma disorder important? – Burns survivors who demonstrate symptoms of mental health conditions (including depression, stress, anxiety) and trauma post-burn often have: – increased hospitalisation times, – reduced adherence to treatment – Increased long-term issues including poorer adjustment 1 – Trauma responses can interfere with many aspects of physical and psychological recovery ( which may worsen over time).2 – Severe and sub-threshold distress have been observed to have worsening distress at 2-years post- burn – Patients who demonstrate PTSD symptoms during hospitalisation also have poorer recovery trajectories 3 Refs: 1 Fauerbach JA et alJ Burn Care Rehabil,2005, 26 (1) 21-32, 2Mason ST et al J Burn Care Res, 31 (1) (2010), pp. 64-72, 3 Sveen J et alJ Trauma, 2011, 71 (6) 1808-1815,
- 6. The University of Sydney Page 7 Ref: Porges SW The polyvagal theory: phylogentic substrates of social nervous system Interj Psychophysiology 2001, 42 (2), 123-146 REST & DIGEST SHARE & CARE
- 7. The University of Sydney Page 8 Phases of Burn Managemen t Acute Recovery/Healing Resolution/ Rehabilitation
- 8. The University of Sydney Page 9 Phase 1 Acute :Management issues Medical Psychological Social Shock Pain Delirium (30-70%) (can include psychotic symptoms- visual/ auditory hallucinations) Acute stress symptoms (Reliving events, poor sleep, high arousal) Pain Anxiety Family crisis “ loss and fear”
- 9. The University of Sydney Page 10 Phase 1 Acute: Management problems Patient Staff role Delirium Pain Anxiety Denial Withdrawal Anger Regression Explanation/ Normalization Sick role support Supportive Reality testing Q: Frequent question to Psychiatry – Is it excessive? + Why?
- 10. The University of Sydney Page 11 ACT for Trauma – ACE A: Acknowledge your thoughts and feelings C: Come back into your body E: Engage in what you’re doing A: Acknowledge your thoughts and feelings Ref: ACT Mindfully Dr Russ Harris
- 11. The University of Sydney Page 12 Dropping Anchor/Grounding GettyImages
- 12. The University of Sydney Page 13 Phase 3: Resolution and Rehabilitation Management issues Medical Psychological Social Slow maturation of scars Rehabilitation of function Reconstructive surgery/ revisions Resolution of loss and acceptance of: • Body image change • Functional change Re-integration into: • Work • Social • interpersona l life
- 13. The University of Sydney Page 14 Predictors of Outcome – Source of self esteem – Good prognostic indicators • Altruism • Empathy • Courage • Perseverance – Less helpful • Physical attractiveness, physical prowess, need for social acceptance – Burn site – Hidden > Exposed – Face/ hands poor influenced by source of self esteem – Social support – Engaged , visiting, empathic families, ‘non blaming’ outlook, stable social economic circumstances – Burn circumstances – Accident/ Negligence – Interaction Personality/ interpretation = MEANING Ref: Oster C, Sveen J The psychiatric sequelae of burn injury Gen Hosp Psychiatry, 36 (5) (2014), pp. 516-522,
- 14. The University of Sydney Page 15 Ref: Cleary M et al Before, during and after: Trauma-informed care in burns settings Burns, 2020.46 (5) 1170-1178
- 15. The University of Sydney Page 16 Caryl.barnes@health.nsw.gov.au