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Journal Entry One: Septic Shock after Acute Pneumonia
On this day a patient was brought into the facility in a critical condition. When we assessed the patient, it was found that the patient was having acute pneumonia. The historical assessment based on the interview with the people who brought him indicated that the patient had been subjected to medication in a previous hospital. We had to administer an antimicrobial therapy using a combination of ertapenem and levofloxacin. The condition of the patient deteriorated in a few minutes and he suffered a septic shock. The case involving this patient was a septic shock after severe pneumonia. The first step in such cases in to restore the respiratory functionality (Saugel et al., 2016). Therefore, the patient was resuscitated and the use of vasopressor intubation and mechanical ventilation restored the balance between systemic oxygen and consumption needs.
Based on the outcome of this case, I noticed that the success of the treatment administered to a patient with acute pneumonia depends on the extent to which the antibiotics could cover the bacterial spectrum (Bodmann, 2015). On the other hand, based on scholarly evidence, when a septic shock occurs among such patients then there is need to consider a step by step intervention (Arabi et al., 2013). However, a combination of the methods meant to restore respiratory functionality is essential and guarantees quality patient outcomes. Furthermore, based on the insights from other experienced professionals in our unit, the septic shock should be handled based on case-specific variations; however, adhering to standards is important.
Arabi, Y. M., Dara, S. I., Tamim, H. M., Rishu, A. H., Bouchama, A., Khedr, M. K., and Kumar, A., 2013. Clinical characteristics, sepsis interventions and outcomes in the obese patients with septic shock: an international multicenter cohort study. Critical Care, Vol. 17, Iss. 2, p. R72.
Bodmann, K. F., 2005. Current guidelines for the treatment of severe pneumonia and sepsis. Chemotherapy, Vol. 51, Iss. 5, pp. 227 - 233.
Saugel, B., Huber, W., Nierhaus, A., Kluge, S., Reuter, D. A., and Wagner, J. Y., 2016. Advanced Hemodynamic Management in Patients with Septic Shock. BioMed Research International, 8268569.
Journal Entry Two: Emergency, Triage, and Assessment
Food poisoning is among the numerous conditions that are presented at the emergency department depending on the severity of the case. A case involving three children in critical condition was presented at the hospital after a suspected food poisoning. Based on the narration of the parents the children started complaining of an acute headache, high fever, and later they started vomiting. It was necessary to assess the children to determine who required immediate intervention. Therefore, I checked whether any of three children exhibited respiratory distress, shock, or possibility of coma based on in physiological imbalance they depicted. I noticed that one of the children had started showing respiratory distress and obstructed breathing since the child had stridor. We considered this child as an emergency case while the other two as a priority case.
Based on the experience of this case involving three children, I realized that triage plays a critical role when seeking to enhance patient outcome at the emergency department. Effective assessment of patients presented at any health facility enables the practitioners to determine whether a case is an emergency, priority, or non-urgent (Richardson, Braitberg, and Yeoh, 2014). The major concerns and indicators based on clinical guidelines include the assessment of the airway, breathing, circulation, and dehydration (Bruijns, Wallis, and Burch, 2008). However, it is important to conduct a comprehensive evaluation especially when assessing children. Such a consideration will ensure that children requiring immediate attention are given priority for emergency treatment (WHO, 2008).
Bruijns, S. R., Wallis, L. A., Burch, V. C., 2008. A prospective evaluation of the Cape triage score in the emergency department of an urban public hospital in South Africa. Emerg Med J., Vol. 25, pp. 398-402.
Richardson, J. R., Braitberg, G., Yeoh, M. J., 2014. Multidisciplinary assessment at triage: a new way forward. Emerg Med Australas., Vol. 16, pp. 41-46.
WHO., 2008. Manual for the health care of children in humanitarian emergencies: Triage and emergency assessment. World Health Organization.
Journal Entry Three: Emergency Case of a Hypertensive Patient with Cushing Syndrome
On this day, a patient was brought to the hospital in a critical condition. The patient was unconscious, the pulse was extremely weak, and was sweating. Based on the signs that we identified, an immediate intervention was needed. We had to perform basic life support measures while evaluating the heart rhythm. Since the response of the patient was poor, we had to consider advanced cardiac life support where the patient was intubated. After about an hour of alternating mild to vigorous cardiac intervention, the pulse rate started to improve and the patient regained consciousness. The historical assessment indicated that the patient had Cushing Syndrome.
Based on this case I learned that effective treatment and management of cardiovascular emergencies depends on the condition and assessment outcomes. The American Heart Association requires practitioners to follow four major steps. The first consideration is to activate EMS, followed by basic life support (CPR). The doctors are then excepted to evaluate the pulse rate and in case there is a limited response or positive change, then advanced cardiac life support should be considered (Go et al., 2013). However, based on this scenario it was necessary to consider the quality of circulation, followed by airway assessment and breathing efficiency. I also learned that the American Heart Association also revised their guideline to set circulation as the first evaluation that practitioners should examine for cardiovascular emergency cases. Nevertheless, the historical and risk factors should be part of the diagnostic process when seeking to enhance patient outcome and reduce instances of repeated unconsciousness (Berg et al., 2004; Sheats et al., 2005).
Berg, R. A., Hilwig, R. W., Ewy, G. A., and Kern, K. B., 2004. Pre-countershock cardiopulmonary resuscitation improves initial response to defibrillation from prolonged ventricular fibrillation: A randomized, controlled swine study. Crit Care Med, Vol. 32, pp. 1352-1357.
Go, A. S., Mozaffarian, D., Roger, V. L., et al., 2013. On behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2014 update: A report from the American Heart Association. Circulation, Vol. 129, pp. e28-e292.
Sheats, N., Lin, Y., Zhao, W., Cheek, D. E., Lackland, D. T., and Egan, B. M., 2005. Prevalence, treatment, and control of hypertension among African Americans and Caucasians at primary care sites for medically under-served patients. Ethn Dis, Vol. 15, pp. 25-32.
Journal Entry Four: Severe Headache and Neurological Assessment
While attending to a patient with a severe headache I noticed that there is a need for comprehensive analysis of neurological emergency cases within the shortest time possible once the patient arrives at the hospital. Clinical recommendations also ascertain a similar postulate (Haut, Veliskova, and Moshe, 2004). In this case that we handled, a middle-aged man was brought to the hospital after complaining an acute headache that persisted even after pain relievers and antibiotic interventions. we assessed the patient and noticed that the pulse rate, body temperature, respiratory rate, and blood pressure was high. The patient depicted abnormal consciousness and could not stand or walk. The neurological assessment indicated the need for an immediate radiology evaluation.
As the patient was undergoing radiology examination we had to check any related background risk factors and conditions. Some of the key factors that we were looking for included possible exposure to excessive heat, animal bites, arboviruses, neurocysticercosis, and drug abuse. However, the family members ascertained that the patient was an employee at a fertilizer plant. While the radiological results did not indicate any potential growth or constriction due to thrombosis, excessive exposure to chemicals or excessive heat remained as the major and potential causes.
I was informed that when handling neurological cases, it is important to consider a variety of potential causes as opposed to the limited elements that I had included in my evaluation list (Kothari et al., 1999). Other factors such as recent immigration from developing states should also be considered since cases of neurocysticercosis and fungal meningitis cannot be ruled out. In fact, the available neurological emergency guidelines include recent vaccination, transplantation, and aids as part of the assessment hallmarks that practitioners should observe. A comprehensive patient assessment determines the nature of neurological intervention and outcomes (Fitch and Beek, 2007).
Fitch, M. T., and Beek, D., 2007. Emergency diagnosis and treatment of adult meningitis. Lancet Infect Dis., Vol. 7, Iss. 3, pp. 191-200.
Haut, S. R., Veliskova, J., Moshe, S. L., 2004. Susceptibility of immature and adult brains to seizure effects. Lancet Neurol., Vol. 3, Iss. 10, pp. 608-617.
Kothari, R., Jauch, E., Broderick, J., Brott, T., Sauerbeck, L., Khoury, J., et al., 1999. Acute stroke: Delays in presentation and emergency department evaluation. Ann Emerg Med., Vol. 33, Iss. 1, pp. 3-8.
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