The term Hepatitis simply means "inflammation of the liver," and can be caused by anything that irritates the organ, from excessive alcohol use, to infection. Hepatitis C is a viral infection of the liver, in many ways similar to Hepatitis B.
Hepatitis C is a contagious disease, and is spread by blood contact with an infected individual. The disease process begins with an acute phase, starting 6 weeks or so after exposure. This stage lasts up to about 6 months. This stage consists of fevers, tiredness, abdominal pain, nausea, vomiting, and jaundice (yellowing of the skin.)
Most people with acute infection will then move into a second stage, chronic Hepatitis C. This stage has minimal outward symptoms, but causes long term problems like progressive liver damage, and cancer. It is certainly possible to be infected with Hepatitis C and not know it.
Perhaps 30,000 people per year are diagnosed with acute Hepatitis C, and it is estimated that about 3 million have chronic Hepatitis C.
At risk individuals are IV drug abusers, dialysis patients, and older populations, as well as health care workers.
There are some new treatments for chronic Hepatitis C, and acute Hepatitis C victims who receive treatment are at reduced risk of chronic infection. Unfortunately, there is currently no vaccine to prevent Hepatitis C.
Hepatitis C, and other common blood-borne infections are covered in AHA's Bloodborne Pathogen course. Contact us to arrange a course for your office.
Author: Scott Carpenter
Image Credit: BruceBlaus (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons
"Carpenter [CPR] Solutions made learning CPR enjoyable and fun, but [also] by the end our group felt well prepared. He was knowledgeable, relaxed and engaging. His knowledge and skill is up-to-date and we had ample time to practice with actual equipment and "dummies". Not only do I recommend getting CPR certification through Carpenter Solutions, but I hope to be able to further improve my skills with Carpenter Solutions." - Katherine E.
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A lot of people have asked me to make a video of my standard ACLS megacode lecture for ventricular fibrillation. Well, here it is! A little rough (sorry, it was spur of the moment!) but it is out there... Hosted on YouTube at the link- https://www.youtube.com/watch?v=qbGZ16S72yg&feature=youtu.be
Epinephrine is the initial drug administered per ACLS protocol to patients in asystole, PEA, and ventricular fibrillation/ pulseless V-tach. For asystole and PEA, it is the ONLY drug indicated, unless specifically treating a reversible cause of arrest (see H's and T's.)
Epinephrine will increase central pressure via alpha agonist effects. The dose, timing and indications for epinephrine use are based on animal studies.
Recent studies question whether epinephrine provides any overall benefit for human patients.
Studies do show that epinephrine for out-of-hospital cardiac arrest will increase the rate of pulse return. The problem is that it doesn't considerably alter longer-term survival. A large Japanese study showed that, despite an increase in pulse return, epinephrine reduces long-term survival (to hospital discharge) and patients who do survive have significantly worse neurological outcomes than patients who did not receive the drug. Perhaps harmful epinephrine-induced reductions in micro-vascular blood flow offset the useful effects of the increase in central circulation.
In a V-Fib or pulseless ventricular tachycardia code situation, epinephrine should NOT be administered until after the second shock (per guidelines) for precisely these reasons. The patient's best chance of a neurologically intact survival is immediate CPR, a shock as soon as available, and two more minutes of uninterrupted CPR. A second shock (followed by epinephrine administration) is only indicated if there is no return of ROSC by that time.
Guidelines do say that it is reasonable to administer epinephrine as soon as practical in an asystole or PEA code, as no shock is advised.
Hagihara A., Hasegawa M., Abe T., Nagata T., Wakata Y., Miyazaki S.; Prehospital epinephrine use and survival among patients with out-of-hospital cardiac arrest. JAMA. 2012;307:1161-1168.
Dumas F, Bougouin W, Geri G, et al. Is Epinephrine During Cardiac Arrest Associated With Worse Outcomes in Resuscitated Patients?. J Am Coll Cardiol. 2014;64(22):2360-2367. doi:10.1016/j.jacc.2014.09.036.
Author: Scott Carpenter
Providers typically use high concentrations of oxygen in ACLS scenarios on a routine basis, and oxygen is frequently considered an adjunct that is advantageous, but this is not always the case. High flow oxygen is a powerful vasoconstrictor, and can actual decrease coronary and vital organ blood flow. This is in addition to many other negative effects of supplemental oxygen (see oxygen toxicity) Oxygen use in critical situations has very limited studies, but the Australian and New Zealand Resuscitation Councils (part of ILCOR) feel that the issue is so important that it has released a set of stand- alone guidelines specifically dealing with supplemental oxygen use.
As a general rule, high flow oxygen should be used during a code, but the decision as to whether to continue oxygenation supplementally after a code, during a stroke, or in association with acute coronary syndrome should be made based on a patient’s oxygen saturation. Oxygen saturations >94% generally require no supplemental oxygen, and placing supplemental O2 may worsen outcomes and INCREASE infarct size! (see: http://circ.ahajournals.org/content/131/24/2101)
American Heart Association guidelines for post-code patients note that the risks of hypoxia are much better known, and suggest that providers err on the side of preventing hypoxia over avoiding hyperoxia. AHA 2015 guidelines of note are in parts 7 and 8 here- http://circ.ahajournals.org/content/132/18_suppl_2
Check out the ANZRC guidelines here: http://www.nzrc.org.nz/assets/Uploads/Guidelines/Adult-ALS/ANZCOR-Guideline-11.6.1-Targeted-Oxygen-Therapy-Jan2.pdf
Author: Scott Carpenter
Image Credit: Häggström, Mikael. "Medical gallery of Mikael Häggström 2014". Wikiversity Journal of Medicine 1 (2). DOI:10.15347/wjm/2014.008. ISSN 20018762. (All used images are in public domain.) [Public domain], via Wikimedia Commons
CPR feedback devices have gained some popularity over recent years. There are several manufacturers and variations, but essentially all CPR feedback devices perform similar functions., They monitor rate - and many monitor depth of compressions to ensure that CPR delivery is consistent with AHA guidelines. The data can also be downloaded in order to assess interruptions and average depth during a code event.
These devices are not cheap. Laerdal, for instance, markets one for $895.
We looked at a few studies aimed at determining whether these devices improve CPR quality during actual cardiac arrests.
In a recent European study, of three different brands of feedback devices, the researchers found that none improved BLS quality during actual code events when compared to standard BLS without devices. Furthermore, placing the devices can cause delay in CPR, potentially creating harmful outcomes.
On the other hand, feedback device maker Laerdal quotes increased survival rates in New York City by over 10 percent after the devices were introduced there. However, these statistics were evaluated in a retrospective data analysis, and there may be other factors at play in increased survival rates during the time period.
Although the AHA advises CPR feedback devices for training purposes, ultimately, the jury is still out as to whether these devices are helpful in an actual code event, which is why the 2015 AHA guidelines state "It may be reasonable to use audiovisual feedback devices during CPR for real-time optimization of CPR performance." Note the equivocal nature of the sentence.
End Tidal Carbon Dioxide Measurement remains THE standard for monitoring CPR quality in patients with an advanced airway.
Author: Scott Carpenter
Adenosine is frequently used in the setting of supra-ventricular tachycardia (SVT), in which a patient has an abnormal pathway allowing electrical activity to re-enter the atria after it has depolarized the ventricles. This family or re-entrant tachycardias (also called AVRT) short circuit the heart's normal pacemaker (the SA node) and cause massive stimulation of the AV node, producing heart rates commonly seen in the 180 (or higher) range.
Adenosine is often thought of as "chemical cardio-version", as when it is given FAST IV push, it's effect is to terminate all cardiac activity for three seconds or so, causing asystole on the monitor. The patient will feel VERY poorly for a short period of time. Generally, upon restoration of cardiac electrical activity, the heart's normal pacemaker, the SA node, will have taken over again, and the patient will be in a normal sinus rhythm.
Adenosine works by hyper-polarizing cardiac cell membranes, particularly in the AV node, making them incapable of firing for a time, and breaking the re-entrant limb of an SVT cycle.
Author: Scott Carpenter
Image Credit: Original art by Monica Murray. Photo by Leisa Marshall. Used with permission.
There has been an increase in local protocols for 911 dispatchers to be able to identify victims in need of CPR based on caller reports, and to coach bystanders in performing CPR until first responders arrive.
Studies show that victims who receive bystander CPR are twice as likely to survive as those who do not receive any bystander CPR until EMS arrives. In order to facilitate this change local emergency response dispatchers must be trained in recognition of arrest based on witness statements and training must take place on efficient ways to coach bystanders in CPR.
These changes began being implemented in the Seattle area in 1982, and have since been started in many communities around the country. That being said, the training and roll out of dispatcher coached CPR is far from universal across EMS systems, despite the evidence.
Another factor is that, although many communities state that they teach dispatcher assisted CPR, few may teach dispatchers to be aggressive in questioning that will lead to coaching the bystander into doing so. Dispatchers also need to know how to give clear, simple instructions, and how to cut through extraneous verbage in order to get the job done.
This addresses the core public health function of assurance, with the linking of the population to care and assurance of a competent public health (dispatcher) workforce.
Two determinants of public health are at play here- the healthcare realm, in which people are linked to appropriate care, and the social environment, where community members can render assistance to those in need with on the spot coaching.
These changes were implemented based on a retrospective study of case results showing increased survival to discharge rates of victims of cardiac arrest when immediate bystander CPR was performed.
MUCH more on "assertively" training dispatchers to identify need for CPR and begin coaching is on page 29-30 here: http://www.resuscitationacademy.com/downloads/ebook/TenStepsforImprovingSurvivalFromSuddenCardiacArrest-RA-eBook-PDFFinal-v1_2.pdf
Author: Scott Carpenter
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