Critical care nursing Essay Example | Topics and Well Written Essays - 1500 words

Critical care nursing - Essay Example The drugs prescribed demonstrate that the endeavor was to keep her blood pressure within normal limits, to keep her cholesterol levels in check and prevent any further cardiovascular complications, primarily as a measure to reduce the risk of a heart attack (NIH). The prescribed drugs are standard regimen to keep the blood thin, control blood pressure and reduce hyperlipidemia. However, 5 days post-discharge, the woman was presented again at the emergency department with the primary complaint being that of sudden onset of breathing difficulty. According to her husband’s statement, the woman had probably forgotten to take some of the prescribed medication, had undergone stress due to current heat wave, and had exerted herself while making preparations for the ensuing Christmas celebrations. Vital signs as registered on arrival at the emergency facility included a respiratory rate of 28, heart rate of 130 suggestive of rhythm sinus tachycardia, a B.P. of 140/100, oxygen saturati on of 94% on 6 litre oxygen via facemask and a capillary refill value greater than 3 seconds. On palpation her skin felt cold as well as clammy. Upon lung auscultation, bilateral fine crackles were discernible. Immediate treatment recommended and provided at this stage was in the form of GTN (Nitroglycerine) infusion and an IV diuretic, frusemide at a dose of 40 mg after which she was shifted to the ICU. In the ICU, sinus tachycardia was observed along with a HR (Heart Rate) of 133. ECG (electrocardiograph) revealed resolving acute anterior septal myocardial infarction with present Q wave. She had marked hypotension with a value of 85/70 and JVP was estimated at 6 cms above the sternal angle. Echocardiography revealed an ejection fraction of 50% with poor diastolic filling. Respiration was shallow and tachypnoeic with a RR of 35. Despite a supplement of 10L/Nonbreathing mask oxygen therapy, she continued to maintain poor oxygen saturation at 80-90%. Her pain score was determined as 5/10 and the urine output was 200mls. GTN infusion was discontinued and she was put on dobutamine at a dose rate of 500 mg/100 mls in 5% dextrose titrated to a MAP of 70 mm Hg. Mask CPAP was initiated. The woman’s age, BMI and the clinical symptoms presented clearly show that she is at a clear risk of a sudden onset heart attack which has occurred according to her presented symptoms on admission at the emergency facility. Such acute heart failure syndromes (AHFS) are a recognized reason for the high rise of cases needing hospitalization over the last few decades due to rising incidence of lifestyle diseases (Coons et al, 2009). The risk of mortality is high in such cases and therapy has to be instituted immediately. The above patient’s history, signs and investigative laboratory scores clearly show that she is suffering from acute onset heart failure. Her low BP (85/70), evidence of sinus tachycardia (HR 133), poor diastolic filling suggestive of reduced left ventricul ar ejection fraction (LVEF), low RR (35) and poor oxygen saturation despite artificial support are clear markers for her diagnosis (Coons et al, 2009). Although the above signs are sufficient for establishing diagnosis of AHFS, it has been suggested that newer diagnostic markers such as cardiac troponin and B-type natriuretic peptide levels can assist in establishing a positive diagnosis and should be employed (Pulkki et al,

Answers on history (Liberalism, State Sovereignty, Marxism, The Cold Essay

Answers on history (Liberalism, State Sovereignty, Marxism, The Cold War) - Essay Example One of the questions the paper deals with is liberalism. The term liberalism has its roots in the Age of enlightenment in the eighteenth century. The intellectual and philosophical developments of that age aspired towards governmental consolidation, centralization and primacy of the nation-state, and greater rights for common people. . Its core was a critical questioning of traditional institutions, customs, and morals. The topic modern liberalism is so wide and consists of political, economical, cultural, and social aspects. It emphasizes the rights of individual and equality of opportunities and freedom of thoughts and the freedom of expression of ideas. Enlightenment thinkers believed that systematic thinking might be applied to all areas of human activity. Its leaders believed they could lead their states to progress after a long period of tradition, irrationality, superstition, and tyranny which they imputed to the Middle Ages.

A Black Cloud Essay Example for Free

A Black Cloud Essay The heart is an organ of fire, filled with intense love and intense hatred. Yet it is the hatred which entwines the lives of people causing them to display acts of violence and cruelty. Hatred is displayed through forms which include: prejudices towards large groups of people, crimes of hatred being committed, and indirect hatred which involves hurting others as an act of rebellion against someone or something. Throughout history, the world has been afflicted by the prejudices of powerful leaders who in turn took their animosity out on large masses of people. Adolf Hitler, the leader of Germany during World War II, is a prime example of this. He took his hatred out on the Jews, forcing them into concentration camps. Another group that is a target of hatred are the blacks. The Ku Klux Klan, otherwise known as the KKK, possess intense hatred for the black race. Their hatred is demonstrated by marching in white cloaks in protest and also by burning the churches and neighborhoods of blacks. Just as Hitler and the KKK express hatred, the Skinheads are yet another group which have strong prejudices. See more: Basic Economic problem of Scarcity Essay These so called Skinheads abominate most races other than their own. White hooded silhouettes, German Soldiers echoing Hail Hitler! , and the infamous Skinheads are harsh reminders of hatred which exists throughout the world. In the same way that prejudices of large groups of people are expressed, hate crimes are committed to demonstrate acts of hatred. Most recent are the burning of black churches across the South. A crime of this sort shows hatred against the black race. Sometimes leading to manslaughter, racial tensions are abundant. Furthermore, the burning of crosses or flags are offensive crimes that are committed to show a persons hatred for religion or the government. Spousal abuse, child abuse, homicide, and wars between races can only be acts of one thing: hatred. Newspapers are filled with page after page of stories revealing the immense amount of hatred that our society possesses. Although crimes are committed to show hatred directly, there are other crimes which can also show hatred but in ways that are indirect. Think back to the Oklahoma City Bombing; it is a perfect example of indirect hatred. This is true because the motive of the bombers was to attempt to take revenge on the government, but instead the bombers took the lives of innocent people who were in the building. Moreover, the Empire State Building gunmans plan was to take revenge on his bitter enemies, who he blamed for making Palestinians homeless , according to a handwritten note he carried. Instead, one tourist was killed and five others were hospitalized in this attempt. Innocent bystanders, who are at the wrong place at the wrong time, are the ones who suffer most from acts of indirect hatred. A black cloud stifles society, suffocating the lives of people, causing pain and suffering. The eyes of mankind are blinded: unable to see passed prejudices. Generations carry the preconceptions of the ones before. Society needs to see the light and learn to accept.

Mark Zuckerberg Management Style

Mark Zuckerberg Management Style Managers of an organization need multiple skills to perform their duties and act consequently. Their job is assorted and complex. A research by Robert L. Katz, he found that the managers need three essential skills: conceptual, human and technical in order to perform the four management functions; planning, organizing, leading and controlling. According to Forbes Magazine, Mark Zuckerberg, the founder of phenomenon Facebook and one of the youngest billionaire ever share the ability of great conceptual skills. Conceptual skills are thus said to be one of the crucial of all managerial skills. Managers with conceptual skills are able to see the organization as a whole, to conceptualize about abstract and complex situationsÂÂ ´ (Robbins, S., Coulter, M. 2005) and to think strategically. Conceptual skills stands out from others skills that required by a manager as the ability to use information to solve organizational problems, identification of opportunities, implementing solutions and selecting critical information from masses of data to direct the organization in the world of overflowing information. He should be able to agonize the problem areas and enforce solutions selecting critical information from masses of data, understand the business. Mark Zuckerberg has managed the facebook quite efficiently and has put the doubts of many people to rest. He uses to prepare the organization for the contingent events in the rapid changing environment. He recognizes problems, identify opportunities and implement solutions. He maximizes the use of information, ideas and concepts. Simultaneously with conceptual skills he uses other skills such as human and technological skills which it is necessitates organization to achieve its goals effectively and efficiently. Human skills, being controversially regarded as the most important set of skills have always been the root of all skills. Conceptual skills is not all that are required by a manager but it is a combination of competencies in various skills which conceptual, human and technical skills jump out from others to be more vital. Top managers use conceptual skills while making a decision since it affects the entire organization. He needs human skills which involve the ability to work well with other people both individually and in groups. Being chief executives officer he should look for to motivate the employers of the organization. Human is the most important asset of an organization and human (interpersonal) skills are regarded as the most important set of skills for a manager in todays competitive environment. Creating culture, building the senior management team, financing road shows and indeed, the delegation itself is done by Mark Zuckerberg. In Facebook, Mark Zuckerberg plays an extensive role in the decision making process. In the organization he deeply and inextricably involved with every major decision that it undertakes. He uses to negotiate and help the subordinates and rest of the employees to produce new ideas and make the final decision. He usually focuses on the technological side and innovation. He plays quite big interpersonal role in the general public by giving speeches and talking in the conferences. He uses to give information to the outsiders through the meetings and speeches conducted by facebook. Besides this he use to visit certain sessions and interact with other business managers and sign the business documents. During such interaction he asks the Sheryl Sandberg COO formerly via president of Google chief of staff for the U.S to assist him and offer some guidance. In general Mark Zuckerberg plays extensive role in all informational, interpersonal and decisional roles in the facebook which allows and makes it to be the leading social media today. (583 words) Q2) Discuss the various dynamics of the external environment Facebook presently operates in. What do you see and understand as real challenges Facebooks management team must grapple with in the days ahead if the company is to succeed in its mission to connect the whole planet? The only thing that would not change in the world is: the world is kept on changing. Although Facebook currently rank as the top social networking sites in terms of revenue and number of users, they still have to persist in innovating to hold on the honor. Facebook always encourage their users to share information public to offer better product to users, marketers and developers who wants to reach them. When so much of data is publish online, it can be a threat to Facebook. It forced by Canadian privacy commissioner to make changes to privacy changes and streamlined permissions dialogue. Just as estimated, Facebook confront disputation on privacy issue after the security researcher Wednesday once Beacon is launched. There are more than 100 million Facebook users personal information is being used or spread out to the public without users authorization. This issue is not just about data leakage for user but also for developers and marketers who uses Facebook as a tool to operate their business. Beacon is a platform which takes data from 44 web destinations and mashes it up with Facebooks internal information to help build more focused advertising messages. It was a system which allowed third parties site being posted on the wall of the users profile. People found out that it actually tracking every single thing people done online even they had logout their Facebook account. Facebook data leakage which disclosed by Wall Street Journal is said to be unintentionally. Press coverage and European Commission have their investigation on their own. The Beacon platform had breached the federal wiretap and video-rental privacy laws. A federal judge on Wednesday approved a $9.5 million settlement to a class action lawsuit challenging Facebooks program that monitored and published what users of the social networking site were buying or renting from Blockbuster, Overstock and other locations. (David Kravets) Under the settlement, Facebook agreed to terminate Beaon platform s tarted from November 2009. Facebook should provide a more user friendly privacy settings for the user to avoid the issue above to happen again. A table containing Top 30 countries with highest number of Facebook users was shown in appendix. Data is updated to 1st of April 2011. The table indicate the number of users is increasing tremendously every year. The figure 154,226,960, is the numbers of users in USA which is surprisingly high and own the first place in the ranking. Although China and India has the largest population in the world but India only own the fifth place at about 22,956,220 users. However, a statistic updated on 6th May 2011 indicates that India is the leading country which owns the highest audience growth rate. It is strange that China is not in the ranking, because Facebook is being banned by China. In the New Era of Management ninth edition by L. D. Richard predict that China will overtake United State economy as number one by midcentury. Unfortunately, China banned FB really bring down a lot registration and opportunities to generate profit. Without China, FB was like losing one of his leg or hand. Chin a Mainland population which is about 1,330,141,295 (July 2010 est.) [Source: CIA World Factbook, Jan 2011 ] China government always being tight to the access of internet, information flow and media censored Facebook because of the fatal riots happen in western region of Xinjiang in province of China. Perhaps they believe that such an action will contain the reports or discussions of the riots or stop them from happening completely. News updated on 28th April 2011 said that, Mark Zuckerberg still wanted to get connected to China and is now creating some sort of localized version of site to fit Chinas government and hope to launch it in China. (622 words) Q3) How would you describe and classify the corporate culture at Facebook? What are the elements and symbols that showcase FBs culture? In this context, how effective is Mark Zuckerberg as a cultural leader for FB? Ravasi and Schultz (2006) define organization culture as a set of shared mental assumptions that guide interpretation and action in organizations by defining appropriate behaviour for various situations. In the past, the hierarchy of management is vital for a corporate. However, Mark Zuckerberg, CEO of Facebook has created a relaxed, unstructured and open corporate culture that emphasizes more on equality. At Facebook, there are no cubicles, no walls, just mainly office furniture. This enables the employees to work in a relaxed and comfortable environment as they can come and go as they please, with no standard work schedules, thus more employee freedom. Furthermore, the managers at Facebook also practice this working environment. Sheryl Sandberg, Facebooks Chief Operating Officer, and even Zuckerberg himself has no office. They work among the employees in the open workspace that could enhance openness and problem solving process. Besides, Mark holds a public question-and-answer session for the entire organization for an hour every Friday. This session has created a great deal of openness in the organization. The openness, according to Zuckerberg, encourages collaboration, team-work and an informal atmosphere and communication. Zuckerbergs company is ballooning into an empire, but it remains scruffy, funky and slightly adorable. That is partly attributable to a workplace that combines playful start-up culture with muscular ambition and bite. Facebooks goal is to be viewed as a hip geek culture in order to attract the best talent.ÂÂ   Zuckerburg is responsible for the foundations of this culture, creating a fun environment by banging a gong when someone finishes a big coding project.ÂÂ   Facebook even hired well-known graffiti artist David Choe to paint murals in the first Facebook offices.Theres a block of meeting rooms named after inventors at the far end of the Facebook ground floor, with one given to Al Gore, who invented the internet. Facebook is creating an intrinsically social culture, rather than enterprise software or geeky, engineer-driven algorithms. At Facebook, the employees can play video or table tennis games whenever they need to unwind on the job. This fun working environment has i ncreased the job satisfaction of employees in the Facebook organization. Job satisfaction is the primary factor in intrinsic motivation. Therefore, due to the corporate culture recognized by Zuckerberg, Facebook employees are satisfied with their jobs and as a result do their jobs well and raise the productivity of Facebook. Facebook is a social utility that connects you with the people around you is the slogan of Facebook. This slogan says quite a bit about the social platform. Facebook has taken a very utilitarian stance on providing a social network. They have created a framework and are expecting you to do most of the work. When we used to wear suits to work, organizational hierarchy was indicated through the price of your suit. With Facebook, Mark forever altered our norms of privacy: our information is now public, our break-ups broadcasted, and our drunken shamings eternalized. However, Zuckerberg has changed this culture by only wear T-shirts, jeans and Adidas flip-flops to work. Mark Zuckerberg shows effectiveness as a cultural leader for Facebook by able and willing to take the risks in hiring the executives for the company, motivate employees to achieve Facebooks goals by established a relaxed, fun and unstructured corporate culture, and think strategically in the incident of refusing to bring Facebook, as a company, public. (555 words) Q4) In what ways does Facebook, as an organisation, fit in with traditional and current, modern-day management thinking and theories and in what ways is FB challenging them? As time passed, many professions had developed several management theories as a guide for manager to run the organization. There are Classical Perspective, which occurred during the nineteenth and early twenty, Management Science Perspective, which emerged during the world war two, The Recent Historical Trend which happen after the world war two and The Modern Management which combine all different theories. In today business world, different management thinking and theory are required by the manager to fits in different industries and achieve their organization goals. Facebook is the new trend in the twenty-first century, which manage and lead by the founder name Mark Zuckerberg. Humanistic perspective was conducted by Mary Parker Follett and Chester Barnard. They believe that manager need to first value peoples feelings, needs, thoughts and social relations. (Daft, n.d). Mark Zuckerberg had this management thinking of creating a social network that allowed people all over the world to engage which each other and get their updates even faster. He found out that as a human, when they disclose feelings and thoughts to their friends will make them feel closer to the person, and also behaviour on understand others emotions and opinions that surrounding. Besides, Mark Zuckerberg also adapting this theory to his employees by providing those free meals along the day, bottomless finger foods and unrestricted dry cleaning service. He allowed subordinates to express themselves, motivate them to have the same goals as the organisations goals by giving opinions on improvement of the organisation. Studies developed by Hawthorne state that in order to increase output, managers firstly need to improve human relation with the subordinates. Managers need to make employees feel respects, appreciated and have the sense of belongings to this organisation. (Daft, n.d). Mark Zuckerberg claim that an office is only just a place to gather people to brain storming to generate profits and human are the most important resources for the organisation. Therefore, Mark Zuckerberg design his headquarter with no wall between departments and the meeting rooms are located at the middle of the work space and separate by glass walls so that all the people can see through the meetings. Besides, Abraham Maslow theories, a study that claim that people are influenced by several needs and by hierarchy order. This has been used by Mark Zuckerberg, firstly, he fulfil the physical needs by providing them free meals and considerable income. Secondly, he satisfied the love and sense of belongings seeks by the employees which allowing them to disclose their thoughts and opinions. Thirdly, he will appreciate them by contribute many ideas and plans to run the business, this will increase employees esteem needs and belief that they are the proper source in helping make the world improve. Lastly, Mark Zuckerberg will somehow challenge the employees to meet certain goals. This will not only increase the improvement of organisation growth, it also acknowledges employees to fulfil their self-actualization needs. Moreover, Contingency View is the modern perspective that managers have no actual plan and managers will base on the situations or industries and economic to lead the organisation. This theory mostly utilize by organisation with structure of effective in an internet company which need to depend on the new technology. (Daft, n.d). Because Facebook is always dealing with trends of the world, and create new trend for the world. This required innovations, inspiration and new technology from the employees. Therefore, it is hard for Mark Zuckerberg to always follow the plan. Furthermore, quality seeking by the user was also a challenge face by Mark Zuckerberg. He use Total Quality Management to deal with it by improving the convenience of user to easily sign up as a user and also create software which allow user to use their mobile phone to log in and keeping on improving the privacy settings of each user. He also create benchmark of user can tag others pictures and status make them to have the same picture and comments. He also came out with the `like button allow user to like the status and which his competitors like Friendster and MySpace does not have. Learning Organisation is a modern theory which allows people not afraid to make mistakes and hope they can learn from the mistakes. It allows managers to raise the capability to discover and grow. (Senge.P. n.d). When Facebook dealing with the mistakes they made in beacon, they understand that not all people like to disclose their thoughts to the public, certain privacy are required from them. Facebook has learnt from this mistake and change their privacy settings. Q5) Describe the personality, leadership and management style of Facebook founder and CEO, Mark Zuckerberg. Discuss his most cherished values and how they govern his life, work, relationships, and the way he leads and manages his people. It is undeniable that Mark Zuckerberg is the key player of the successful of Facebook in the global nowadays. Therefore, the personality and cherished values that he holds are strongly affected his life, work and relationship. As a young billionaire, Mark did not dress himself up with branded clothes and accessories. In fact, he always wears jeans, T-shirt and North Face fleece. Besides, he rents a house with his girlfriend and drives an entry-level luxury car. Yet, his life is nothing more than meetings and talking to people due to the expansion of Facebook. He is a simple man and has showed no concern to spend much money or make money. Perhaps, these are the reason why he rejected offers from big companies such as Yahoo and Microsoft. People think that he was wrong and questioned him why would he refuse the offer because the field that he involves is unpredictable. However, from the interview with Diane Sawyer, he saying, We really just believe in what were doing. This showed that, making money is not the primary motivation of the formation of Facebook but the vision is simple as to attach people from different countries or even culture and share their life to people that they care about. Mark, as a stud ent of computer science and psychology definitely has a great sensitivity of vision. He knows that the most powerful thing in this world perhaps is the connection of people and the usefulness of the Internet. Therefore, Facebook achieved success in just few years because people like the ideas of sharing their feelings and life to their loved ones. Such personalities that Mark had affected the way he presents in work. He said everyone has a voice and people can organise whatever they want. For that reason, the open floor plan in the headquarters of Facebook allows all the workers know each single thing that happens in the buildings. Also, he holds a public question-and-answer meeting for the company for an hour on each Friday. Giving thought to these seemingly minor issues has the potential to drastically improve the working environment and employee engagement. Furthermore, although Mark is a young and rich leader, he never behaves arrogantly and still sincerely apologizes due to the mistakes that he have made. For example, membership of a group named Students against Facebook news feed that formed by Ben Parr has increased to 750,000 users within a week. Instead of being enemy with him, Mark actually posted a letter on Facebook and promised that they will come out with privacy controls. This is a leader quality that Mark had, which is problem solving. On one hand, he did not mention to make changes to the new features and support the usefulness of News Feed to know more about close friends. On the other hand, he promised to strengthen the privacy control. It seems like two-way benefit to him and Facebook without throw the new features away that causes losses and at the same time can settle the negative comment on Facebook. The tough-minded that Mark Zuckerberg had also affected the way he held the position as CEO in Facebook. Mark will improve each role in the organization each six months and performance of employees is being rank from one to five. He valued those hardworking and brilliant employees that can make him success. Some co-workers said that it is stress and fear when working in Facebook. However, the situation has been changed when Mark hired Sheryl Sandberg and people now are regretting they did not join the company. Nevertheless, Mark hire people not only because of their talent but also follow through and do things creatively such as hiring the former Firefox developer, Blake Ross. Mark showed his tough-minded completely when he turned the offer from Yahoo down. The former CEO of Yahoo, Terry Semel said, Id never met anyone-forget his age, twenty-two then or twenty-six now-Id never met anyone who would walk away from a billion dollars. But he said, Its not about the price. This is my baby , and I want to keep running it, I want to keep growing it. I couldnt believe it. (695 words)

The people bomb on 20-20 :: essays research papers

The film â€Å"The people bomb† was a compilation of stories and videos collected from diverse cultures and geographical locations focusing on dramatic increases in human population over short spans of time. This population explosion was having a direct, negative impact on the environment and society of the locations discussed. As a result, involved governments began taking action to alleviate the repercussions of this population expansion and to prevent its continuance. Some of these actions were received harshly by citizens under the acting governments, some were wavered and seen as ineffective for religious reasons and others were successful and becoming more so as time continues. One example of a harshly received marshal action was that of either forced, or persuaded, mass sterilization of societal members. This particular action was taken in India, where citizens from the general population were either forced or coerced into thinking they were being forced to accept ster ilization procedures. Many health and wrongful death issues ensued, as well as moral and emotional objection.   Ã‚  Ã‚  Ã‚  Ã‚  Population expansion, on scales demonstrated in â€Å"The people bomb,† create serious issues for the societies that experience them. A large congestion of people in an area not designed, or capable of maintaining them spawns problems with waste disposal, employment, availability of necessary resources, health, and proper living accommodations. Most commonly experienced in the third world, matters such as these are quickly becoming pandemic in their proportions. Without proper regulation and control of the population or the existence of necessary support programs for a number of people not conducive to their environment, conditions will only worsen.   Ã‚  Ã‚  Ã‚  Ã‚  One may argue that the problem of overpopulation in areas experiencing absolute poverty is inevitable. It may be viewed as a situation only repaired by either force, such as forced sterilization, or the simple end result of an abnormally high mortality rate amongst the population due to poor health conditions.

Dulce et Decorum Est :: English Literature

Dulce et Decorum Est Wilfred Owen Owen's poem Dulce et Decorum Est is a passionate expression of outrage at the horrors of war and of pity for the young soldiers sacrificed in it. From the title of this poem people back home would have expected an understanding poem, helping to overcome their grief at the loss of a loved one, instead what they got was a poem expressing outrage at the lies surrounding the ‘Great’ War. The quote by Horace translates as ‘It is sweet and right to die for ones’ country’, but the poem is about proving to people at home that this isn’t a sweet and honourable way to die (if there is any). It goes through the worst parts of the war and describes them in detail. The horrors in these descriptions contradict the glorification of the war The poem consists of four stanzas, the first describes the soldiers, the second a gas attack, the third Owen’s nightmares and last an accusation to the people back home. Owen’s poems are suffused with the horror of battle, and yet finely structured and innovative. The first stanza sets the scene as it describes the conditions the men fought in and their feelings. Owen immediately shocks the readers by describing the young soldiers as ‘bent double’ emphasising their exhaustion and the way they slump along, deformed by fatigue, I think this is an effective simile because no one back home will be expecting their proud soldiers described as beggars. The simile ‘coughing like hags’ was used because the men who went into battle were relatively young, yet after battle they looked old and ugly, hence hags. With this one sentence Owen implies health conditions that no one at home would ever dream of. Words like Hags, Cursed and Haunting are used as they all have connotations of evil to emphasise the misery and hardship of the front lines. Owen chooses his word carefully using ones the readers will understand to describe processes they can’t, ‘Drunk with fatigue’ (Line 7), comparing the effects of being drunk to being overly tired, for example the wavering walk, tripping and stumbling. This is effective because everyone reading would know what it’s like to be drunk. The ‘tired, outstripped Five-Nines’ being a type of gun, but also the soldiers being sent from the trenches for some rest and relaxation. He uses words like We, Our to show that he is part of this mayhem. He seems almost detached as if he has seen this so often, that to him it has lost the horror value that we feel. In the second stanza there is a dramatic change in pace to demonstrate

Major Benefits Of The Airtraq Health And Social Care Essay

The undermentioned entry lineations my proposal to present the AirtraqA ® Video Intubation ( Airtraq by Prodol, 2010 ) device into the Airway Management Clinical Practice Guidelines of Ambulance Victoria. Endotracheal Intubation ( ETI ) has ever been considered the gilded criterion of airway direction and is presently a MICA merely skill. My proposal is to present a new piece of equipment which will non merely do it easier for MICA trained paramedics, but may take to ALS paramedics one twenty-four hours besides being accredited in ET cannulation. At present Ambulance Victoria do non use any picture laryngoscopy equipment, alternatively trusting on the standard Macintosh laryngoscope and perfect line of sight of the vocal cords to execute the cannulation. Clinical grounds has shown that with the usage of the Airtraq Guided Video Intubation tool successful in increasing cannulation rates, even in awaited hard instances. The Airtraq device is compatible with IFS and RSI cannulations and has even been used in awake patients following consumption of a lignocaine solution. They have been used in morbidly corpulent patients, patients fitted with cervical neckbands, patients restrained in autos following MVA ‘s, and pediatric instances to call a few. They have besides been used as portion of a failed cannulation drill after direct laryngoscopy cannulation was non achieved. This proposal aims chiefly to present the Airtraq as the standard tool used by AV for cannulation, or neglecting that, as the following measure during a hard patient following the failed cannulation bore CPG before making for the cricothyroidotomy scalpel. Kind respects,BackgroundETI is an intricate accomplishment that requires pattern and apprehension in order to execute and keep the proficiency. To set up or keep a patent airway a soft plastic tubing is threaded past the patients vocal cords and into the windpipe. Different methods of interpolation apply and scope from necessitating general anesthesia or local anesthesia to none at all referred to as an awake cannulation. Currently cannulation in Ambulance Victoria is reserved merely for MICA officers due to the terrible reverberations if it is non performed right. However, it is a basis of advanced airway direction and indispensable in clinical scenarios where the patients air passage is compromised or oxygen bringing is imperative such as traumatic encephalon hurt. The accomplishment is non merely used in the prehospital scene but predominately in exigency sections worldwide which is where the bulk of our informations has been sourced from. Paramedics are invariably required to can nulate in less than ideal fortunes out in the field. Any device or tool that would be helpful in helping cannulation and consequence in fewer complications or troubles should be considered earnestly. Macintosh Laryngoscope ( Dimeda, 2009 ) Previous surveies show that paramedic pupils executing traditional Macintosh cannulations required extended preparation that may turn out to be financially unrealistic for an establishment ( Warner et al. , 2010 ) . The survey reported that in order to accomplish high success rates of first-pass ETI, drawn-out preparation plans and patient exposure was required. Whilst it was fortunate that the peculiar university carry oning the survey was attached to an adjoining infirmary, obtaining in-hospital patients to pattern upon may be far more ambitious for most other preparation plans and universities.So what makes the Airtraq different?The Airtraq is preponderantly based upon the Macintosh laryngoscope design. Both are long metallic blades aimed at making the groove channel to let for a good visual of the vocal cords. However the differences between the two designs and the subsequent positive consequences are good documented. AirtraqA ® Laryngoscope ( Enayah, 2010 ) There is marked curvature toward the tip of the Airtraq blade, ensuing in less manoeuvring and force per unit area during interpolation, hence supplying less opportunity of dental injury. More significantly, the in-built optical camera placed at the distal tip of the blade is designed to give the best possible position of vocal cords with the mini proctor built into the grip of the device. The two most common landmarks used during interpolation ( vallecula channel for Macintosh and epiglottis for Miller blade ) can both be used with the Airtraq, doing it a really various pick for those coming to work in Victoria from interstate of abroad ambulance services. There is the option of an extra radio proctor to give a larger image of the camera position and provides a docking station in instance charging is required. It besides integrates an anti-fog system to give the best opportunity at a clear position. Additionally the Airtraq is a individual usage disposable device that wholly cuts out any cross-contamination hazards that may originate due to improper cleansing after usage. A survey performed in the UK comparing proficiency of medical pupils with no anterior advanced airway direction preparation, provides cardinal grounds in favor of the Airtraq being used amongst ALS and MICA crew likewise. The survey compared a scope of state of affairss including normal air passages in supine place, left sidelong place, during cervical immobilization and in a pharyngeal obstructor scenario. They so evaluated the figure of cannulation efforts, figure of optimization tactics ( seting of the caput, bougie, helper ) , continuance of the cannulation efforts and dental injury caused ( Maharaj, Costello, Higgins, Harte & A ; Laffey, 2007 ) . Across the board there were better consequences recorded with the Airtraq – pupils stated it was easier to utilize, they had less trouble, cannulation times were shorter and tactics and incidence of dental injury were significantly lower compared to the Macintosh laryngoscope. The survey so went on to re-test the participants in 6 months clip in order to measure a â€Å" impairment in cannulation accomplishments † ( Maharaj et al. , 2007 ) . Consequences in favor of the Airtraq once more proved positive, frequently demoing about dual the success rate when utilizing the Airtraq. 90 % of Airtraq cannulations required zero optimization maneuverers compared to 50 % whilst utilizing the Macintosh. This information tells us that there is the possible to do ETI far easier and safer for paramedics whilst utilizing this tool compared to the current Macintosh laryngoscope. It so shows us that because of the design of the Airtraq, even if the medical practician has non used the device in a important clip, they are more likely to be able to cannulate right and rapidly utilizing the Airtraq. This would be wondrous good for those MICA staff that have n't performed ETI for a piece and are experiencing rusty. It besides shows possible that possibly in the hereafter, ETI could perchance be introduced to ALS paramedics provided a thorough and supportive preparation plan can be provided.Major benefits of the AirtraqAs the population becomes older, less active and increasingly more corpulent, new techniques and get bying schemes will necessitate to be devised to battle progressively hard cannulations. Taking patients that were undergoing bariatric surgery, a survey was performed to find the best manner in which to use the Airtraq in respects to way of interpolation ( Dhonneur et al. , 2007 ) . In mean leaden patients it is practical to utilize the standard method of laryngoscope interpolation without excessively many complications. However in morbidly corpulent patients a somewhat different method was developed to battle the extra fatty tissues barricading the throat. The blade can be inserted with the curve rotated 180A ° prior, so rotated into the normal pharyngeal place known as a contrary tactic. This process was shown to diminish cannulation times during the survey which is ideal and implies that the patient will hold the shortest clip possible in between oxygenation and airings with this method. Difficult cannulations including corpulent patients have been reported to take 4 times every bit long as standard cannulations ( Dhonneur et al. , 2007 ) so safely and efficaciously cut downing interpolation times is overriding when researching new methods and tools. An extended survey was performed to find if the Airtraq truly was every bit adept as it claimed to be when used in concurrence with patients that has suffered from spinal hurts and had later been fitted with cervical neckband. The survey was performed utilizing patients undergoing surgery whom had no anterior or current spinal injury. Alternatively motions between occipital and cervical sections were measured utilizing skiagraphy and the information was recorded in grades of angle ( Hirabayashi, Fujita, Seo & A ; Sugimoto, 2008 ) . Again, this research compared between the Macintosh laryngoscope and the Airtraq. Whilst both devices used did make some extension motion when cannulation was performed, the Numberss were still lower and in favor of the Airtraq. The research workers used the patients impersonal head place as the baseline figure and found that divergences in spinal angles were smaller, sometimes up to 40 % compared with the Macintosh. The article besides finished by saying that the troubles in go throughing a ET tubing down through the vocal cords utilizing a Macintosh blade ( being unable to put patient in the sniffing place ) would ask significant and accordingly, a important angulation of the laryngoscope ( Hirabayashi, 2008 ) . However in contrast the Airtraq has a built in counsel channel for weaving the ET tubing into the windpipe when cords have been adequately visualised. This would ensue in a decrease of motion bing less possible for spinal hurts caused by cannulation injury. Whilst old surveies had recorded and analysed the clip it took to execute cannulation with Airtraq ( Nowicki et al. , 2009 ) , this survey specifically showed scope of motion alternatively of clip and velocity.Discussion and DecisionThe information gathered in this proposal is designed to demo the board that the Airtraq device has superior effectivity when comparing cannulation consequences against the standard Macintosh laryngoscope. The curvature of the blade and camera make it far easier to visualize vocal cords whilst the patient is supine or even sitting. Cannulations performed were systematically faster and required fewer efforts than normal. The Airtraq system has proven it has a rapid acquisition curve with novitiates and professionals likewise being able to visualize class 1 cords rapidly, easy and still be far more effectual than the options at a ulterior day of the month after nothing exposure. The device has shown its ego to be the preferable tool when cannulating the corpulent or spinally immobilised. It was documented that the Airtraq did non raise blood force per unit area up by 50mmHg after cannulation unlike its Macintosh equivalent ( Maharaj et al. , 2008 ) . The Airtraq caused less dental injury and soft tissue hurt. Was suited and encouraged during hard cannulations state of affairss such as spinal hurts, corpulent patients, tissue hydrops These points and more are presumptively what a paramedic would look for in an cannulation tool if given the option. If given the pick between what is presently in usage and the easier, safer and more various option, the Airtraq appears to be a clear victor. Compatible with both IFS and RSI guidelines the Airtraq would comfortably steal into our presently used cannulation CPG ‘s and could potentially replace the Macintosh wholly. The possible cost factors at buying the disposable tool would hopefully be seen as secondary to its benefits for both the patient and the paramedic. Logistically buying the new device would hold to be determined informations exposing how many cannulations MICA performs on a regular footing. Using the Airtraq would potentially alter the manner we think about cannulation and let it to go incorporate into the ALS accomplishment set. More research would be required into uniting the Airtraq without the terrible paralytic drugs such suxamethonium used in RSI and whether it could be a possible option for ALS paramedics. Considerations for extra CPG information are included below. Airtraq by Prodol. ( 2010 ) Retrieved from hypertext transfer protocol: //airtraq.com/airtraq/portal.portal.action Dhonneur, G. , Ndoko, S. K. , Amathieu, R. , Attias, A. , Housseini, L. E. L. , Polliand, C. , & A ; Tual, L. ( 2007 ) . A comparing of two techniques for infixing the Airtraq laryngoscope in morbidly corpulent patients. Anaesthesia, 62, 774-777 Dimeda ( 2009 ) . Dimeda Surgical Instruments. Retrieved from hypertext transfer protocol: //www.dimeda.de/images/laryngoscope.jpg Enayah, A. ( 2010 ) . Emergency and Critical Care Solutions. Retrieved from hypertext transfer protocol: //www.al-enayah.com/Product.html Hirabayashi, Y. , Fujita, A. , Seo, N. , & A ; Sugimoto, H. ( 2008 ) A comparing of cervical spine motion during laryngoscopy utilizing the Airtraq or Macintosh laryngoscopes. Anaesthesia, 63, 635-640. Maharaj, C. H. , Costello, J. , Higgins, B. D. , Harte, B. H. , & A ; Laffey, J. G. ( 2007 ) . Retention of tracheal cannulation accomplishments by novice forces: a comparing of the Airtraq and Macintosh laryngoscopes. Anaesthesia, 62, 272-27. Maharaj, C. H. , Costello, J. , Higgins, B. D. , Harte, B. H. , & A ; Laffey, J. G. ( 2008 ) . Evaluation of the Airtraq and Macintosh laryngoscopes in patients at increased hazard for hard tracheal cannulation. Anaesthesia, 63, 182-188 Nowicki, T. A. , Suozzi, J. C. , Dziedzic, M. , Kamin, R. , Donahue, S. , & A ; Robinson, K. ( 2009 ) Comparison of usage of the Airtraq with direct laryngoscopy by paramedics in the fake air passage. Prehospital Emergency Care, 13 ( 1 ) , 75-80 Warner, K. J. , Carlbom, D. , Cooke, C. R. , Bulger, E. M. , Copass, M. K. , & A ; Sharar, S. R. ( 2010 ) . Paramedic preparation for adept prehospital endotracheal cannulation. Prehospital Emergency Care, 14 ( 1 ) , 103-108.