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Sobh ZK, Ghanem M, Kholief M. Physicians' perspectives on different therapeutic approaches for aluminum phosphide poisoning and their relevant outcomes. Toxicol Res (Camb) 2023; 12:615-625. [PMID: 37663810 PMCID: PMC10470372 DOI: 10.1093/toxres/tfad053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/09/2023] [Accepted: 06/20/2023] [Indexed: 09/05/2023] Open
Abstract
Background Aluminum phosphide is a highly toxic pesticide that results in high mortality. To date, there is neither a definitive antidote nor a unified protocol for managing acute aluminum phosphide poisoning. Objectives This cross-sectional questionnaire-based study aims to explore different management approaches and rely on the expertise of Egyptian medical professionals to enhance the prognosis for acute aluminum phosphide poisoning. Subjects and methods A self-administered questionnaire was formulated and electronically distributed according to published literature and experience of senior physicians. Results and conclusions Responses were received from 151 physicians from 10 governorates. Management modalities were variable among respondents. Noradrenaline was used by 90.7% of respondents with no fixed-dose regimen. In all, 84.1% of participants utilized oil in gastrointestinal decontamination; paraffin oil was the most used solution. Overall, 92.1, 61.6, 46.4, and 34.4% of participants used sodium bicarbonate, proton pump inhibitors, IV magnesium sulfate, and antioxidants, respectively. Regarding the frequency of acute aluminum phosphide poisoning, 47% of participants managed these cases daily or a few times a week. Participants' responses denoted a poor prognosis of acute aluminum phosphide poisoning, and high percentages attributed the prognosis to exposure factors rather than treatment modalities. Statistical analysis revealed that using oil in gastrointestinal decontamination improved the outcome by 4.62-fold. Clinical toxicologists were more likely to rescue ≥ 30% of the cases about 3-fold (2.97) than other specialties. Clinical toxicologists used oil in gastrointestinal decontamination, magnesium sulfate, and antioxidant therapy and calculated base deficit before administration of sodium bicarbonate by 7.70-, 5.30-, 3.26-, and 2.08-fold than other specialties.
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Affiliation(s)
- Zahraa K Sobh
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Alexandria University, Alexandria 21517, Egypt
| | - Maha Ghanem
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Alexandria University, Alexandria 21517, Egypt
| | - Marwa Kholief
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Alexandria University, Alexandria 21517, Egypt
- Center of Excellence for Research in Regenerative Medicine and Applications (CERRMA) in Faculty of Medicine, Alexandria University, Alexandria 21517, Egypt
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Janatolmakan M, Nouri R, Soroush A, Andayeshgar B, Khatony A. Barriers to the success of cardiopulmonary resuscitation from the perspective of Iranian nurses: A qualitative content analysis. Int Emerg Nurs 2020; 54:100954. [PMID: 33360362 DOI: 10.1016/j.ienj.2020.100954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 10/26/2020] [Accepted: 11/21/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The survival rate following Cardiopulmonary Resuscitation (CPR) has been reported to be 7-26.7%. Various studies have shown that CPR failure is high in many countries. This study was aimed to explore the barriers to the success of CPR from the perspective of Iranian nurses. METHODS Participants were 14 Iranian nurses recruited through purposive sampling. In-depth semi-structured interviews were used to collect data. Data were analyzed using qualitative content analysis. RESULTS The barriers to successful CPR were developed in three main categories and nine subcategories. Some of the barriers to CPR success were: "delayed attendance of the CPR team and start of CPR", "inadequate experience and skill of the CPR team", "poor access to special units", "insufficient and deficient CPR equipment", "poor CPR location", "critical clinical conditions of the patient", and "interference of the patient's family members. CONCLUSION The results showed that human and environmental factors can result in CPR failure. These barriers can be minimized by measures such as empowerment of the CPR team, and providing the necessary facilities and equipment.
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Affiliation(s)
- Maryam Janatolmakan
- Clinical Research Development Centre, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Roghayeh Nouri
- Clinical Research Development Centre, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Soroush
- Clinical Research Development Centre, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Bahare Andayeshgar
- Clinical Research Development Centre, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Khatony
- Clinical Research Development Centre, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran; Health Institute, Social Development and Health Promotion Research Centre, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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3
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Lotz C, Muellenbach RM, Spieth P. Extracorporeal cardiopulmonary resuscitation: tool or toy? Minerva Anestesiol 2020; 87:101-105. [PMID: 32755091 DOI: 10.23736/s0375-9393.20.14564-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Neurological outcome and quality of live are of uttermost interest in survivors of cardiac arrest. Assuming acceptable rates of return of spontaneous circulation, the long-term effects on neurological function and quality of live after cardiopulmonary resuscitation remain unsatisfactory. Extracorporeal cardiopulmonary resuscitation (eCPR) can reduce low-flow times and therefore provide adequate cerebral tissue perfusion and oxygenation. This may improve favorable outcomes after cardiac arrest. Due to the risk of procedure related complications and ethical issues, this technique should be only performed in selected patients by specially trained and experienced teams. In this review we aimed at providing an insight into the sparse evidence in this field and discussing ethical issues associated with the use of eCPR.
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Affiliation(s)
- Christopher Lotz
- Department of Anesthesia and Critical Care, University of Würzburg, Würzburg, Germany
| | - Ralf M Muellenbach
- Department of Anesthesia and Critical Care, Städtisches Klinikum Kassel, Kassel, Germany
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Dresden, Dresden, Germany -
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Ruemmler R, Ziebart A, Kuropka F, Duenges B, Kamuf J, Garcia-Bardon A, Hartmann EK. Bi-Level ventilation decreases pulmonary shunt and modulates neuroinflammation in a cardiopulmonary resuscitation model. PeerJ 2020; 8:e9072. [PMID: 32377456 PMCID: PMC7195831 DOI: 10.7717/peerj.9072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/06/2020] [Indexed: 11/23/2022] Open
Abstract
Background Optimal ventilation strategies during cardiopulmonary resuscitation are still heavily debated and poorly understood. So far, no convincing evidence could be presented in favour of outcome relevance and necessity of specific ventilation patterns. In recent years, alternative models to the guideline-based intermittent positive pressure ventilation (IPPV) have been proposed. In this randomized controlled trial, we evaluated a bi-level ventilation approach in a porcine model to assess possible physiological advantages for the pulmonary system as well as resulting changes in neuroinflammation compared to standard measures. Methods Sixteen male German landrace pigs were anesthetized and instrumented with arterial and venous catheters. Ventricular fibrillation was induced and the animals were left untreated and without ventilation for 4 minutes. After randomization, the animals were assigned to either the guideline-based group (IPPV, tidal volume 8–10 ml/kg, respiratory rate 10/min, FiO21.0) or the bi-level group (inspiratory pressure levels 15–17 cmH2O/5cmH2O, respiratory rate 10/min, FiO21.0). Mechanical chest compressions and interventional ventilation were initiated and after 5 minutes, blood samples, including ventilation/perfusion measurements via multiple inert gas elimination technique, were taken. After 8 minutes, advanced life support including adrenaline administration and defibrillations were started for up to 4 cycles. Animals achieving ROSC were monitored for 6 hours and lungs and brain tissue were harvested for further analyses. Results Five of the IPPV and four of the bi-level animals achieved ROSC. While there were no significant differences in gas exchange or hemodynamic values, bi-level treated animals showed less pulmonary shunt directly after ROSC and a tendency to lower inspiratory pressures during CPR. Additionally, cytokine expression of tumour necrosis factor alpha was significantly reduced in hippocampal tissue compared to IPPV animals. Conclusion Bi-level ventilation with a constant positive end expiratory pressure and pressure-controlled ventilation is not inferior in terms of oxygenation and decarboxylation when compared to guideline-based IPPV ventilation. Additionally, bi-level ventilation showed signs for a potentially ameliorated neurological outcome as well as less pulmonary shunt following experimental resuscitation. Given the restrictions of the animal model, these advantages should be further examined.
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Affiliation(s)
- Robert Ruemmler
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Alexander Ziebart
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Frances Kuropka
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Bastian Duenges
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Jens Kamuf
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Andreas Garcia-Bardon
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Erik K Hartmann
- Department of Anesthesiology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
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Druwé P, Benoit DD, Monsieurs KG, Gagg J, Nakahara S, Alpert EA, van Schuppen H, Élő G, Huybrechts SA, Mpotos N, Joly LM, Xanthos T, Roessler M, Paal P, Cocchi MN, Bjørshol C, Nurmi J, Salmeron PP, Owczuk R, Svavarsdóttir H, Cimpoesu D, Raffay V, Pachys G, De Paepe P, Piers R. Cardiopulmonary Resuscitation in Adults Over 80: Outcome and the Perception of Appropriateness by Clinicians. J Am Geriatr Soc 2019; 68:39-45. [PMID: 31840239 DOI: 10.1111/jgs.16270] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 08/29/2019] [Accepted: 09/05/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the prevalence of clinician perception of inappropriate cardiopulmonary resuscitation (CPR) regarding the last out-of-hospital cardiac arrest (OHCA) encountered in an adult 80 years or older and its relationship to patient outcome. DESIGN Subanalysis of an international multicenter cross-sectional survey (REAPPROPRIATE). SETTING Out-of-hospital CPR attempts registered in Europe, Israel, Japan, and the United States in adults 80 years or older. PARTICIPANTS A total of 611 clinicians of whom 176 (28.8%) were doctors, 123 (20.1%) were nurses, and 312 (51.1%) were emergency medical technicians/paramedics. RESULTS AND MEASUREMENTS The last CPR attempt among patients 80 years or older was perceived as appropriate by 320 (52.4%) of the clinicians; 178 (29.1%) were uncertain about the appropriateness, and 113 (18.5%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the "appropriate" subgroup was 8 of 265 (3.0%), 1 of 164 (.6%) in the "uncertain" subgroup, and 2 of 107 (1.9%) in the "inappropriate" subgroup (P = .23); 503 of 564 (89.2%) CPR attempts involved non-shockable rhythms. CPR attempts in nursing homes accounted for 124 of 590 (21.0%) of the patients and were perceived as appropriate by 44 (35.5%) of the clinicians; 45 (36.3%) were uncertain about the appropriateness; and 35 (28.2%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the nursing home patients was 0 of 107 (0%); 104 of 111 (93.7%) CPR attempts involved non-shockable rhythms. Overall, 36 of 543 (6.6%) CPR attempts were undertaken despite a known written do not attempt resuscitation decision; 14 of 36 (38.9%) clinicians considered this appropriate, 9 of 36 (25.0%) were uncertain about its appropriateness, and 13 of 36 (36.1%) considered this inappropriate. CONCLUSION Our findings show that despite generally poor outcomes for older patients undergoing CPR, many emergency clinicians do not consider these attempts at resuscitation to be inappropriate. A professional and societal debate is urgently needed to ensure that first we do not harm older patients by futile CPR attempts. J Am Geriatr Soc 68:39-45, 2019.
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Affiliation(s)
- Patrick Druwé
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Dominique D Benoit
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - James Gagg
- Department of Emergency Medicine, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, United Kingdom
| | | | | | - Hans van Schuppen
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Gábor Élő
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Sofie A Huybrechts
- Department of Emergency Medicine, Antwerp University Hospital, Antwerp, Belgium
| | - Nicolas Mpotos
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Luc-Marie Joly
- Department of Emergency Medicine, Rouen University Hospital, Rouen, France
| | - Theodoros Xanthos
- European University, Nicosia, Cyprus, Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | - Markus Roessler
- Department of Anaesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Peter Paal
- Department of Anesthesiology and Critical Care Medicine, Hospitallers Brothers Hospital, Medical University Salzburg, Salzburg, Austria
| | - Michael N Cocchi
- Harvard Medical School, Department of Emergency Medicine and Department of Anesthesia Critical Care and Pain Medicine, Division of Critical Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Conrad Bjørshol
- Department of Anesthesiology and Intensive Care, Stavanger University Hospital, The Regional Centre for Emergency Medical Research and Development (RAKOS), Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jouni Nurmi
- Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Radoslaw Owczuk
- Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Gdansk, Poland
| | | | - Diana Cimpoesu
- University of Medicine and Pharmacy Gr.T. Popa and Emergency County Hospital Sf. Spiridon, Iasi, Romania
| | | | - Gal Pachys
- Emergency Department, Sourasky Medical Center, Tel Aviv, Israel
| | - Peter De Paepe
- Department of Emergency Medicine, Ghent University Hospital, Ghent, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
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Ruemmler R, Ziebart A, Moellmann C, Garcia-Bardon A, Kamuf J, Kuropka F, Duenges B, Hartmann EK. Ultra-low tidal volume ventilation-A novel and effective ventilation strategy during experimental cardiopulmonary resuscitation. Resuscitation 2018; 132:56-62. [PMID: 30176273 DOI: 10.1016/j.resuscitation.2018.08.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/05/2018] [Accepted: 08/28/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The effects of different ventilation strategies during CPR on patient outcomes and lung physiology are still poorly understood. This study compares positive pressure ventilation (IPPV) to passive oxygenation (CPAP) and a novel ultra-low tidal volume ventilation (ULTVV) regimen in an experimental ventricular fibrillation animal model. STUDY DESIGN Prospective randomized controlled trial. ANIMALS 30 male German landrace pigs (16-20 weeks). METHODS Ventricular fibrillation was induced in anesthetized and instrumented pigs and the animals were randomized into three groups. Mechanical CPR was initiated and ventilation was either provided by means of standard IPPV (RR: 10/min, Vt: 8-9 ml/kg, FiO2: 1,0, PEEP: 5 mbar), CPAP (O2-Flow: 10 l/min, PEEP: 5 mbar) or ULTVV (RR: 50/min, Vt: 2-3 ml/kg, FiO2: 1,0, PEEP: 5 mbar). Guideline-based advanced life support was applied for a maximum of 4 cycles and animals achieving ROSC were monitored for 6 h before terminating the experiment. Ventilation/perfusion ratios were performed via multiple inert gas elimination, blood gas analyses were taken hourly and extended cardiovascular measurements were collected constantly. Brain and lung tissue samples were taken and analysed for proinflammatory cytokine expression. RESULTS ULTVV provided sufficient oxygenation and ventilation during CPR while demanding significantly lower respiratory and intrathoracic pressures. V/Q mismatch was significantly decreased and lung injury was mitigated in surviving animals compared to IPPV and CPAP. Additionally, cerebral cytokine expression was dramatically reduced. CONCLUSION Ultra-low-volume ventilation during CPR in a porcine model is feasible and may provide lung-protective benefits as well as neurological outcome improvement due to lower inflammation. Our results warrant further studies and might eventually lead to new therapeutic options in the resuscitation setting.
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Affiliation(s)
- Robert Ruemmler
- Department of Anesthesiology, Medical Center of the Johannes Gutenberg-University, Langebeckstrasse 1, 55116 Mainz, Germany.
| | - Alexander Ziebart
- Department of Anesthesiology, Medical Center of the Johannes Gutenberg-University, Langebeckstrasse 1, 55116 Mainz, Germany
| | - Christian Moellmann
- Department of Anesthesiology, Medical Center of the Johannes Gutenberg-University, Langebeckstrasse 1, 55116 Mainz, Germany
| | - Andreas Garcia-Bardon
- Department of Anesthesiology, Medical Center of the Johannes Gutenberg-University, Langebeckstrasse 1, 55116 Mainz, Germany
| | - Jens Kamuf
- Department of Anesthesiology, Medical Center of the Johannes Gutenberg-University, Langebeckstrasse 1, 55116 Mainz, Germany
| | - Frances Kuropka
- Department of Anesthesiology, Medical Center of the Johannes Gutenberg-University, Langebeckstrasse 1, 55116 Mainz, Germany
| | - Bastian Duenges
- Department of Anesthesiology, Medical Center of the Johannes Gutenberg-University, Langebeckstrasse 1, 55116 Mainz, Germany
| | - Erik Kristoffer Hartmann
- Department of Anesthesiology, Medical Center of the Johannes Gutenberg-University, Langebeckstrasse 1, 55116 Mainz, Germany
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Dignam C, Brown M, Thompson CH. Changes in resuscitation and end-of-life documentation in older patients' clinical case notes: A comparison of 2011 and 2017 practice. Australas J Ageing 2018; 38:28-32. [PMID: 30239083 DOI: 10.1111/ajag.12587] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To compare 2011 and 2017 documentation of resuscitation decisions in older patients, including the frequency and clarity of documentation. METHODS The clinical case notes of 130 patients aged 70 years and over were examined to identify how resuscitation decisions are discussed and documented at a major teaching hospital. Results were compared to 2011 data. RESULTS The proportion of patients with a documented order significantly increased, from 34 to 63%, with a concurrent increased number of patients identified as Not For Cardiopulmonary Resuscitation (Not for CPR). The standardised documentation has also improved rates of documented discussion, legibility and identification of the involved doctor. CONCLUSION The Resuscitation Plan 7-Step Pathway has markedly improved the frequency of documented discussion, the rate of recorded Not For CPR status and clarity of documentation. There is scope for improvement as this policy is embraced across South Australia.
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Affiliation(s)
- Colette Dignam
- Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Margaret Brown
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,University of South Australia, Adelaide, South Australia, Australia
| | - Campbell H Thompson
- Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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Mazutti SRG, Nascimento ADF, Fumis RRL. Limitation to Advanced Life Support in patients admitted to intensive care unit with integrated palliative care. Rev Bras Ter Intensiva 2016; 28:294-300. [PMID: 27626949 PMCID: PMC5051188 DOI: 10.5935/0103-507x.20160042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/05/2016] [Indexed: 01/16/2023] Open
Abstract
Objective To estimate the incidence of limitations to Advanced Life Support in
critically ill patients admitted to an intensive care unit with integrated
palliative care. Methods This retrospective cohort study included patients in the palliative care
program of the intensive care unit of Hospital Paulistano
over 18 years of age from May 1, 2011, to January 31, 2014. The limitations
to Advanced Life Support that were analyzed included do-not-resuscitate
orders, mechanical ventilation, dialysis and vasoactive drugs. Central
tendency measures were calculated for quantitative variables. The
chi-squared test was used to compare the characteristics of patients with or
without limits to Advanced Life Support, and the Wilcoxon test was used to
compare length of stay after Advanced Life Support. Confidence intervals
reflecting p ≤ 0.05 were considered for statistical significance. Results A total of 3,487 patients were admitted to the intensive care unit, of whom
342 were included in the palliative care program. It was observed that after
entering the palliative care program, it took a median of 2 (1 - 4) days for
death to occur in the intensive care unit and 4 (2 - 11) days for hospital
death to occur. Many of the limitations to Advanced Life Support (42.7%)
took place on the first day of hospitalization. Cardiopulmonary
resuscitation (96.8%) and ventilatory support (73.6%) were the most adopted
limitations. Conclusion The contribution of palliative care integrated into the intensive care unit
was important for the practice of orthothanasia, i.e., the non-extension of
the life of a critically ill patient by artificial means.
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Abstract
Many seriously ill geriatric patients are at higher risk for perioperative morbidity and mortality, and incorporating proactive palliative care principles may be appropriate. Advanced care planning is a hallmark of palliative care in that it facilitates alignment of the goals of care between the patient and the health care team. When these goals conflict, perioperative dilemmas can occur. Anesthesiologists must overcome many cultural and religious barriers when managing the care of these patients. Palliative care is gaining ground in several perioperative populations where integration with certain patient groups has occurred. Geriatric anesthesiologists must be aware of how palliative care and hospice influence and enhance the care of elderly patients.
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Affiliation(s)
- Allen N Gustin
- Department of Anesthesiology, Stritch School of Medicine, Loyola University Medicine, 2160 South 1st Avenue, Building 103, Room-3102, Chicago, IL 60153, USA.
| | - Rebecca A Aslakson
- Department of Anesthesiology and Critical Care Medicine, Palliative Medicine Program at the Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins School of Medicine, 1800 Orleans Street, Meyer 289, Baltimore, MD 21287, USA; Department of Health, Behavior, and Society, The Johns Hopkins Bloomberg School of Public Health, 1800 Orleans Street, Meyer 289, Baltimore, MD 21287, USA
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Abstract
BACKGROUND Decision-making and assessment in emergency situations are complex and result many times in ethical conflicts between different healthcare professionals. AIM To analyse and describe situations that can generate ethical conflict among nurses working in emergency situations. METHODS Qualitative analysis. A total of 16 emergency nurses took part in interviews and a focus group. ETHICAL CONSIDERATIONS Organisational approval by the University Hospital, and informed consent and confidentiality were ensured before conducting the research. RESULT/CONCLUSION Two categories emerged: one in 'ethical issues' and one in 'emotions and feelings in caring'. The four ethical subcategories are presented: Autonomy, the first sub category: first, the nurse's ability to practise care on an emergency ward and, second, to support the patient and/or relatives in terms of care and medical treatment. The conflicts arise when the nurse ends up in the middle between the patient and the physician responsible for the diagnosis and treatment from a nature scientific perspective. Reification of injured body: patient was often reified and fragmented, becoming just a leg or arm. Different factors contributed in this perspective. Pain: pain relief was often inadequate but more effectively treated in the emergency medical services than at the emergency department. The nurses highlighted the phenomenon of suffering because they felt that pain was only an object, forgetting the patients' care need, like separating mind from body. Death: the nurses felt that the emergency services are only prepared to save lives and not to take care of the needs of patients with 'end-of-life' care. Another issue was the lack of ethical guidelines during a cardiac arrest. Resuscitation often continues without asking about the patient's 'previous wishes' in terms of resuscitation or not. In these situations, the nurses describe an ethical conflict with the physician in performing their role as the patient's advocate. The nurses express feelings of distress, suffering, anger and helplessness.
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