Wow, I cannot believe that this is already our last blog!

Anyhow, since I had such an interesting patient two weeks ago and since this blog has to relate to critical care I have decided to talk about his vent settings. I don’t know about anyone else, but I truly enjoyed learning about vents; which is also why I have decided to talk about vents: using the PSV mode to be specific. The pressure support ventilation (PSV) mode is a pressure mode that is commonly used for weaning off the ventilator. When a patient is placed on this vent mode, the patient has the ability to initiate their own breath. When the patient initiates a breath then the vent kicks in and assists them to the point where they achieve the desired pressure level. Not only does the vent help the patient reach a desired pressure level, but it also makes sure that the patient maintains the pressure level throughout the inspiratory phase of breathing. A advantage of this mode is that it decreases the work of breathing in the patient. on the other hand, a disadvantage is that the patient must have an intact respiratory drive.

Morton, P. G., & Fontaine, D.K., (2013). Essentials of critical care nursing: a holistic approach. Philadelphia, PA: Lippincott Williams & Wilkins.

I focused my research on the hazard spill that occurred in Santa Paula on November 18, 2014. For those of you who don’t know, I actually live in Santa Paula and thus I was really interested in examining this event.

On November 18, 2014 at 3:45 a.m. there was a spill of approximately 1,000 gallons consisting of an unknown liquid organic peroxide. The spill was a result of a leaking truck which then later exploded. At the time of the first explosion there were two people injured. In response to the explosion, firefighters responded and they noted that when they stepped on to the dry area, in which the chemical had spilled, their rubber boots began to melt as well as the tires from their fire truck. As a matter of fact one of the fire trucks ended up exploding as a result from the mysterious chemical. At this time the Ventura County Geoff Dean declared the situation as a local emergency and ordered for an evacuation plan to be made. The evacuation plan consisted of any people living within a one mile radius, and people living within a 3-mile radius were asked to remain in their homes with all their windows and doors closed. As a result of the evacuation, the American Red Cross created a temporary shelter on Main St.

As for the 44 people that were exposed, they were all sent to VCMC to be treated. Unfortunately, this led to further explosion of the mysterious chemical; not only were the people coming in exposed, but the healthcare workers as well as their patient exposed as well.  Despite the help of many individuals (public health workers, environmental health workers, fire fighters, and etc.) none of them were able to identify the chemical or an antagonist to stop all chemical reactions from occurring.

Overall, I personally believe that this event was very eye-opening for a lot of people, like myself. I was really happy to hear how many people actually responded to this event. Santa Paula is a fairly small city and thus often times I feel like when something happens in Santa Paula it is not really a big deal; but this definitely proved me wrong. I think, because of such event local hospitals have now implemented a response team if such event ever were to happen again. The reason why I say this is, because at the time that this occurred I was in my leadership rotation and thus I saw how Ojai Valley Community Hospital implemented a plan if ever such event was to happen again.

References:

Small fire ignites in chemical spill area outside of santa paula (2014). Ventura County Star. Retrieved from http://www.vcstar.com/news/local-news/santa-paula/small-fire-ignites-in-chemical-spill-area-outside-santa-paula_98585274

Quednow, C.V. (2014). Santa paula chemical explosion causes injuries, evacuations, and road closures. Ventura County Star. Retrieved from http://www.vcstar.com/news/local-news/ventura/officials-working-to-decontaminate-people-at-vcmc-exposed-to-substance-in-santa-paula-explosion_29956958

Since I worked today and work was probably going to be the most exposure to people that I was going to have, I decided to question co-workers; I asked a total of three co-workers.

Co-worker One: She is taking Accutane for acne. When asked what she knew about her medication she informed me that is it is for acne, she needs to stay out of the sun, she always needs to wear sunscreen, and she is on birth control because the medication can cause severe birth defects if she gets pregnant.

Co-worker two: She is taking Aspirin and blood pressure medications. When asked about what she knew about the Aspirin, she stated that she is taking it because of the stroke heart attack she had last year and the side effect she stated was bleeding.

Co-worker three: He uses the Nicoderm patch. When asked what he knew about the Nicoderm patch, he stated that he is using it to help him stop smoking, he cleans the area before putting it on or else “it won’t stick”, he changes a new patch every morning, and he applies them in a sequential order on his arms. With respect to side effects, all he stated was that he can become addicted to the patch.

In response to my co-workers’ answer I used my medication app and I just told them some basic information regarding their medications. Two of my co-workers seemed to really appreciate me educating them a little and the other didn’t seem very interested 

The CardioMEMS HF System is a small implantable device for patients with heart failure, hypertension, peripheral neuropathy and other additional cardiovascular disorders that eventually result in heart failure. This device was created with the purpose of better managing heart failure in patients from their homes. The CardioMEMS HF is a sensor/ monitor device that is smaller than a dime and does not require any batteries. The device is placed through the distal pulmonary artery. Once home, the patient’s heart rate and artery pressures will be monitored daily by the CardioMEMS HF; on the other side, at a health facility, a physician or nurse will review the information. If there is an abnormality noted then a change to the patient’s medical therapy will be made. Through the use of CardioMEMS HF, the researchers hope to decrease hospitalizations by not having the patients come in to the hospital until they are experiencing severe symptoms from HF. In other words, the aim is to reduce hospitalizations through early interventions.

In regards to my opinion regarding CardioMEMS HF, I think it’s a great idea in that it could possibly decrease hospitalizations through early intervention; however, I find it a bit difficult on how the healthcare workers are going to get in contact with the patient to change the medical regimen when they identify an abnormality. Furthermore, in the case when the patient does have the CardioMEMS HF is implanted I believe that the patient should use standard self-monitoring in conjunction; this includes: self-monitoring of blood pressures.

Below is the link regarding CardioMEMS HF.

http://www.ucsf.edu/news/2014/10/119411/new-miniature-device-monitors-heart-failure-patients-remotely

Here is what I have eaten all day:

1. Hot chocolate
2. Fruit smoothie (spinach, 1 slice of cantaloupe, 1 slice of pineapple, ½ banana, and one orange)
3. Sandwich (mayo, mustard, 2 slices of ham, spinach, and pickles) with one bag of hot cheetos :/
4. Mexican cobb chicken salad
5. Lots of water
6. Hershey chocolate

If I were to have to change my diet to a low sodium/ low fat diet I do not think I would struggle a lot with the “low-sodium” part, because I do not like to eat a lot of salt in general. However, with respect to the “low- fat” part I might find it a bit challenging to adjust at first.

Testing =)