Hjärtstillestånd: Sjukskötarens erfarenheter av omvårdnadssituationen

Bakgrund: Vid hjärtstillestånd som sker inom sjukhusmiljö är det oftast sjukskötaren som är först på plats. Sjukskötare är ofta de första som måste ta initiativ och påbörja återupplivningsförsök, kalla på hjälp och se till att patienten får den akuta hjälp som den behöver. Syfte: Syftet är att beskriva sjukskötarens erfarenheter av omvårdnadssituationen vid hjärtstillestånd. Metod: Detta arbete är en kvalitativ litteraturöversikt med ett induktivt förhållningssätt. Resultat: Litteraturöversiktens åtta artiklar resulterade i ett övergripande tema det är på liv och död samt tre underteman känslan av att kämpa tillsammans, utmaningen med att finnas för närstående samt kampen mellan rätt och fel. Slutsats: Sjukskötaren kan komma i kontakt med många olika utmaningar under ett hjärtstillestånd och de får ta ett stort ansvar gällande patientens liv. När sjukskötare har den kompetens och färdigheter som krävs kan de känna sig mer förberedda för ett hjärtstillestånd. När en patient pendlar mellan liv och död är det många olika faktorer som påverkar arbetet och överlevnadschansen för patienten

Exercise-related cardiac arrest in Västra Götaland; Incidence,

Introduction Total incidence of out-of-hospital cardiac arrest (OHCA) with attempt to resuscitation in Sweden is around 5.000 cases annually, 11 % of these survives. The incidence of exerciserelated OHCA is scarcely studied, as well as the characteristics, prognosis and outcome of these cardiac arrests. Aim This study aims to assess the incidence of exercise-related OHCA in Västra Götaland and to compare characteristics, prognosis and outcome for these cardiac arrests with the nonexercise- related OHCAs. A secondary aim is finding high-risk activities and describe incidence and prognosis of the exercise-related OHCA for each activity. Method This is a retrospective cohort study including all OHCA’s occurring outside of home in Västra Götaland year 2011-2015 that is a part of the online Swedish Cardio- Pulmonary Resuscitation Register (Svenska Hjärt-lungräddningsregistret). A computer software with additional questionnaire was used to collect the data concerning the characteristic of the OHCAs. Result 1415 OHCAs outside of home where resuscitation was attempted occurred in Västra Götaland year 2011-2015. 90 (6.4%) of the OHCA were exercise related and 86 (95.6%) of these occurred in men. Patients suffering an exercise-related OHCA were on average 10 years younger than those who had a non-exercise-related OHCA, 57.4 vs 67.3 years and they had a significantly better survival rate to 30 days, 53.6 % survival, compared to 19.7% in the nonexercise related group (p < 0.001). The sports with most exercise-related OHCA were bicycling, gym- workout and golf. Conclusion Exercise related OHCA has a low incidence in the general population, 1 per 100 000 personyears. Cardiac arrests that occur in relation to exercise have a significantly better prognosis and outcome than non-exercise related cardiac arrests.Introduction Total incidence of out-of-hospital cardiac arrest (OHCA) with attempt to resuscitation in Sweden is around 5.000 cases annually, 11 % of these survives. The incidence of exerciserelated OHCA is scarcely studied, as well as the characteristics, prognosis and outcome of these cardiac arrests. Aim This study aims to assess the incidence of exercise-related OHCA in Västra Götaland and to compare characteristics, prognosis and outcome for these cardiac arrests with the nonexercise- related OHCAs. A secondary aim is finding high-risk activities and describe incidence and prognosis of the exercise-related OHCA for each activity. Method This is a retrospective cohort study including all OHCA’s occurring outside of home in Västra Götaland year 2011-2015 that is a part of the online Swedish Cardio- Pulmonary Resuscitation Register (Svenska Hjärt-lungräddningsregistret). A computer software with additional questionnaire was used to collect the data concerning the characteristic of the OHCAs. Result 1415 OHCAs outside of home where resuscitation was attempted occurred in Västra Götaland year 2011-2015. 90 (6.4%) of the OHCA were exercise related and 86 (95.6%) of these occurred in men. Patients suffering an exercise-related OHCA were on average 10 years younger than those who had a non-exercise-related OHCA, 57.4 vs 67.3 years and they had a significantly better survival rate to 30 days, 53.6 % survival, compared to 19.7% in the nonexercise related group (p < 0.001). The sports with most exercise-related OHCA were bicycling, gym- workout and golf. Conclusion Exercise related OHCA has a low incidence in the general population, 1 per 100 000 personyears. Cardiac arrests that occur in relation to exercise have a significantly better prognosis and outcome than non-exercise related cardiac arrests

Djursjukskötarens roll vid en EKG-undersökning

Djurägare som kommer med sina hundar till djurvården har höga krav på den veterinärmedicinska professionen. Utvecklingen inom djurvården går fort och tillstånd som tidigare var svåra att behandla eller i värsta fall ledde till avlivning, kan idag behandlas. För att säkerställa hundarnas mående används många olika metoder, inte minst vad det gäller hjärtats funktion. En metod som används för att studera hjärtats funktion är elektrokardiogram, EKG. En väl genomförd EKGundersökning och efterföljande tolkning med eventuell behandling kan i vissa fall vara livsavgörande för hunden. Det är därför betydelsefullt för djursjukskötare att veta vad som förväntas av dem inom sin yrkesutövning gällande EKGundersökningar. Denna studie avsåg att genom intervjuer med djursjukskötare och veterinärer undersöka vad djursjukskötare tror sig behöva kunna veta om EKG och vad veterinärerna förväntar sig av djursjukskötarna vid EKG-undersökningar och EKGtolkning. I studien intervjuades fyra djursjukskötare och en veterinär som arbetade antingen på operations- eller intensivvårdsavdelning samt en kardiolog som konsultativt besvarade EKG-frågeställningar på bland annat dessa två avdelningar. Vid sammanställning av resultatet framkom det att samtliga djursjukskötare var väl bevandrade i EKG-apparatens olika inställningar, hur själva undersökningen bäst utförs och samtliga hade gedigen kunskap vad gällde tolkning av EKG. Det fanns en god samstämmighet mellan djursjukskötarnas kompetens och veterinärernas förväntningar. Utifrån intervjustudien gjordes även en fördjupad litteraturbakgrund om EKG. Syftet med detta var att belysa de kunskaper som kan ligga till grund för djursjukskötare som arbetar med EKG framför allt på en operations- eller intensivvårdsavdelning. Studien är begränsad och resultaten är sannolikt ej representativa för kunskapen hos gemene djursjukskötare och motiverar därför till ytterligare studier. Konklusionen av studien är att det finns ett visst stöd för att djursjukskötare generellt ska kunna utföra en tillfredsställande EKG-undersökning och tolka ett normal-EKG. Studien talar även för att djursjukskötare som arbetar på operationseller intensivvårdsavdelning förväntas ha kunskap om olika arytmier.Animal owners’ have high expectations of the veterinary professionals. The development in veterinary medicine is very rapid and conditions that used to be difficult to treat or even worse, was a cause for euthanasia, can be treated today. To secure the well-being of animals a lot of methods are used, not least when it comes to monitoring heart function. One method that is used is electrocardiogram, ECG. An ECG tracing well executed with a following interpretation and an eventual treatment, can be lifesaving. Therefore, it is of importance for the veterinary nurse to know what is to be expected of them when it comes to ECG in their professional practice. This study intended, by interviewing veterinary nurses and veterinarians, to try to answer what veterinary nurses believe they have to know about ECG and what the veterinarians expect from the veterinary nurse when it comes to performing and interpreting an ECG. Four veterinary nurses and one veterinarian who all worked either in an operating room or in an intensive care unit were interviewed as well as one cardiologist who did ECG consultative work amongst these two units. We found in the interview study that the veterinary nurses were well versed when it came to the ECG machine and its different settings, how an ECG is best executed, and all the nurses had solid knowledge in ECG interpretation. There was a good correspondence between the competence of the veterinary nurses and the expectations from the veterinarians. After the interview study an in-depth literary study regarding ECG was conducted, as a background. The purpose with the literary study was to illustrate the knowledge that a veterinary nurse working in an operational theater or an intensive care unit can be expected to have. Even though this is a small study and the results most likely are not representative for the ECG knowledge of the veterinary nurse in general which motivates more studies to be done within the field, the conclusion is that this study indicates that the veterinary nurse should be able to perform a satisfactory ECG and be able to interpret a normal ECG tracing. The study also indicates that veterinary nurses working in an operating room or in an intensive care unit are expected to have knowledge of different arrhythmias

Critical care : cardiovascular disorders-symptoms, causes and measures

The cardiovascular system is one of the three major body systems. When an animal in a critical state arrives at the animal hospital, it is important to know the normal parameters in order to assess the patient’s cardiovascular status. Triage is a process where you considerate the patient’s condition instead of check in time, or other criteria. Many critically ill patients suffer cardiovascular disorders at the time of clinical examination. These disorders can lead to multiple organ failure and death if not addressed. A successful cardiopulmonary resuscitation is a team effort where the veterinary nurse has an important role. The purpose of our report is to shed light on what cardiovascular disorders are and the veterinary nurse’s part in the treatment of the disease in the critical state. Advanced animal care is an essential element for the care of the critically ill patient. It is important to distinguish different types of shock because treatments can vary. In most situations, the type of shock can be discerned by careful examination. Regardless of the type of shock, the treatment is always aimed at maximizing oxygen delivery and to provide fluid therapy. The jugular vein is an effective access port for administring both infusions and drugs that also can be used for blood sampling and monitoring. This report describes function of monitoring equiment, the normal parameters of the animal, life-supporting measures, drugs and the veterinary nurse’s role in the treatment of dogs and cats. The report also includes a discussion of arguments as to why the animal owner may choose to refrain from resuscitation and why defibrillation isn’t as frequently used in veterinary medicine as in human medicine. The report is structured as a literature review and a small observation and contains an intensive care schedule that facilitates monitoring of the critically ill animal