ABCDE Approach for Critically Ill Patients

ABCDE Approach for Critically Ill Patients The topic I have chosen for my vignette is a patient with chest pain. The Resuscitation Council (UK 2006) recommends that clinical staff should follow the ABCDE approach when assessing and treating critically ill patients. This will help to identify the deterioration of critically ill patients.With this in mind, it is important that patients presenting with cardiovascular conditions are promptly assessed and treated. Here I am following an ABCDE assessment on a patient with chest pain. The 58-year-old (anonymous) male patient admitted with chest pain, 8hours after the onset of the symptoms. Initially patient was thinking it is heartburn and been taken gaviscon and paracetamol. As I went to see the patient, I introduced myself and checked identity by asking the name.Patient is able to communicate.This incates that the airway is patent. Patient is looking pale and in short of breath. Complaining of heaviness and crushing pain around the chest radiating to left arm. Sat patient upright position and checked breathing. Respiratory rate is 20bpm. (9-14bpm is normal resp rate-bts guidelines). The pattern of the breathing is normal, the movement of the chest wall is equal, and symmetrical.SaO2 checked is, 95% on room air. (Above 94%is normal or 88%-92% for those with resp problem (copd) BTS 2008).I administered 35% oxygen via venturi mask. Supplemental oxygen therapy is important to maintain adequate oxygen levels in the tissues and organs when patients experiencing pain and shortness of breath. (Critical care assessment booklet) Patients peripheries are cold and clammy.this indicates poorly perfused tissues. Pressed on patients finger for 5 seconds to check the capillary refill time.(in health,initial blanching should disappear within 2seconds of releasing pressure(Athern and Philpot 2002).CRT is 4 seconds. delayed CRT indicates poor perfusion(Lima and Bakker 2005). checked radial pulse is tachycardic 114bpm.rate is regular. A manual pulse should always checked, as machines that measure heart rate tend to give an averaged value and therefore do not pickup irregularities or arterial insufficiency (Torrance and Elley, 1997).HR is above systolic blood pressure indicating that patient having cardiac problem. Blood pressure is 101/54 mmhg, Temp 36 deg. Patient was very restless due to pain. Obtained ECG and showing small elevation in the ST segment in standard leads.ST elevation is the first sign of infarction. This happens when myocardium injured. ECG is showing Acute Myocardial infarction. Pain relief is the first priority, as uncontrolled pain increases sympathetic stimulation, which leads to increased myocardial oxygen consumption. This can further aggravate the ischemia (T Moore P Woodrow). Informed doctor about patients condition. Inserted cannula and taken bloods for troponin t and routine investigation fbc, ues, coagulation profile. Doctor arrived and examined the patient, advised to give GTN spray and Diamorphine injection (GTN generates nitric oxide that is Vasoprotective.Nitrovasodilators act primarily to dilate veins and therefore has a major effect on reducing the filling pressures of the heart. This helps to reduce myocardial contraction, wall stress, oxygen demands .It is short acting, and its effects last up to 30 minutes. The sublingual route is preferred as this avoids metabolism by the liver which reduces the drug concentration (H Chummun,KGopaul,A. Lutchman 2009) Diamorphine injection 5mg intravenously given .This is both potent analgesic and has pos itive hemodynamic effects particularly,vasodialatation which reduces the myocardial oxygen demand. Metochlorpromide 10mg intravenously (Antiemetic) given along with opiates to minimize nausea, a side effect of opiates therapy. Aspirin and Clopidogrel 300mg given .These are antiplatelet drugs ,decrease the platelet aggregation and inhibit thrombus formation in the arterial circulation ,because in faster-flowing vessels,throbi are composed mainly of platelets with little fibrin. (BNF 2010) Patient is not thrombolysed with streptokinase injection, because the late presentation and later administration is less effective outcome. Currently most protocols advocate a time window of 6hrs from the onset of pain during which it is appropriate to give thrombolytics.After this time it is usually considered that the risk of the drug outweigh the limited benefit gained(MrBassets and Mr Makins). Reassessed vital signs and pain. The pain is easing off slightly, scoring 2.respiratory rate 16bpm , HR 98bpm BP 112/68,CRT 2. Patients condition is improving. Pain assessment is a priority because continued pain is a symptom of ongoing MI, which places additional risk on myocardial tissue (Urden et al, 2002). Repeat Diamorphine injection given as advised by doctor. Closely observed the patient, monitored breathing and oxygen saturation. Oxygen therapy continued, because it is important to assist the myocardial tissue to continue its pumping activity and to repair the damaged tissue around the site of the infarct (Sole et al, 2001).No shortness of breath at present. Repeat ECG taken in 15 minutes interval for assessment of dysrhythmias and it is noninvasive, well tolerated by patients and provides continuous information about the heart (Docherty and Douglas, 2003). Patients blood sugar checked and it is 6.7mmol.patient has no diabetic history. Patient is very anxious and worried. Anxiety can play a role in acute MI. It may affect the development of further heart disease, further morbidity or prognosis, health care use and rehabilitation. (Crow et al,1996, Januzzi et al 2000).I reassured patient. Anxiety management is assigned a high priority in the early management of Acute MI. Doctor discussed with family about present condition and treatment. Family member who are anxious or upset about the patients condition may heighten patient anxiety, research suggest that family members should provide with information to meet their needs to reduce family anxiety (Quinn et al 1996).Doctor explained to the family about patients diagnosis and treatment. Heart rate monitored continuously by attaching telemetry. This helps to identify cardiac arrhythmias. Vitals signs and pain score recorded regularly. Recognizing the signs of clinical deterioration and taking appropriate timely action can be a vital part of providing optimal patient care. The clinical signs of critical illness usually reflect compromised respiratory, cardiovascular and neurological function.The underlying aim of the initial interventions should be seen as a holding measure to keep the patient alive,and produces some clinical improvement ,in order that definitive treatment may be initiated(Nolan et al,2005).

Employment Law HRM Strategy Essay

Employment law is critical to an organization allowing it to fulfill needs and business ventures applicable to state and federal laws. In this paper we will be discussing the laws that allow and disallow seasonal employees from another country to be able to work in the state of Georgia. In the paragraphs below I will explain to you the reader the scenario listed above, I will set a plan in accordance to the HRM situation, justify my approach to HR management, state the competitive advantage, and describe the situation that may occur from not properly following the appropriate laws. Everyone has the right to work, and there are many opportunities in this country. In order to enjoy these liberties workers need to be documented in order to be legally able to work without consequence to them, and the company that they are occupying a position. Employment law consists in the body of laws and rules regulating civil rights and non-union related conduct in the workplace (Stewart, 2012). Civil rights include a workplace free from discrimination and harassment for people who fit into one of the legally protected class (Stewart, 2012). Conduct law refers to equal and fair pay immigrant and employment at will laws (Stewart, 2012). These laws are the laws that are pertaining to the laws that are corresponding with the situation of seasonal employees from another country. The Migrant and Seasonal Agricultural Worker Protection Act (MSPA) provides employment-related protections to migrant and seasonal agricultural workers and is administered and enforced by the Wage and Hour Division of the U. S. Department of Labor (DOL,2012). Within the confines of the law I came up with a plan for seasonal workers, first these are the parameters that we must follow. Every non-exempt farm labor contractor, agricultural employer, and agricultural association must: * Disclose the terms and conditions of employment to each migrant worker in writing at the time of recruitment and to each seasonal worker when employment is offered, in writing if requested; * Post information about orker protections at the worksite; * Pay each worker the wages owed when due and provide each with an itemized statement of earnings and deductions; * Ensure that housing, if provided, complies with substantive federal and state safety and health standards; * Ensure that each vehicle, if transportation is provided, meets applicable federal and state safety standards and insurance requirements and that each driver be properly licensed; * Comply with the terms of any working arrangement made with the workers; and * Make and keep payroll records for each employee for three years (DOL. 012) The plan that we will use to manage the situation will be by appointing two or three HR professionals, and a project manager to oversee the project. They will coordinate events as per the MSPA which regulates the seasonal workers. The MSPA requires farm labor contractors, agricultural employers, and agricultural associations, who recruit, solicit, hire, employ, furnish, transport, or house agricultural workers, as well as providers of migrant housing, to meet certain minimum requirements in their dealings with migrant and seasonal agricultural workers (DOL, 2012). Our plan resembles closely to what is already in state as per state, federal and local legislations. Human resource is the greatest asset that any organization possesses and it must ensure that this potential is harnessed to the maximum to contribute positively towards the growth of the organization (Amillionlives, 2010). Every non-exempt farm labor contractor, agricultural and seasonal agricultural association must; disclose the terms and conditions of employment to each migrant worker in writing at the time of recruitment and to each seasonal worker when employment is offered in writing (DOL, 2012). HR management would use this information to aide in writing the offers of employment for the migrant and farm workers. There are many competitive advantages of HRM practices meets the employment laws, typically business are more competitive with a structured HRM practice in place. Having an HRM in place makes it easier to organize employment according to the laws. An effective HRM in a competitive advantage will use information provided from the Department of Labor (DOL), one instance that would be useful in this situation is Employers must provide each migrant and seasonal day-haul worker with a written disclosure at the time of recruitment that describes the terms and conditions of his or her employment. When offering employment, the employer must provide such isclosure to all seasonal workers upon request. The disclosure must be written in the worker’s language. If the HRM is effective they will be able to utilize different commodities of the job in order to provide the service as per employment laws and contract obligations. If the situation of the need for seasonal employees who may be from another country were not to follow proper laws could result in major fines and penalties to the company. Ethics related problems are faced by the organizations whenever there is a practice of using favoritism rather than ability or job performance for managerial decisions regarding employment, promotion, pay and discipline. These problems can be reduced and eliminated by maintaining the highest standards of professional and personal conduct, encouraging employers to make fair and equitable treatment of all. Severe penalties may arise from the state and federal departments for not following proper protocol. Immigration may also be informed of the situation due to the fact that they are dealing with non-citizen workers. In the paragraphs above I have explained to you the reader the scenario of the seasonal workers, provided a plan, justified the approach of HR management, competitive advantage, and provided the consequences that may arise from not following proper laws and protocol.

Economists Asset Market - Free Essay Example

Sample details Pages: 6 Words: 1758 Downloads: 7 Date added: 2017/06/26 Category Economics Essay Type Analytical essay Did you like this example? Literature Review There have been different views between Economists and financial market participants upon the valuation of an asset. Economists believe that the price of an asset should reflect the fundamental value given the assumption of rational behavior and of rational expectations. On the other hand, financial market participants believe that the fundamental value is part of the asset price. Thus, Markets participate will interpret a positive price volatility as the herd behavior. However in the past they were unable to interpret the excess volatility which was followed by the collapse of the market. Don’t waste time! Our writers will create an original "Economists Asset Market" essay for you Create order Volatility Some of the major crashes such as Tulip mania, the South Sea Bubble, Mississippi Bubble and the Great Crash of 1929 have induced researches to concentrate their study on asset price volatility. Asset price volatility shows by how much an asset deviates from its fundamental value i.e. the risk with is attached to an asset. During the above listed crashes, the volatility rate was very high, as a result researches found the presence of bubble in the assets. Bubble can be defined as a state of rising asset prices. Once a peak price is attained there may be substantial decrease in the price. A famous example will be the South Sea Bubble whereby the stock value of the South Sea Company rose by over 700% during the first half of 1720. And at the end of 1720, the price fell back to about fifty percent of its value at the start of the year. The existence of bubbles can be depicted by comparing the fundamental value with the market value of an asset. The fundamental value of an asset means the share price should include information about the present and future return of the asset i.e. the discounted present and future cash flows. The bubble component reflects the value which is actually bigger than the present value of expected future price. Moreover, bubbles affect the riskiness of the market and it may also contribute to the fluctuations of the macroeconomic variables as it had been the case during the occurrence of the October 1929 Wall Street Crash and the Great Depression. It is interesting to note that bubbles create excess demand in the market while supply remains constant. Therefore, in other words, there will be a shortage and this will lead to an increase in the share price. Most models of market behavior are based on rational expectations, which assume that: individuals have rational information processing Individuals have a correct model of the fundamental structure of the economy. If any of the condition listed above is violated, bubbles may arise. Bubbles may be classified into speculative bubbles and speculative bubbles cover two kinds of bubbles: rational bubbles and irrational bubbles. There will be irrational bubble if the first one is violated whereas the violation of the second condition will give rise to irrational bubbles. The theory of rational bubbles demonstrates that, even with rational expectations, asset price deviations from the fundamental value would be possible. The growth of rational bubbles reflects the presence of self-fulfilling expectations about future increases in the asset price. A common feature of the market will be that investors buy an asset only with expectation that it could be resold in the future at a higher price to another investor who is willing to purchase the asset for the same reason. In an irrational bubble, market participants may focus on noise instead of fundamentals. Some noise or unsophisticated traders in a market may overwhelm rational or sophisticated investors if the time horizons for arbitrage are finite. How Bubble was created Overinvestment and malinvestment may create bubbles in the market. Overinvestment means investing in too many capital assets to meet the required demand. On the contrary, malinvestment means investing in the wrong capital assets to produce goods and services. A most recent example will be Asian Financial Crises 1997. The Chinese Government injected a lot of assets in the red chips companies in the expectation to increase the share price. The stock price did increase but it did not last for last as a bubble was being created. EMH It is arguable that the market is not efficient if there exists bubble in the market more precisely speculative bubbles. A speculative bubble can be distinguished as a persistent rise in the price of an asset. The initial rise creates forecasts of further rises and attracting new buyers, in general speculators interested in the rise of the price of the asset rather than in its use or its potential incomes. However, studies have show that despite the presence of speculative bubbles, the market is efficient. The share price has effectively deviates from the fundamental value but it does not have necessarily violated the efficient market hypothesis. In other words, the prices comprise of all available information about the present and future return taking into account the bubble component. Further, rationality of behavior and of expectations, together with market clearing, imply that assets are voluntarily held and that no agent can, given his private information and the information revealed by the prices, increase his expected utility by reallocating his portfolio. The following assumptions must be meant in order for a market to be efficient in spite of the presence of bubbles: Interest rate is constant, no constraints on short selling, risk neutrality All agents have the same set of information after having observe the market Bubbles are likely to increase the risk associated with holding the asset Risk averse individual requires higher rate to be compensated for taking higher risk Herd Behavior Self-fulfilling expectation of investors helps to develop bubbles. These may include herd behavior, panics, manias and among others. It is often argued that choice of an investor is based on the information derived by observing the actions of other investors i.e. they behave in herd. Thus, investors ignore their own information and rely on the uninformed choice of the previous investors. As such, they will try to acquire asset which is highly traded or which other investors are purchasing. In this event there will be bubble in the market and this will lead to an abnormal increase in the price. Moreover, a future increase in price will attract investors, they will thus buy low and sell high in the future and be realizing a capital gain. However, their common action will create excess demand for the share in the market leading to an equal increase in share prices assuming that supply is constant. This is an event that will create bubbles. Growth of Bubbles Rational bubbles may grow at a rate r each period but this may not be necessary the case. The rate r represents the growth rate at which a price increases normally. Notably, if traders are risk-averse, bubbles will grow faster than the rate of r, effectively paying traders a risk premium in the expected value to hold the asset i.e. they are being compensated for holding additional amount of risk. Growing bubbles may have harmful real effects on the economy by inefficient supply at high prices or making asset prices poor signal. Bubbles also harm welfare because they redistribute wealth, but random redistribution is only harmful if traders are risk-averse since risk-averse traders will avoid a bubble which grows at a rate r. A bubble may grow at a negative rate in some periods for example when it bursts or in all periods where the discount rate is negative. However the bubble component for price may not be negative as investors have the choice to dispose of the asset and also the price of an asset can not become negative at a future date. Effects of Bubbles Initially the price of a stock is considered to be at equilibrium, with a marginal product of capital equal to interest rate. In the absence of bubble, the value of the share can be said to be the replacement cost and the firm has no incentive to increase its number of stocks. Suppose that a bubble starts on its shares, increasing the price, say by 8%. In order to reconcile the price, the firm should add value to the capital stock until the marginal product has been reduces by 8% and the market price will equal to the fundamental value. On the other hand, if the firm issues more shares, this will help the bubble to grow and burst in the future. Further, at a certain price level no one will be willing to purchase the stock and thus creating an excess of supply in the market, leading to a substantial decrease in the value of the stock. How bubbles can be rule out. The major problem with bubble in asset prices is that you never know when it is going to burst. Further the burst of the bubbles will affect the market as a whole as evidence can be taken for the past crashes. Several ways can be adopted to rule out a bubble from the market. Many countries have even enacted laws in order to protect themselves from such a framework. For example, the South Sea Bubble caused the British Parliament to pass the South Sea Act which effectively eliminated the stock market as a source of funds for over a century and in the United States, the Great Crash of 1929 led to the creation of the SEC and the introduction of numerous regulations. There are also other ways in which bubbles can be rule out of the market. Firstly, firms can impose an upper limit on the stock prices and stock should be issued in response to stock price increases. Secondly short selling may help to cancel out the bubble effect. This is in the sense that a positive bubble will attract agents to short sell the assets. At the same time, they will invest some of the proceeds to pay for the stream of dividend and as such there will be positive wealth left over and arbitrage would rule out bubbles. Evidence The study of bubbles behavior can be classified as direct or indirect test. Indirect test was used to study the difference between the actual price and the fundamental value. However the main problem remain on the interpretation part as the effect of bubble in stock prices could not be distinguished from the effects of unobservable market fundamentals. On the other hand, direct test try to directly test for the presence of bubbles. As such researchers try to identify the type of bubble that is present in the market and hence carry out the test accordingly.

Taking a Look at Same-Sex Marriages - 1029 Words

Same-Sex Marriages Over the years, the levels of acceptance to same-sex marriages have risen gradually. On large scale, much of this ‘acceptance’ comes in the form of tolerance. It is now perfectly bearable for heterosexuals to turn show approval of their relatives or their friends procuring gay marriages. After all, it is much easier to put aside one’s distaste to this occurrence, than face the vicious accusations that would follow if they said a word that in the least betray their objections. However, do you suppose that this tolerance makes this kind of marriages okay? No, on the contrary, this passive acceptance is not only hypocritical, but it also masks the real moral questions surrounding this issue. Often, the proponents of same sex-marriages are those individuals who personally gay. They base their argument in their supposed orientation to same-sex attraction. According to these individuals, this orientation is inborn and consequently involuntary. That being the case, they argue that the only way they can lead happy and actualized lives is only if they are able to pursue exploit their sexuality in the way they are oriented. Given that, they have a claim to human rights, like every other person who is not gay; they claim that any restriction to their formalizing of gay marriages is contemptuous to the inalienable nature of their rights. Secondly, the proponents of same-sex marriages base their defence in the consensual nature any marriage. Essentially, two adultsShow MoreRelatedTaking a Look at Same-Sex Marriage938 Words   |  4 PagesSame-sex marriage is against the law and against the moral standards of the religious society. In this paper I will sympathize with the homosexual community in order to improve their views on marriage. First amendment of the Constitution protects and makes homosexuality legal. Marriage is also legal. Marriage laws and the rights that fall under marriage are defined and upheld by the states. 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This is the exact direction that our country is taking as we speak right now, with each state giving same-sex marriage a second thought, and most starting to make heterosexual marriage legal. There are plenty