Management of perinatal HPP during critical illness/ECMO

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Neetu Krishnan ◽  
Nancy Dunbar
Keyword(s):  
Critical Illness ◽  
Respiratory Distress ◽  
Health Care Providers ◽  
Influenza A ◽  
Bone Mineralization ◽  
Close Monitoring ◽  
Care Providers ◽  
Enzyme Replacement ◽  
Life Saving ◽  
Chest X Ray

Abstract Objectives With the advent of asfotase alfa, the enzyme replacement therapy (ERT) approved for hypophosphatasia (HPP), health care providers need to navigate management of ERT during critical illness. Case presentation We present the case of a young girl, treated with ERT for severe perinatal HPP, who had cardiorespiratory arrest in the setting of influenza A. Her life-saving treatment involving extra corporeal membrane oxygenation (ECMO) required a two-week interruption of ERT leading to persistent hypercalcemia and hyperphosphatemia. A three year old female presented with respiratory distress and blood tinged secretions. She was influenza A positive with bilateral opacities on chest X-ray (CXR). Worsening respiratory distress and bradycardic arrest required intubation, CPR and venoarterial ECMO cannulation. She remained on ECMO for 10 days with anticoagulation restrictions requiring her thrice-weekly subcutaneous ERT to be held. Hypercalcemia (12.3 mg/dL) and hyperphosphatemia (7.6 mg/dL) developed two weeks after restarting ERT and resolved six weeks later. Conclusions We highlight that the obligatory cessation of ERT while on ECMO led to the loss of functional TNSALP with a profound decrease in bone mineralization leading to excess circulating calcium and phosphorus. In cases where it is necessary to interrupt ERT, we advise close monitoring of calcium and phosphorous levels.

Pandemic 2009 (A)H1N1 influenza (swine flu) — the Manitoba experienceThis paper is one of a selection of papers published in this special issue entitled “Second International Symposium on Recent Advances in Basic, Clinical, and Social Medicine” and has undergone the Journal's usual peer review process.

2010 ◽  
Vol 88 (4) ◽  
pp. 589-593 ◽  
Author(s):  
Joanne Embree
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Influenza A ◽  
Peer Review Process ◽  
Swine Flu ◽  
Infection Prevention And Control ◽  
Close Monitoring ◽  
Care Providers ◽  
Diagnostic Laboratory ◽  
Influenza A H1n1

The pattern of illness associated with the first wave of the pandemic influenza A H1N1 (swine flu) in the spring and early summer of 2009 in regions of the province of Manitoba in Canada was more severe, on a population basis, than any other northern hemisphere jurisdiction outside of Mexico City. Manitoba accounted for 50% of intensive care admissions and 25% of pediatric admissions, but only 6.5% of deaths, attributable to the virus in Canada during the first wave. Activation and use of emergency response protocols embedded within the routine health authority management system and good communication between the diagnostic laboratory, public health, and health care practitioners was effective in coping with the sudden need for hospitalization of large numbers of children and young adults with severe respiratory illness over a short time period. Early treatment with oseltamivir was associated with a shorter duration of hospitalization among children. Intensive education of health care providers, patients, and visitors, along with close monitoring of infection prevention and control practices, were instrumental in preventing both nosocomial and health care worker infections.

scholarly journals 0907 Implementation Of Pathway For Severe Obstructive Sleep Apnea Management In Children

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A345-A345
Author(s):  
S Gehring ◽  
L Auricchio ◽  
S Kidwell ◽  
K Oppy ◽  
S Smallwood ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Health Care Providers ◽  
Therapeutic Option ◽  
Sleep Medicine ◽  
Close Monitoring ◽  
Severe Obstructive Sleep Apnea ◽  
Care Providers ◽  
Oxygen Supplementation ◽  
Obstructive Sleep

Abstract Introduction Obstructive Sleep Apnea (OSA) is associated with neuro-cognitive, cardiovascular and metabolic morbidity in children. Adeno-tonsillectomy is the first line of treatment for OSA with PAP therapy and Oxygen supplementation being alternative therapeutic options in select cases. Severe Obstructive Sleep Apnea is a known risk factor for postoperative respiratory complications after adenotonsillectomy. Therefore, inpatient adenotonsillectomy with close monitoring is recommended for this group of children. Challenges to safe and timely care for this high risk group of children can be overcome with effective coordination of care between different locations and health care providers. Methods All children seeking treatment at Dayton Children’s Division of Sleep Medicine were managed through a pathway developed by a multi-disciplinary team involving sleep medicine, otolaryngology and clinical logistics. Severe OSA was defined as AHI ≥15 events/hr (children <2 year old), AHI ≥15 events/hr with three or more Oxygen desaturations <80% (children ≥2 to <6 years old), AHI ≥ 30 events/hr with three or more Oxygen desaturations <80% (Children ≥6 to 18 years old). Results A total of 78 children were diagnosed with severe OSA in 2019. All children were successfully triaged to appropriate therapeutic option (Adenonotonsillectomy, PAP, O2) within 24 hours of diagnosis. Urgent adenotonsillectomy was performed on the same day in 4 children and within 2 weeks on 12 children. There was no postoperative respiratory complication after urgent adenotonsillectomy. Thirteen children had adenotonsillectomy after 2 weeks. PAP therapy was started in 28 children (34%). Therapy was initiated on the same day in 10 children and the next day on one child. Oxygen supplementation was started in 21 children (27%). Conclusion A multidisciplinary collaborative approach can result in delivery of timely and safe care for severe OSA in children. Support NA

scholarly journals Mitigating the Twin Threats of Climate-Driven Atlantic Hurricanes and COVID-19 Transmission

2020 ◽  
Vol 14 (4) ◽  
pp. 494-503 ◽  
Author(s):  
James M. Shultz ◽  
James P. Kossin ◽  
Attila Hertelendy ◽  
Fredrick Burkle ◽  
Craig Fugate ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Care Providers ◽  
Protective Measures ◽  
Rapid Acquisition ◽  
Atlantic Hurricane ◽  
Hygiene Practices ◽  
Emergency Managers ◽  
Life Saving ◽  
Atlantic Hurricanes ◽  
Timely Warning

ABSTRACTThe co-occurrence of the 2020 Atlantic hurricane season and the ongoing coronavirus disease 2019 (COVID-19) pandemic creates complex dilemmas for protecting populations from these intersecting threats. Climate change is likely contributing to stronger, wetter, slower-moving, and more dangerous hurricanes. Climate-driven hazards underscore the imperative for timely warning, evacuation, and sheltering of storm-threatened populations – proven life-saving protective measures that gather evacuees together inside durable, enclosed spaces when a hurricane approaches. Meanwhile, the rapid acquisition of scientific knowledge regarding how COVID-19 spreads has guided mass anti-contagion strategies, including lockdowns, sheltering at home, physical distancing, donning personal protective equipment, conscientious handwashing, and hygiene practices. These life-saving strategies, credited with preventing millions of COVID-19 cases, separate and move people apart. Enforcement coupled with fear of contracting COVID-19 have motivated high levels of adherence to these stringent regulations. How will populations react when warned to shelter from an oncoming Atlantic hurricane while COVID-19 is actively circulating in the community? Emergency managers, health care providers, and public health preparedness professionals must create viable solutions to confront these potential scenarios: elevated rates of hurricane-related injury and mortality among persons who refuse to evacuate due to fear of COVID-19, and the resurgence of COVID-19 cases among hurricane evacuees who shelter together.

Creating Coronary Care Units and Empowering Nurses

2015 ◽  
Author(s):  
W. Bruce Fye
Keyword(s):  
Cardiac Arrest ◽  
Health Care Providers ◽  
Vital Role ◽  
Care Providers ◽  
Vulnerable Patients ◽  
Life Saving ◽  
Life Threatening ◽  
Coronary Care ◽  
Infarction Heart ◽  
Coronary Care Units

The coronary care unit (CCU) concept was proposed in 1961 as a strategy to save the lives of patients hospitalized after an acute myocardial infarction (heart attack). The notion was to place vulnerable patients in an area where their heartbeats were monitored continuously and where specially trained nurses could initiate cardiopulmonary resuscitation (CPR) if a patient had a cardiac arrest. Cardiac defibrillators and temporary pacemakers, technologies developed in the 1950s to treat life-threatening heart rhythms, were combined with CPR in 1960 in an attempt save patients’ lives. Nurses played a vital role in CCUs, and the new care model transformed the traditional nurse-doctor relationship. Nurses were trained to initiate life-saving treatments without a physician being present. The resulting empowerment of nurses had significant implications for their status as health care providers. The CCU movement also contributed to the development of cardiac arrest teams and paramedic-staffed, defibrillator-equipped ambulances.

Patient with a History of Active Substance Abuse Requesting Opioids for Chronic Pain

2021 ◽  
Author(s):  
Alan D. Kaye ◽  
Martin J Carney ◽  
Mark R. Jones ◽  
Harold J. Campbell ◽  
Burton R. Beakley
Keyword(s):  
Substance Abuse ◽  
Chronic Pain ◽  
Health Care Providers ◽  
Active Substance ◽  
Ethical Issues ◽  
Clinical Manifestations ◽  
Prescription Opioid ◽  
Close Monitoring ◽  
Care Providers ◽  
History Of

Health care providers face a considerable challenge when treating chronic pain patients with prescription opioid medications. Although indications exist for the use of these drugs, their addictive nature and street value render them high-risk targets for abuse, misuse, and diversion. All patients receiving opioids should, therefore, be screened for abuse potential before beginning opioid therapy, be required to sign an opioid agreement, and receive close monitoring throughout the course of their treatment. Patients who present with a history of active substance abuse are at higher risk for iatrogenic dependence and necessitate more frequent monitoring. Herein arise several ethical issues, such as the principle of justice, which mediates equitable treatment for all patients. This review discusses the disease underlying substance abuse and clinical manifestations thereof, as well as relevant pathophysiology, ethical issues, and guidelines for the safe treatment with opioids. This review contains 3 tables and 43 references. Key Words: addiction, ethics, opioids, safety, substance abuse 

Needs Assessment for Simulation Training for Prehospital Providers in Botswana

2018 ◽  
Vol 33 (6) ◽  
pp. 621-626 ◽  
Author(s):  
Nicolaus W. Glomb ◽  
Adeola A. Kosoko ◽  
Cara B. Doughty ◽  
Marideth C. Rus ◽  
Manish I. Shah ◽  
...  
Keyword(s):  
Respiratory Distress ◽  
Needs Assessment ◽  
Health Care Providers ◽  
Low Income ◽  
Simulation Training ◽  
Educational Needs ◽  
Care Providers ◽  
Publication Type ◽  
Simulation Based ◽  
Gastrointestinal Complaints

AbstractBackgroundIn June 2012, the Botswana Ministry of Health and Wellness (MOHW; Gaborone, Botswana) initiated a national Emergency Medical Services (EMS) system in response to significant morbidity and mortality associated with prehospital emergencies. The MOHW requested external expertise to train its developing workforce. Simulation-based training was planned to equip these health care providers with clinical knowledge, procedural skills, and communication techniques.ObjectiveThe objective of this study was to assess the educational needs of the pioneer Botswana MOHW EMS providers based on retrospective EMS logbook review and EMS provider feedback to guide development of a novel educational curriculum.MethodsData were abstracted from a representative sample of the Gaborone, Botswana MOHW EMS response log from 2013-2014 and were quantified into the five most common call types for both adults and children. Informal focus groups with health professionals and EMS staff, as well as surveys, were used to rank common response call types and self-perceived educational needs.ResultsBased on 1,506 calls, the most common adult response calls were for obstetric emergencies, altered mental status, gastrointestinal/abdominal pain, trauma, gynecological emergencies, and cardiovascular and respiratory distress-related emergencies. The most common pediatric response calls were for respiratory distress, gastrointestinal complaints/dehydration, trauma and musculoskeletal injuries, newborn delivery, seizures, and toxic ingestion/exposure. The EMS providers identified these same chief complaints as priorities for training using the qualitative approach. A locally relevant, simulation-based curriculum for the Botswana MOHW EMS system was developed and implemented based on these data.Conclusions: Trauma, respiratory distress, gastrointestinal complaints, and puerperal/perinatal emergencies were common conditions for all age groups. Other age-specific conditions were also identified as educational needs based on epidemiologic data and provider feedback. This needs assessment may be useful when designing locally relevant EMS curricula in other low-income and middle-income countries.GlombNW, KosokoAA, DoughtyCB, RusMC, ShahMI, CoxM, GalapiC, ParkesPS, KumarS, LabaB.Needs assessment for simulation training for prehospital providers in Botswana. Prehosp Disaster Med. 2018;33(6):621–626.

scholarly journals Older Cancer Patients during the COVID-19 Epidemic: Practice Proposal of the International Geriatric Radiotherapy Group

Cancers ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 1287 ◽  
Author(s):  
Nam P. Nguyen ◽  
Vincent Vinh-Hung ◽  
Brigitta G. Baumert ◽  
Alice Zamagni ◽  
Meritxell Arenas ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Trials ◽  
Cancer Patients ◽  
Social Services ◽  
Health Care Providers ◽  
Close Monitoring ◽  
Care Providers ◽  
Phone Calls ◽  
Short Period ◽  
Older Cancer Patients

The coronavirus disease 19 (COVID-19) pandemic is unprecedented as it reached all countries in the world within a record short period of time. Even though COVID-19 infection may be just severe in any adults, older adults (65-year-old or older) may experience a higher mortality rate. Among those affected, cancer patients may have a worse outcome compared to the general population because of their depressed immune status. As the health resources of most countries are limited, clinicians may face painful decisions about which patients to save if they require artificial ventilation. Cancer patients, especially the older ones, may be denied supportive care because of their shorter life expectancy. Thus, special considerations should be taken to prevent infection of older cancer patients and to provide them with adequate social support during their cancer treatment. The following proposal was reached: (1) Education of health care providers about the special needs of older cancer patients and their risks of infection. (2) Special consideration such as surgical masks and separate scheduling should be made to protect them from being infected. (3) Social services such as patient navigators should be provided to ensure adequate medical supply, food, and daily transportation to cancer centers. (4) Close monitoring through phone calls, telecommunication to ensure social distancing and psychological support from patient family to prevent anxiety and depression. (5) Shorter course of radiotherapy by use of hypofractionation where possible to decrease the needs for daily transportation and exposure to infection. (6) Enrollment of older cancer patients in clinical trials for potential antiviral medications if infection does occur. (7) Home health care telemedicine may be an effective strategy for older cancer patients with COVID-19 infection to avoid hospital admission when health care resources become restricted. (8) For selected patients, immunotherapy and targeted therapy may become the systemic therapy of choice for older cancer patients and need to be tested in clinical trials.

scholarly journals Respiratory Care in Children with COVID-19

2021 ◽  
Author(s):  
Shalu Gupta ◽  
Suresh K. Angurana ◽  
Virendra Kumar
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Distress ◽  
Health Care Providers ◽  
Respiratory System ◽  
Oxygen Delivery ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Support ◽  
Critically Ill Children ◽  
Care Providers ◽  
Novel Coronavirus

AbstractThe novel coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is causing significant morbidity and mortality worldwide. The common presentations in children include involvement of respiratory system leading to pneumonia and acute respiratory distress syndrome, as well as multiorgan dysfunction syndrome and multisystem inflammatory syndrome in children (MIS-C). Pediatric COVID-19 is a milder disease as compared with the adults. Also, there is rise in MIS-C cases which is a hyperinflammatory condition temporally associated with SARS-CoV-2. Since respiratory system is predominantly involved, few of these critically ill children often require respiratory support which can range from simple oxygen delivery devices, high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), invasive mechanical ventilation, and extracorporeal membrane oxygenation (ECMO). Most of the oxygen delivery devices and respiratory interventions generate aerosols and pose risk of transmission of virus to health care providers (HCPs). The use of HFNC and NIV should be limited to children with mild respiratory distress preferably in negative pressure rooms and with adequate personnel protective equipments (PPEs). However, there should be low thresholds for intubation and invasive mechanical ventilation in the event of clinical deterioration while on any respiratory support. The principle of providing respiratory support requires special droplet and air-borne precautions to limit exposure or transmission of virus to HCPs and at the same time ensuring safety of the patient.

scholarly journals Use of rabies immune globulin in seven urban emergency rooms in Pakistan

2014 ◽  
Vol 8 (1) ◽  
pp. 61-65 ◽  
Author(s):  
Naseem Salahuddin ◽  
Khadija Mubashar ◽  
Naila Baig-Ansari
Keyword(s):  
Emergency Room ◽  
Immune Globulin ◽  
Health Care Providers ◽  
Cross Sectional Study ◽  
Human Rabies ◽  
Care Providers ◽  
Emergency Rooms ◽  
Cross Sectional ◽  
Life Saving ◽  
The Cost

Abstract Background: Human rabies is a fatal infectious disease that is entirely preventable if correct and timely postexposure prophylaxis is given. Unfortunately, rabies immune globulin (RIG) administration, a life-saving biological, is often avoided by Emergency Room health care providers (HCPs). Objective: To understand the practices of HCPs for administration of RIG in severe dog-bite exposures, which are common causes of emergency room visits in Pakistan. Methods: A cross-sectional study was conducted among 103 HCPs working in seven hospitals in three cities of Pakistan. Results: Of 103 HCPs who responded to the questionnaires, 97.1% had administered rabies vaccine and 31.1% had administered ERIG in the past three years of their practice; three quarters said they would prefer to use HRIG if available; 35% said they would not inject wounds at all, 24.3% would only vaccinate a patient with severe dog bites, but not administer RIG. More than 55% were concerned about the cost of human and equine RIG. Conclusion: Although there is awareness about use of RIG, this life saving biological is grossly underused because of poor availability in Emergency Rooms (ERs) even though stocked by local dealers. Animal bite centers must make RIG available for severe exposures.

scholarly journals Detection of SARS-CoV-2 by Real-Time PCR under challenging pre-analytical conditions reveals independence of swab media and cooling chain

2020 ◽  
Author(s):  
Sabrina Summer ◽  
Ralf Schmidt ◽  
Anna Nele Herdina ◽  
Isabella Krickl ◽  
Julia Madner ◽  
...  
Keyword(s):  
Real Time ◽  
Health Care Providers ◽  
Real Time Pcr ◽  
Influenza A ◽  
Storage Temperature ◽  
Respiratory Viruses ◽  
Storage Conditions ◽  
Care Providers ◽  
Viral Transport ◽  
Syncytial Virus

AbstractWith global demand for SARS-CoV-2 testing ever rising, shortages in commercially available viral transport media pose a serious problem for laboratories and health care providers. For reliable diagnosis of SARS-CoV-2 and other respiratory viruses, executed by Real-time PCR, the quality of respiratory specimens, predominantly determined by transport and storage conditions, is crucial. Therefore, our aim was to explore the reliability of minimal transport media, comprising saline and the CDC recommended Viral Transport Media (HBSS VTM), for the diagnosis of SARS-CoV-2 and other respiratory viruses (influenza A, respiratory syncytial virus, adenovirus, rhinovirus and human metapneumovirus) compared to commercial products, such as the Universal Transport Media (UTM). We question the assumptions, that the choice of medium and temperature for storage and transport affect the accuracy of viral detection by RT-PCR. Both alternatives to the commercial transport medium (UTM), namely the CDC viral transport media (HBSS VTM) and saline, allow adequate detection of SARS-CoV-2 and other respiratory viruses, regardless of the storage temperature and time.Our study revealed the high resilience of SARS-CoV-2 and other respiratory viruses, enabling proper detection in clinical specimens even after long-time storage at high temperatures, independent of the transport medium’s composition.

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