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Beginner’s Guide Beginner’s Guide Foreword Dear Reader, This Beginner’s Guide h

Beginner’s Guide Beginner’s Guide Foreword Dear Reader, This Beginner’s Guide has been made for you, who have recently joined the sales, market- ing, technical or administrative team of your country. As you may not be very familiar with Datex-Ohmeda, we would like to provide you this tool for understanding the basics behind our business. This book will give you information about the customer environment, basic anatomy and physiology, and the different monitoring parameters. This book will help you to understand 1 the patient care processes and the basic function of the five care areas, emergency, anesthesia, post-anesthesia, critical care and patient transportation 1 the basic physiology of breathing, blood circulation and brain function 1 the clinical monitoring parameters of patient’s vital functions 1 the importance of monitoring and taking care of patient’s vital functions Hopefully this Beginner’s Guide will help you to understand the needs of your customer even better. Yours truly, Timo Koskinen Director of Human Resources Datex-Ohmeda Division Instrumentarium Corporation 1 PATIENT CARE ................................................................................................................................. 1 1.1 Emergency .............................................................................................................................. 1 1.2 Anesthesia ............................................................................................................................. 3 1.2.1 Types of Anesthesia.................................................................................................... 4 1.2.2 Historical Review ....................................................................................................... 5 1.2.3 Patient Flow ................................................................................................................. 5 1.2.4 Physical Environment................................................................................................ 6 1.2.5 Anesthesia Machine .................................................................................................. 7 1.2.6 Care Providers in the Operating Room .................................................................. 9 1.2.7 Preoperative Care ..................................................................................................... 10 1.2.8 Intraoperative Care .................................................................................................. 11 1.2.9 Postoperative Care.................................................................................................... 13 1.2.10 Information Management and Documentation ................................................ 13 1.3 Critical Care ........................................................................................................................ 15 1.3.1 Physical Environment .............................................................................................. 16 1.3.2 Care Providers in the ICU....................................................................................... 16 1.3.3 Patient Admission..................................................................................................... 17 1.3.4 Patient Care ............................................................................................................... 18 1.3.5 Rehabilitation and Discharge ................................................................................. 18 1.3.6 Ethical Considerations ............................................................................................ 19 1.4 Transport.............................................................................................................................. 20 1.4.1 Principles of Safe Transfer...................................................................................... 21 1.4.2 Modes of Transfer and Associated Risks ............................................................. 21 2 BASIC PHYSIOLOGY .................................................................................................................... 23 2.1 Breathing.............................................................................................................................. 23 2.1.1 The Respiratory Organs ........................................................................................... 24 2.1.2 Mechanics of Breathing .......................................................................................... 25 2.1.3 Regulation of Breathing........................................................................................... 26 2.1.4 Problems Associated with Breathing .................................................................... 27 2.1.5 Assisting a Patient’s Breathing ............................................................................... 29 2.2 Heart and Blood Circulation ............................................................................................ 33 2.2.1 Anatomy of the Heart .............................................................................................. 35 2.2.2 Electrical Activity of the Heart .............................................................................. 36 2.2.3 Functioning of the Heart......................................................................................... 38 2.2.4 The Components of Oxygen Delivery .................................................................. 39 CONTENTS 2.3 Metabolism .......................................................................................................................... 42 2.4 Nervous System .................................................................................................................. 44 2.4.1 Brain Anatomy .......................................................................................................... 46 2.4.2 Peripheral Nervous System .................................................................................... 47 2.4.3 Neurons and Signal Transmission ........................................................................ 48 2.4.4 Factors Affecting Nervous Function ..................................................................... 48 2.4.5 Regulation of Body Temperature........................................................................... 48 3 PATIENT MONITORING.............................................................................................................. 50 3.1 Monitoring Ventilation ...................................................................................................... 51 3.1.1 Spirometry.................................................................................................................. 51 3.1.2 Carbon Dioxide ......................................................................................................... 54 3.2 Monitoring Oxygenation ...................................................................................................56 3.2.1 Patient Oxygen .......................................................................................................... 56 3.2.2 Pulse Oximetry.......................................................................................................... 57 3.2.3 Mixed Venous Oxygen Saturation......................................................................... 58 3.3 Monitoring Metabolism by Gas Exchange .................................................................... 59 3.4 Monitoring Blood Circulation.......................................................................................... 61 3.4.1 Blood Pressures ......................................................................................................... 61 3.4.2 Cardiac Output.......................................................................................................... 63 3.4.3 Gastric Perfusion ...................................................................................................... 63 3.5 Monitoring Electrocardiography..................................................................................... 65 3.6 Monitoring EEG.................................................................................................................. 68 3.7 Monitoring Adequasy of Anesthesia .............................................................................. 70 3.7.1 Inhalational Anesthetic Agents .............................................................................. 71 3.7.2 Muscle Relaxation .................................................................................................... 72 3.7.3 Depth of Anesthesia and Sedation........................................................................ 73 3.8 Monitoring Temperature .................................................................................................. 76 4 ANSWERS TO THE TASKS .........................................................................................................77 Beginner’s Guide 1 1 PATIENT CARE Learning objectives: After studying this chapter you will 1 have an overview of patient flow in the hospital within the five care areas, emergency, anesthesia, post-anesthesia, critical care and transportation 1 understand the characteristics of the five care areas 1 understand how patient care varies according to a patient’s medical condition and therapy 1 understand the specific challenges the care providers face in all five care areas Hospitals around the world vary in size from small clinics to huge hospitals. They are either privately owned, owned by community, or by state. There are veteran hospitals and children’s hospitals. There are hospitals for acutely ill, and for the dying. People come to the hospital looking for cure to their illness. The ultimate goal of every hospital is to improve patients’ condition, or if that is not possible, to ease their suffering. 1.1 Emergency When a sudden, serious medical crisis or a natural disaster that threatens the life of a person or a group of people occurs, it is called an emergency. Emergencies also exist when an individual’s psychological or physiological integrity is impaired. To meet these sudden needs, hospitals have developed specialized departments in which to care for people with the aforementioned crises. Emergency Unit, Emergency Department (ED), Emergency Room, Trauma Unit, and Casualty Unit may all be synonyms of places where emergency care is given in a hospital. 2 Beginner’s Guide TASKS 1.1 Emergency Q1 What is an emergency? ____________________________________________________________________ _________________________________________________________________________________________ Q2 Triage means _____________________________________________________________________________ _________________________________________________________________________________________ Q3 How many of the ED patients have a life threatening problem? __________________________________ _________________________________________________________________________________________ Q4 How would you describe the nature of the ED? _______________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ The staff in the emergency department consists of physicians, physician’s assistants, nurses, and ancillary staff. The emergency department is also supported by all other professional services in the hospital. For example, members of the radiology, laboratory, respiratory therapy, or social service teams can be involved in the client’s care, as well. Emergency units regularly receive clients with a wide range of needs. Since there is generally no pre-knowledge of the incoming client’s condition or history, nurses in the emergency unit are taught triage skills to assist in evaluating the severity of a client’s needs. Triage, meaning ‘to sort’, was developed during the World War I as a means of quickly and accurately assessing the urgency of care, the best place for care, and the prioritization of care. Today, clients are assessed as soon as they enter the department using the triage method. While most clients arrive to the emergency unit in crisis and soon leave, approximately 20% of those entering the emergency department have a life- threatening problem. These urgent cases are expediently cared for, while those cases deemed as non-urgent may have to wait for long periods of time. One of the most common complaints of people in the emergency room is that the wait was too long. Often, the emergency unit is the first contact the public has with the hospital, and a generalization of the hospital is based on the treatment received in the emergency unit. Continual monitoring is indicated as a diagnostic aid in caring for symptomatic clients. For example, in the event of a trauma client, the need for rapid assessment, diagnosis, and intervention is acute. Often, intra-venous and intra-arterial catheters, tubes, and drains are inserted, various types of monitoring are commenced, laboratory specimens are taken, medication and fluid infusions are started, and physical examinations are made simultaneously. During the entire care process, accurate documentation related to the client must be maintained. The nature of the emergency department is highly unpredictable. With an increasing number of annual patient visits and higher patient acuity levels, the challenges for the emergency care professional have grown. Often, multiple tasks are being handled at the same time, and while some clients are entering the department, others are being discharged to other departments, other hospitals, or home. The work pace is fast and the staff burn out rate is high. Yet, it is the variability, fast pace and the expecting the unexpected that gives the ED staff the strength and willingness to keep going. To be able to save lives and ease the suffering of the patients gives joy and satisfaction. Beginner’s Guide 3 1.2 Anesthesia The word anesthesia originates from the Greek word anaisthesis meaning ‘no sensation’. Anesthesia means the loss of sensation during an operation or a treatment. Depending on the type of procedure, consciousness, memory, and muscle activity may be absent, as well. The goal of anesthesia is to ensure the patient a safe, painless operation (picture 1). For the surgeon the anesthesia provides optimal conditions for the procedure. Anesthesia enables procedures to be performed without pain, comfortably and safely. Picture 1. The goals of anesthesia. Analgesia Relaxation Unconsciousness 4 Beginner’s Guide General Local 1.2.1 Types of Anesthesia There are three different types of anesthesia: local, regional and general (picture 2). The anesthesia method is selected according to the surgical needs, the condition and the wishes of the patient. Regional Picture 2. Different types of anesthesia. 1. Local anesthesia means numbing a small area by applying the numbing medicine directly to the area of the body which is going to be operated, e.g. for the removal of a mole. 2. Regional anesthesia is produced by applying the local anesthetic to nerves innervating a certain region of the body and numbing the whole innervated area e.g. for operating on a knee or an elbow. Local anesthetics can be applied to spinal cord either to spinal or epidural space to numb the legs or the abdominal (stomach) area. Local and regional anesthesia provide numbness, pain relief (analgesia), and some degree of immobility (muscle relaxation) in the anesthetized region of the body. 3. Administering anesthetic medication causing sleep, pain relief, and relaxation produces general anesthesia. Medication can be administered into a peripheral vein (intravenously) or by letting the patient to breathe in (inhale) a uploads/Sante/ beginner-x27-s-guide.pdf