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This presentation deals with the Air Force Nurse as a movice assigned to a CCU area and her contributions to patient care as a member of the Air Force Health Care Team. The novice nurse's contributions to the patients care lie in her ability to manage expected behavioral responses to the CCU experience even with a basic working knowledge of normal sinus rhythm and CPR procedure. The expected responses to the CCU expereince discussed are: anxiety, denial, depression, and aggressive sexual behavior. These usual behavioral responses have, at times, been referred to as "a disease of medical progress" or the so-called "intensive care syndrome". The nurse is in a key position to observe the patient's behavioral responses since she spends most of the time with the patient. When these behavioral patterns are considered as part of a normal patterns of adaptation, the nurse can utilize these for effective management of the patient's hospitalization experience as well as an indicator to the patient standpoint in his process of adaptation. It would be wise to mention that the detailed manifestations and primary causes of these behavioral responses should be part of the nurse's working knowledge and can be easily referred to in recent texts on coronary care nursing. The presentation progresses to specific discussion on nursing intervention of the behavioral responses. In summary, the Air Force novice nurse to a CCU area can be an equally contributory member on the Health Care Team if not compelled to place an exaggerated amount of attention on equipment, but focus more on the patient, leaving more technical learning until she becomes more aware of the unit administration and has the opportunity to attend a coronary training course.
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PMID:Any nurse can prevent dehumanization by the CCU experience. 86 46

Feeding behavior of Aplysia is associated with an arousal state characterized by a constellation of maintained behaviors and by a potentiation or depression of responses to specific stimuli. A neuron (the cerebral-pedal regulator or CPR) that has widespread actions on various systems connected with feeding has been identified. CPR excites neurons that modulate or drive (i) body posture, (ii) biting, and (iii) cardiovascular behaviors. CPR also inhibits neurons concerned with defensive responses. Food stimuli, which elicit food arousal in the animal, produce prolonged excitation of the CPR. The results suggest that the CPR may evoke a central motive state representing the neuronal correlate of feeding motivation.
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PMID:An identified neuron (CPR) evokes neuronal responses reflecting food arousal in Aplysia. 229 96

Automatic external defibrillation (AED) offers the potential for minimally trained individuals to convert life-threatening ventricular arrhythmias prior to arrival of emergency rescue personnel but optimum usage of AED remains undefined. To test the practical aspects of home AED in high risk patients after myocardial infarction, we identified 40 consecutive high risk post-MI patients, who satisfied inclusion and exclusion criteria. Fifteen (38%) patients were eliminated at their physician's request and nine others refused to participate. Twenty-six family members of the remaining 16 patients were trained in AED with follow-up testing at 3 months. Level of skill, especially in CPR performance, decline to unsatisfactory levels in 35% of trainees, including all over age 55. Trainees felt more confident due to availability of AED and 90% felt no strain in intrapersonal relationships. Psychological testing revealed a decrease in patient and trainee depression scores and no change in anxiety or obsessiveness during the study. These observations suggest the following: (1) better awareness of benefits of AED by physicians and lay persons is necessary, (2) retraining at less than 3 month intervals will be required for many spouse trainees and (3) there are no common adverse psychologic sequelae to training in AED.
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PMID:Automatic external defibrillation of patients after myocardial infarction by family members: practical aspects and psychological impact of training. 246 83

Before expanding a health education program, the staff of the George Washington University Health Plan conducted a needs assessment of members. Patients in the HMO's adult care and parents in pediatric waiting areas answered survey questions, and a random sample of members was polled by mail. Patients rated their interest in a list of 45 topics, and plan clinicians chose from the same list topics which "would be of greatest help in your practice." Anxiety/stress was the most popular topic among patients and those who responded by mail. Depression, physical fitness, CPR, and nutrition also rated high. Only 4 topics appeared among the top 10 choices of both plan members and clinicians. After discussion of the patients' choices, the clinicians were asked, several weeks later, to rate the topics again. Clinicians' choices in the second round much more closely approximated the choices of the members. The most frequently chosen method of instruction was "written material," although videotape and other, more expensive media were also listed. When seminars geared to the members' top choices in the survey were offered, the response was so enthusiastic that additional seminars--a total of 12 in 6 weeks--were held.
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PMID:HMO members and clinicians rank health education needs. 686 54

The purpose of this study is to investigate the daily life and care condition of elderly people living in Korea, and to observe the symptom of senile dementia among them. In the first survey, 713 subjects were screened and 42 subjects were diagnosed as suffering from senile dementia. In the second survey, 26 elderly and their caregivers who agreed to participate in this program, were interviewed. The results were as follows. 1. About 25% of the 713 subjects needed some kind of help in their daily life. 2. 85% of the subjects could go out and about their houses without help. Only 5% of them had a complete or a partial loss of activity. 3. Of all the subjects, 42 were diagnosed as suffering from senile dementia. The prevalence of this disease was calculated at 5.6% in the survey. 4. Each demented elderly person had 5.3 mental symptoms on the average. Depression was observed more among women and violence was observed more among men. 5. The elderly who had a lower CPR score (Caretaker-Patient Relationship Score), indicating a poor relationship between the patient and caretaker, had a higher prevalence of mental symptoms than those who had a higher CPR score.
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PMID:[The study of senile symptoms and home care on the elderly living in Korea]. 824 57

Resuscitation decisions during the first 6 weeks were analysed for 97 admissions to a psychogeriatric ward of a general teaching hospital. Seventy-seven patients (79%) had a written 'do not resuscitate' (DNR) order on admission and 74 patients (875) had a written DNR order after 6 weeks. Morbidity was assessed with a pre-arrest morbidity (PAM) index and a modified PAM index (MPI). Dementia influenced the presence of a DNR order, both because lack of effectiveness of CPR and lack of quality of life. Age was related to a DNR order. The MPI was associated with the presence of a written DNR order, while the PAM score failed to reach significance. Six weeks after admission DNR orders were predictable by the four variables of dementia, the use of antidepressants, age and PAM, in that order. The association of the use of antidepressants with the presence of a written DNR order was surprising. The use of antidepressants is not the same as the diagnosis of depression. Because of the design, our results cannot permit any conclusion whether depression acts as an additional factor considered in decision-making in psychogeriatric patients. We suggest that depression and its correlates should be considered in discussions and studies about DNR.
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PMID:Dementia in resuscitation policy: a prospective study of a psychogeriatric ward in a Dutch general teaching hospital. 867 May 60

We describe a cardiac arrest which occurred during general anaesthesia in the prone position for surgical correction of lumbar kyphosis in a patient with Marfan's syndrome. Peroperative monitoring was routine with ECG, non-invasive arterial pressure, oximetry, PETCO2 and central venous pressure, plus aortic blood flow and and systolic time intervals via an oesophageal echo-Doppler device. Forty-five minutes after the start of surgery, a sudden decrease in aortic blood flow followed by a decrease in PETCO2 suggested acute cardiac failure despite continuation of the ECG signal. Initial CPR in the prone position produced a slight increase in PETCO2. When the patient was turned to the supine position and the legs elevated, chest compression was more efficient and spontaneous circulation was rapidly restored. Circulatory arrest could be explained by incompletely treated hypovolaemia, or by myocardial depression (decrease in aortic blood flow and lengthened pre-ejection period) combined with excessive hypotension in a patient with Marfan's syndrome, thus compromising coronary blood flow producing ST segment depression. Continuous non-invasive aortic blood flow and PETCO2 monitoring proved valuable in the early detection and treatment of circulatory arrest and in the evaluation of the efficiency of peroperative CPR.
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PMID:Non-invasive continuous haemodynamic and PETCO2 monitoring during peroperative cardiac arrest. 870 1

Depression can be the first sign of dementia or can occur in the follow-up of a clearly demented patient. One must be able to distinguish symptoms of depression and dementia, and recognize depression superimposed on dementia in order to provide optimal treatment. Suicidal risk must be assessed, and major depressive episodes must be appropriately treated. Useful drugs to treat depression in demented patients are reviewed. At this stage of the dementing illness, the patient still needs medical attention for other medical problems, periodic health exams, other chronic conditions, etc. It is also important to address the issues of CPR and level of care, if it has not been done previously. Legal aspects must also be clarified at this stage. The patient's ability to consent or to make financial decisions must be assessed. Some objective criteria are suggested. At this stage of the disease, the family physician can really make the difference between a premature nursing home placement and a patient staying at home with his family.
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PMID:[My patient has dementia, but so far, it is not that bad...]. 1508 7

In acute poisoning with beta-blocking drugs and calcium-channel blockers patients may present with serious symptoms. We present a case of life-threatening sotalol and verapamil intoxication in a 29-year-old female suffering from depression. She was admitted to our hospital a few hours after she had taken 3.6 g verapamil and 4.8 g sotalol. On being found the patient was breathing and had a palpable pulse. On admission the patient experienced a cardiovascular collapse and CPR was started. Echocardiography confirmed cardiac standstill. After 4 h of normothermic CPR, extra corporeal heart lung assist (ECHLA) was established. Vasoactive drugs could be stopped after 2 days with ECHLA, and after 5 days the patient was extubated. The patient experienced several complications (intestinal bleeding, transient nerve paralysis, and renal failure due to rhabdomyolysis) but made a complete recovery and started working 6 months after the poisoning. She was no longer depressed.
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PMID:Severe poisoning with sotalol and verapamil. Recovery after 4 h of normothermic CPR followed by extra corporeal heart lung assist. 1614 79

Cardiac arrest and cardiopulmonary resuscitation (CA/CPR) increase the risk for affective disorders in human survivors. Postischemic anxiety- and depressive-like behaviors have been documented in animal models of CA/CPR; however, the stability of post-CA/CPR anxiety-like behavior over time and the underlying physiologic mechanisms remain unknown. The hypothalamic-pituitary-adrenal (HPA) axis and the corticotropin releasing factor (CRF) system may mediate the pathophysiology of anxiety and depression; therefore, this study measured CA/CPR-induced changes in CRF receptor binding and HPA axis negative feedback. Mice were exposed to CA/CPR or SHAM surgery and assessed 7 or 21 days later. Consistent with earlier demonstrations of anxiety-like behavior 7 days after CA/CPR, increased anxiety-like behavior in the open field was also present 21 days after CA/CPR. On postoperative day 7, CA/CPR was associated with an increase in basal serum corticosterone concentration relative to SHAM, but this difference resolved by postoperative day 21. The Dexamethasone Suppression Test showed that the CA/CPR group had enhanced negative feedback compared with SHAM controls at postoperative day 21. Furthermore, there was a gradual increase in CRF(1) receptor binding in the paraventricular nucleus of the hypothalamus and bed nucleus of the stria terminalis, as well as a transient decrease of both CRF(1) and CRF(2A) receptors in the dorsal hippocampus. Therefore, sustained changes in activity of the HPA axis and the CRF system after CA/CPR may contribute to the postischemic increase in affective disorders.
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PMID:Cardiac arrest and cardiopulmonary resuscitation dysregulates the hypothalamic-pituitary-adrenal axis. 1955 8


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