Abstract This paper discusses cardiopulmonary resuscitation,often abbreviated to CPR, a potentially life-saving procedure to temporarily restore blood flow and breathing to a person whose heart and lungs have stopped. It also looks at how the phrase is sometimes used to refer to interventions used to attempt to save patients already hospitalized, as well as to skills any person can acquire and use on a loved one or total stranger in an emergency. It looks at the discovery and development of the process, whether it actually works, and also discusses its limitations.
From the Paper "CPR by itself is unlikely to save a person's life. The best outcomes occur when CPR is followed by defibrillation as soon as possible followed by intensive medical support at a medical center. Unless CPR is begun within 4 - 6 minutes of when breathing has stopped, the person is likely to suffer significant brain damage, so early intervention is crucial. If there is only one person who is not strong enough to do both breathing and chest compressions, then chest compressions should be done. If the person's hear resumes beating, often the person will begin breathing again as well. Together, the American Heart Association and the American Red Cross train more than five million people each year in CPR (De Milto, 1999)."
Abstract This paper reports on the current relevant literature on cardiopulmonary bypasses, which provide a temporary substitute for a patient's heart and lungs during the course of open-heart surgery. In particular, it looks at how the memory loss and other cognitive problems long known to result from bypass surgery are often minimized by heart surgeons as being merely transient problems and how there is a need for cerebral protection, since studies have shown that for a substantial minority who undergo this operation, will incur mental impairment years later. A review of the literature is followed by a summary of the research in the conclusion.
Outline
Overview
Need for Cerebral Protection
Cerebral Protection Methods
Technological Developments
From the Paper "Today, the trend is towards providing brain protection with either antegrade or retrograde perfusion during circulatory arrest. The study by Igari et al. and work by others have demonstrated the ability to isolate cerebral perfusion from lower-body perfusion while performing the necessary great vessel anastomoses. A Boston Children's Study that cited by these researchers demonstrated the overall superiority of low-flow versus no-flow that may have applicability to the adult situation as well. In this study, the authors used a moderately hypothermic perfusate, thus decreasing cerebral oxygen consumption. "The combination of hypothermia to decrease metabolic rate and moderate-flow perfusion to wash out metabolites provides cerebral protection" (Igari et al., 1999, p. 108)."
Abstract The paper defines VO2 max, giving a clear explanation of the term. The paper demonstrates that the literature associated with VO2 max, in the peer reviewed press and the popular sports and fitness literature and e-information states that the limiting factor of VO2 max in any individual is cardiopulmonary function. If cardiopulmonary function is impaired due to illness, disease, lack of overall fitness, genetics or altitude, the VO2 max measurement will be skewed. The paper argues that this work is demonstrative of the fact that all exercise/training programs should be done only after the clearance of such a program by a trained physician. The paper also argues for the utilization of VO2 max testing in medicine,before the onset of a strenuous physical training regimen. The paper includes figures and a table.
From the Paper "Currently in the medical arena, VO2 Max testing often called cardiac stress testing is done under controlled circumstances on patients who have a known cardiopulmonary function issues, but is only rarely done on healthy individuals in the younger populations. ("Health Matters: Angina Drug," 2005, p. 4) Yet, in many cases those are the people most likely to begin regimens of serious physical training. The current trend of older individuals seeking to become more physically active and also competitive in sports has also increased the numbers of people exposed to VO2 max testing, as many are seeking trainers to help them develop essential endurance they feel they may have lost due to age, and as a result of the fact that they tend to have more expendable income to hire professionals to assist them with fitness goals. This trend of increased VO2 max testing is fundamentally good, if such testing is conducted under the best conditions and if results are utilized as a part of the whole fitness picture, i.e. in conjunction with other tests and measures."
Abstract This paper examines how death has become more clinical and more involved with medical intervention and how, as such, it has been removed from our everyday lives. It discusses how medical professionals of every kind must deal with death and dying issues on a daily basis. It provides a literature review covering aspects of of euthanasia, cardiopulmonary resuscitation, and living wills. The common themes identified in studies in end-of-life decisions are discussed and analyzed, and conclusions are reached.
Outline
Introduction
Abstract
Euthanasia
Ending a Patient's Life
Patient's Choice: Consent/Autonomy
Living Wills
Do Doctors Really Act Beneficently?
Conclusion
From the Paper "Do the patient's desires have any bearing on the outcome of the case? Can the patient be considered to have given informed consent in the matter of the administration of a lethal dose of a lethal drug? In the United Kingdom, all medical professionals are bound by very strict rules regarding informed consent. All patients are considered to be competent to provide consent unless they demonstrate otherwise. In all cases, the medical professional must ask themselves if the patient can understand the decisions being recommended and make a proper decision with the information which has been provided. It must also be understood that a patient who refuses treatment or makes an unexpected decision when full information has been given is not necessarily incompetent, but an unexpected decision may show the need for further explanation by the professional."
Abstract This paper explains that the threatened birth of an extremely preterm or anomalous infant presents complex medical, social, and ethical issues for the family and the involved physicians. The author points out that cardiopulmonary resuscitation in the delivery room is a modality that presents clinicians with significant ethical issues because the decision to not resuscitate is made rapidly and most often without the advice of a bioethics committee. The author suggests the importance of facilitating change in the care of pregnant women and marginally viable infants resulting in parents developing an understanding of the risks that their newborn faces if delivered and resuscitated.
Table of Contents
Introduction
Media
Legal
Ethical
Economics
Facilitating Change
From the Paper "The current and most frequent policy on resuscitating neonates of marginal viability is from the "Textbook of Neonatal Resuscitation". It suggests the non-initiation of resuscitation for newborns less than 23 weeks gestation and/or 400 grams in birth weight. It consists of resuscitating infants of 23- 24 weeks or greater unless they have a previously diagnosed lethal anomaly. Current practice is to not resuscitate infants with congenital anomalies that are incompatible with life (Bloom, 1993). The fetus of 23 weeks is considered a possible but unlikely survivor. Since there is some evidence of survival of 23 week infants, various hospitals have adopted the policy of resuscitating these fetuses. Very low birth weight (VLBW) infants that survive represent a small percentage of those delivered."
Abstract This paper examines the physiological changes that occur in the body at high altitude, particularly in respect to the heart. The paper examines what happens to the body during short-term exposure and long-term exposure to high altitude, and exposure to extremely high altitudes.
From the Paper "Several circulatory changes mediated by stimulation of the carotid body which causes activation of the sympathetic nervous system are stimulated by short-term altitude exposure less than three or four days. These changes occur within a few minutes of altitude exposure and are related to a transient epinephrine secretion combined with a more sustained secretion of norepinephrine. These cause immediate changes which include an increase in ventilation, increased heart rate, increased cardiac output and an elevation of blood pressure. There is also an increase in coronary blood flow."
Tags:cardiopulmonary, high altitude, acclimatization
Abstract The paper discusses the importance of knowing CPR and first aid. The focus of the paper is the growing rate of cardiovascular disease and the problems with not enough people knowing how to properly perform CPR. This paper cites references to lives being saved by those who know it, references the new offerings of the American Heart Association and makes appropriate recommendations.
From the Paper "According to the American Heart Association, 335,000 Americans die each year from sudden cardiac arrest before they reach a hospital; and an astounding 80 percent of these heart attacks happen in the victim's home while a family member watches helplessly. In a situation like this the estimated survival rate is less than 5 percent. The American Heart Association believes that the proper application of cardio-pulmonary resuscitation (CPR) can double the heart attack victim's chance of surviving until either Emergency Medical Technicians (EMT) arrive with an ambulance for transport or the patient arrives through other means to the hospital or their physician's office. Cardiopulmonary Resuscitation (CPR) is a life-saving technique and skill that most people should be trained and certified in but that few are. As Bill Radford states, only 5 million individuals per year..."
Abstract In this article, the writer discusses that when there are patients receiving treatments or interventions that keep them alive, one may face the decision of whether to discontinue treatment. The writer offers the example of an adult male patient at the HIV Treatment Center on dialysis for acute renal failure and mechanical ventilation for respiratory failure. The writer notes that in this case the total parenteral nutrition (TPN) treatments are no longer of benefit, even though the patient's family wants them continued. The writer maintains that if life expectancy can be prolonged with additional chemotherapy, it may be reasonable to give TPN to allow the patient to enjoy that benefit. However, the writer concludes that in the case where additional chemotherapy offers no substantial increase in quantity or quality of life, TPN could become another burden for the patient without any meaningful benefit, and ought to be withheld.
Outline:
Transference and Counter transference
Futility Judgments
Debating Cardiopulmonary Arrest and Resuscitation
From the Paper "Transference and countertransference are both normal phenomena that may arise during the course of the therapeutic relationship. Transference is the tendency on the part of the patient to "transfer" past feelings, conflicts, and attitudes into situations, circumstances and present relationships. According to psychoanalytic theory, transference evolves from unresolved or unsatisfactory childhood experiences in relationships with parents or other important figures. From a behavioral orientation, patients may have developed habit-forming patterns in how they relate and interact with others. These habits involve development of attitudes and ideas based on the learning and retention of information from past relationships. The habits learned from past relationships may create behavioral and thought patterns in subsequent relationships, even though the actions and attitudes may be inappropriate for the current relationship. As caregivers have frequent contact with patients, the potential for caregivers to be objects of transference is significant."
