Archive for January 2011
Bacterial pneumonia (Streptococcus pneumoniae) is a gram positive organism that typically causes infection in the elderly, alcoholic, and other physically compromised individuals. People who have sickle cell disease or have undergone a spleenectomy are also more susceptible to pneumococcal disease. Even healthy people can become infected with bacterial pneumonia.
Pneumococcal pneumonia usually begins in the lower lobes but can also be found in the posterior segments of the upper lobes. The terminal airways are usually involved initially. The infection can quickly spread to the contiguous airspaces via interalveolar connections. Radiographically acute pneumococcal pneumonia appears are lobar consolidation. Air bronchograms are often evident and empyema is common in 50% of patients tested. The lungs can be cleared of this infection in 10 to 14 days with proper treatment. Older patients may have a more difficult time clearing an infection and can take 8 to 10 weeks before complete resolution is achieved.
The typical radiographic pattern (if you are interested in how to become a radiologist) of pneumococcal pneumonia shows patchy lobar opacities similar to the type seen with bronchopneumonia or rarely a reticulonodular pattern may be visible. Some patients with an atypical appearance may have preexisting lung disease (like emphysemia), partial treatment or an impaired immune response from and autoimmune disease. A radiograph of a child with pneumococcal pneumonia will likely show spherical opacity that looks similar to a parenchymal mass.
Although bacterial pneumonia affects mostly the elderly and physically compromised, this organism can infect health individuals. Fortunatley, radiographs can be used to help identify the type of infection and treatment programs exist that can help to clear infections quickly.
There are many ways a healthcare provider can be exposed to biohazards. The most recognized means is ingestion but there are other routes that have nothing to do with the digestive tract. These non digestive routes are called parenteral routs and are also susceptible to biohazard exposure. The most common biohazard exposure routes are as follows:
Airborne. Biohazards can become airborne. This takes place when an agent is splashed, or aerosols or fumes are generated. Aerosols and splashes commonly occur in a laboratory environment where specimens are centrifuges, when tube stoppers are removed, and when preparing specimen aliquots. Improperly stored, mixed or handled chemicals can create dangerous and toxic fumes. Airborne diseases can be transmitted by patients unless healthcare providers wear N95 respirators when caring for them. The best way to protect against airborne biohazard exposures is to follow safe handling procedures, wear appropriate personal protective equipment, and work behind safety shields or splash guards.
Ingestion. One of the easiest ways to ingest a biohazard is by no following proper hand sanitizing procedures before handling food, gum, candy, cigarettes, or drinks. Other ways that biohazards can be ingested is by using your hands to cover your mouth instead of using a tissue when coughing or sneezing, biting nails, chewing on pens or pencils, and licking fingers when turning pages in books. The best way to avoid ingesting biohazards is to avoid hand to mouth activities and to refrain from putting items in the mouth. Having clean hands can prevent a lot of potential ingestion.
A phlebotomist has an important role in a laboratory team. The phlebotomist is primarily responsible for collecting blood samples from patients. Most often these samples are collected using venipuncture or microcollection techniques. Venipuncture refers to the puncturing of the vein to obtain blood. Microcollection techniques can include capillary puncture, dermal puncture, microsampling, finger stick and heel stick to obtain a blood sample. The phlebotomist is responsible for ensuring that these samples are collected and transported to the laboratory expeditiously. In many instances, the phlebotomist may be the only contact the patient has to the medical lab and should ensure the patients comfort and safety are maintained during a blood draw. Learn how to become a phlebotomist.
More responsibility has been given to phlebotomists over the past few years. Many of these responsibilities have been given to help reduce costs, improve efficiency and control quality. Phlebotomists in many laboratories are required to know how to perform vital signs, electrocardiograms, and point-of-care testing. It is also expected that the phlebotomist be current in cardiopulmonary resuscitation (CPR) and the use of automated external defibrillation (AED) devices. A good working knowledge of the computer software used in the laboratory is expected as well as medical record documentation. It is also important that the phlebotomist receives training from a formal educational setting that can prepare him or her for certification.
Although a majority of a phlebotomist’s responsibilities are within the laboratory, he or she should be comfortable working with patients. Having a cheerful demeanor, a positive attitude and a good work ethic are great attributes for this and any other profession.
Human Immunodeficiency Virus (HIV) attacks the body’s immune system. With time it can cause Auto Immune Disease Syndrome (AIDS) by allowing the body to become susceptible to opportunistic infections. An opportunistic infection is an infection by an organism that would not normally adversely affect a normal healthy individual.
When working with HIV in blood, it is important to take the same precautions as would be taken when handling Hepatitis. All of the same exposure routes are available and needlesticks or other injuries that place contaminated blood in contact with broken skin are the most common causes of laboratory exposure.
The incubations phase for HIV infection can range from a few weeks to several years. The initial symptoms are mild-to-severe flulike symptoms. Many people who are infected with HIV are completely unaware unless diagnostic tests are preformed. The T lymphs of the body are affected and eventually destroyed by HIV. Once the T lymph count is reduced to 200 or fewer per milliliter of blood, the patient is officially diagnosed as having AIDS. With very few T lymphs to help combat infection, opportunistic infections have the upper hand and easily take hold. Two common symptoms of AIDS are hairy leukoplakia and Kaposi’s sarcoma. The nervous system eventually deteriorates leading to neurologic symptoms and dementia.
Although there are relatively few incidences of work-related HIV infection, the Center for Disease Control has done studies on the healthcare related exposure. These studies have shown that phlebotomy procedures were involved in approximately 50% of the HIV exposures that have occurred in healthcare environments.
Emergency Medical Technicians encounter many different types of medical situations. In some instance, a patient may refuse medical treatment. If this occurs there are several important things to consider before discontinuing medical aid.
First and foremost, a mentally competent adult may refuse medical treatment at any time. Individuals that suffer from mental disorders may not refuse treatment. Children may not refuse treatment, but their guardians can refuse treatment for them.
When an EMT is confronted with a person who refuses care there are certain guidelines that should be followed. The EMT should ensure that the patient is capable of making rational and informed decisions. A patient who is under the influence of alcohol, drugs, metal illness or who may be suffering from shock due to injury should receive medical attention. If the patient is rational but still refuses care, the EMT should inform the patient of what could occur if care is not given. This explanation should be specific and easily understood. Multiple attempts should be made to convince the patient to receive care. If the patient is adamant, the EMT should seek medical direction as to whether or not to transport the patient to a medical facility. The EMT should not make the decision not to transport a patient without consulting with a supervisor or other associate. If a decision is made to allow the patient to refuse care, a liability form should be signed by the patient and a disinterested witness. A disinterested witness is someone who is not a family member or friend of the patient. Before leaving, an EMT should inform the patient that he or she can call at any time for medical assistance and advise friends and family to stay with the patient. After the medical team leaves the patient, they should thoroughly document assessment findings and any medical care that was given to the patient on the prehospital care report.
An Emergency Medical Technician (EMT) has legal responsiblities and duties to the patient, medical director and the public. These duties are by federal and state statutes and regulations and are often based on generally accepted standards within the medical community. Maintaining these ethical responsibilites shows professionalism and prevents the likelihood of civil or criminal lawsuits. When studying in EMT and paramedic classes, you will delve into ethics more in deeply into this subject….but here is a brief overview.
Ethics are the principals of moral responsibility that a person has to a given situation. The ethical responsibility of an EMT combine the physical and emotional needs of the patient. These responsibilities include responding to the needs of the patient by showing respect. This can be challenging in situations where an EMT may experience opposition from the patient or family members about medical aid. In all situations an EMT has the ethical responsibility of maintaining a professional attitude. Maintaining sufficient skill and knowledge is another ethical responsibility. This can often be accomplished by participating in continuing education and refresher programs. Not only will this help to uphold ethical standards but it can be beneficial for personal career advancement. Each medical case should be reported honestly and accurately regardless of the outcome or mistakes that may have occurred. Respecting the confidentiality of the patient is another important ethical responsibility that all medical personnel have to uphold. EMTs usually work in teams. Even when personalities and working styles are different each EMT should work cooperatively and with respect for other emergency professionals.
The ethical responsibilities of an EMT are not much different from the responsibilities that are expected from other healthcare providers. When these standards are upheld the quality of service and care is maintained for each peron that receives emergency medical aid.
The job of an Emergency Medical Technician (EMT) is more than just physically helping someone who is sick or injured. This job requires being able to address the physical and emotional needs of the patient and the by standers, especially family members, at the scene.
An EMT can encounter many stressful situations, including the death and dismemberment of patients, terminal illnesses, traumatic situations, and domestic or child abuse. In most instances, the EMT will have to not only care for the patient, but must also be able to interact with the other people who may be at the scene. These bystanders may be angry, violent, ill, seriously injured, or family members. An effective and professional EMT must know how to help those at the scene, family members, and other EMTs to deal with stress.
When dealing with the dying patient, family members and bystanders there are important needs to consider for each group. The dying patient should be treated with dignity and respect. It is important to share information, maintain communication (when possible) and ensure patient privacy. At no time should the EMT loose control or give up control of the situation to the patient or anyone else at the scene, who is not qualified.
When dealing with family members at a scene it is very likely that they may express fear, anger or despair. If the EMT is dealing with a situation where the patient is dying and the family is there, it is important to take the time to listen empathetically. Do not give false reassurance or make promises that can not be guaranteed. Use a gentle tone of voice and comfort the family.
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How To Protect Yourself: EMT Protective Equipment
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Using personal protective equipment can help prevent the spreading of infectious diseases and should always be used in situations where exposure to blood or other potentially infectious material can be anticipated. Not using personal protective equipment increases the potential for contracting a communicable disease. Personal protective equipment includes eye protection, protective gloves, gowns and masks.
The use of eye protection is not usually necessary and is seldom used for routine patient care. However, eye protection should definitely be worn in circumstances when bodily fluid may potentially splash into the face or eyes of the emergency worker. Examples potential situations include childbirth and arterial bleeding.
Protective gloves should always be used when there will be contact with blood or bodily fluids. Most protective gloves are made with vinyl or latex and should be changed between contact with different patients. This prevents the spreading of any potential diseases to others. Do not reuse vinyl or latex gloves and use utility gloves to clean vehicles and equipment.
Gowns are commonly used in situations where large amounts of blood or bodily fluid are anticipated, such as during childbirth or in the event of severe trauma. Disposable gowns are recommended. After patient care activities are complete, the emergency medical provider should remove and discard of the gown and should change into a new uniform to prevent contracting anything that may have possibly come into contact with his clothing.
Masks should always be used in situations where airborne diseases are suspected. Patients with a known or suspected airborne disease should also wear a surgical mask to prevent or reduce the risk of spreading disease. Emergency personnel who are treating a patient with known or suspected tuberculosis should use a mask with a High-Efficiency Particualte Air respirator.
If you are an emergency medical provider, you are constantly in contact with many different situations, people, places and conditions. As a medical provider your responsibility is to help people who may be hurt or sick. It is impossible to know immediately all of the risks or dangers at any given scene. This is why it is important to understand all of the potential ways diseases can be transmitted. Having this knowledge can help you prevent spreading on contracting a disease in any given situation. This may be something you want to look into before heading down the EMT or Paramedic career path.
Contact: Diseases are easily spread through contact. There are two types of contact- direct or indirect. Direct contact allows for the direct transfer of a pathogen from an infected person to a susceptible host. Some examples of direct contact include sexual contact with an infected person or contact with the excretions of a person who may have an open sore. Indirect contact is when a susceptible host comes into contact with something that may have been contaminated. For example: intravenous needles, toys, eating utensils and glasses, bedding, wound dressings.
Air: Coughing, sneezing, and talking can transmit pathogens into the air.
Vehicles: This does not refer to your car. A “vehicle” is an inanimate object is able to transmit a pathogen from an infected person to a susceptible hose. Examples of some vehicles include liquids like, blood or water and food that has been improperly handled or stored.
Vectors: A vector is an insect that can transmit a pathogen to an animal or human that it may sting. Mosquitos are common vectors for malaria. Other common vectors include fleas, ticks and lice.
Other methods: Disease can also be transmitted from consuming contaminated animal products or through direct contact with animal urine or feces.
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Classifications and Examples of Communicable Diseases
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A communicable disease is any disease that can be transferred from an infected person to another individual. There are four types of communicable diseases- airborne, bloodborne, foodborne, and sexually transmitted.
Airborne diseases are spread through droplets in the air that are produced by coughing, sneezing and even talking. These types of diseases are very difficult to avoid because there is almost no way of knowing that they are around unless you know that you are with an infected person. Examples of some common airborne diseases include tuberculosis, measles, meningitis, rubella, and chickenpox (varicella).
Bloodborne diseases are spread by contact with body fluids like blood, semen or saliva. These types of disease do not necessarily require direct contact from person to person. Indirect contact and transmission often occurs with Drug users in contact with shared and infected needles. Examples of common bloodborne diseases include hepatitis B (HBV), hepatitis C, human immunodeficiency disease (HIV), and syphilis.
Foodborne diseases are spread by the improper handling of food or by poor or inadequate personal hygiene. These types of diseases are commonly transmitted in restaurants. Examples of common foodborne diseases include salmonella (which is commonly referred to as food poisoning) and hepatitis A.
Sexually transmitted diseases can be spread by blood or through sexual contact. Examples of sexually transmitted diseases are Chlamydia, Gonorrhea and HIV.
It is nearly impossible to identify a person with a potential communicable disease just by looking at them. The best way to avoid contracting such a disease is to have monogamous sexual relationships, abstain from using intravenous drugs and avoid eating at places that are known to make people sick.
