Outcome of Vascular Complications After Arterial Punctures

Outcome of Vascular Complications After Arterial Punctures Introduction :- Arterial catheterizations are used routinely for continuous haemodynamic monitoring in the operating room and also in critically ill patients (1). It provides easy and appropriate access for several blood samplings and blood gas analysis (2) and has frequently been found to be a safe procedure, with a few severe complications (3,4). Percutaneous arterial cannulation is used widely in the clinical management of critically ill adults second in frequency to intravenous cannulation(5). Common sites of percutaneous needle puncture include the radial, femoral, brachial, dorsalispedis, or axillary artery. There is no evidence that any site is superior to the others. However, the radial artery is used most frequently due to its easy palpability, low complication rates, location and patients comfortability than the other sites. Patients undergoing radial or dorsalispedis artery puncture should have the collateral flow to those vessels evaluated prior to puncture, to avoid the risk of ischemic complications (6, 7). Each arterial catheterization site is associated with a unique set of potential complications. Radial artery insertion is associated with peripheral neuropathy, femoral artery insertion with retroperitoneal hematoma, axillary artery insertion with brachial plexopathy, and brachial artery insertion with injury to the median nerve(8). Although many sites share the same possible complications (eg, bleeding), the frequency of these complications varies among the different insertion sites. The most common complications associated with radial artery catheterization are occlusion (2 to 35 percent) and hematoma (up to 15 percent) (9). Permanent injury usually results from either complication. Frequent temporary occlusion of artery has been identified as one of the main complications of radial arterial cannulation(10, 11).Arterial complications have serious ischemic damage to the hand after radial artery cannulation which lead to necrosis and amputation of fingers or t he whole hand. (12). Femoral artery is the another commonest site of arterial cannulation in intensive care units (13). The femoral artery is usually preferred than the radial artery because the it is usually palpable even in hypotensive shock patients and is the only available route for haemodynamic monitoring(14). The incidence of related complications in the femoral artery is much lower than that in the radial artery and can be recognized easily because of the larger vessel diameter (15). Chances of sepsis is more in femoral artery cannulation because of the proximality of perianal region(16). The most common complication associated with femoral artery catheterization is hematoma (6%), which can be larger and difficult to detect if extends to the retroperitoneum(17). The third most dangerous site of arterial cannulation is axillary artery and it is preferred to be uncannulated because of its close proximity to carotid artery and may compromise cerebral circulation (18). Axillary artery cannulation is technically difficult, although pulsation and pressure are maintained even with peripheral vascular collapse where as femoral artery cannulation is less difficult, can be cannulated, even during profound hypotension (24). Arterial catheter infectionsof 10 -20% are complicated by local (eg, insertion site) infection, and 5 % by bacteremia or sepsis (11). It is generally known that arterial puncture related complications are common in ICU. The purpose of this prospective analysis was to evaluate the nature and outcome of vascular complications following arterial punctures in intensive care units of King Abdulaziz Medical City. Wendt M, Hachenberg Th, Lawin P, Vietor G. Electronic monitoring and data interpretation [in German]. In: Larwin P, Bruessel T, Prien T, editor.In Praxis der Intensivbehandlung. Stuttgart, New York: Thieme; 1993. pp. 155–186. Gauer PK, Downs JB. Complications of arterial catheterization. Respir Care. 1982;27:435–444. Hartung HJ. Monitoring [in German]. In: List WF, editor. In Komplikationen in der Anà ¤sthesie. Berlin: Springer; 1990. pp. 248–260. Gardner RM. Direct arterial pressure monitoring. Curr Anaesth Crit Care.1990;1:239–246. Durbin CG Jr. Radial arterial lines and sticks: what are the risks? Respir Care. 2001;46:229-230. Kohonen M, Teerenhovi O, Terho T, et al. Is the Allen test reliable enough? Eur J CardiothoracSurg 2007; 32:902. Jarvis MA, Jarvis CL, Jones PR, Spyt TJ. Reliability of Allens test in selection of patients for radial artery harvest. Ann ThoracSurg 2000; 70:1362. OMalley MK, Rhame FS, Cerra FB, McComb RC. Value of routine pressure monitoring system changes after 72 hours of continuous use. Crit Care Med 1994; 22:1424. Russell JA, Joel M, Hudson RJ, et al. Prospective evaluation of radial and femoral artery catheterization sites in critically ill adults. Crit Care Med 1983; 11:936. Wilkins RG: Radial artery cannulation and ischaemic damage: a review. Anaesthesia 1985, 40:896-899. Slogoff S, Keats AS, Arlund C: On the safety of radial artery cannulation. Anesthesiology 1983, 59:42-47. Bedford RF: Long-term radial artery cannulation: effects on subsequent vessel function. Crit Care Med 1978, 6:64-67. Frezza EE, Mezghebe H: Indications and complications of arterial catheter use in surgical or medical intensive care units: analysis of 4932 patients. Am Surg 1998, 64:127-131. Kaye W: Invasive monitoring techniques: arterial cannulation, bedside pulmonary artery catherization, and arterial puncture. Heart Lung 1983, 12:395-427. Riker AI, Gamelli RL: Vascular complications and femoral artery catheterization in burn patients. J Trauma 1996, 41:904-905. Thomas F, Burke JP, Parker J, Orme JF, Gardner RM, Clemmer TP, Hill GA, Macfarlane P:The risk of infection related to radial vs femoral sites for arterial catherization.Crit Care Med 1983, 11:807-812. Norwood SH, Cormier B, McMahon NG, et al. Prospective study of catheter-related infection during prolonged arterial catheterization. Crit Care Med 1988; 16:836. Czepizak CA, OCallaghan JM, Venus B, Gravenstein N: Vascular access. In In Clinical anesthesia practice.. Edited by Kirby RR, Gravenstein N. Philadelphia: W.B. Saunders Company; 1994::542-550. Johnstone R, Greenhow D. Catheterization of the dorsalis pedis artery. Anesthesiology 1973; 39:654–655 Bedford RF. Long-term radial artery cannulation: effects on subsequent vessel formation. Crit Care Med. 1978;6:64-67. Groell R, Schaffler GJ, Rienmueller R. The peripheral intravenous cannula: a cause of venous air embolism. Am J Med Sci 1997; 314:300 Soderstrom CA, Wasserman DH, Dunham MC, Caplan ES, Cowley RA. Superiority of the femoral artery for monitoring: a prospective study. Am J Surg. 1982:144:309-312 Russell JA, Joel M, Hudson RJ, Mangano DT, Schlobohm RM. Prospective evaluation of radial and femoral artery catheterization sites in critically ill patients. Crit Care Med. 1983;11:936-939. Teresa R. Cousins, John M. O’Donnell, Arterial cannulation: A critical review 2004:267,271. Complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring in anaesthesia and intensive care medicine Bernd Volker Scheer1, Azriel Perel2 and Ulrich J Pfeiffer3

My Philosophy of Life Essay -- essays research papers

  Ã‚  Ã‚  Ã‚  Ã‚  I can remember as a child always asking myself the â€Å"why† questions of life. What is the purpose of life? Why are we here? What is the purpose of life? Why do certain things happen? And is there really a God? I had always kept these questions to myself and eventually pushed them out of my mind altogether. I was raised in a Christian household and you just were not allowed to ask questions of that nature and doubt the faith. The world is the way it is because God made it that way and that is all there is to it. I was really excited to take this class because it would finally give me the opportunity to exercise my personal thoughts and beliefs. I have come to agree with Socrates that â€Å"the unexamined life is not worth living.† In my opinion life is a combination of philosophical ideas such as morality, respect, free-will and scientific issues.   Ã‚  Ã‚  Ã‚  Ã‚  The study of philosophy is a very complex and complicated task. There are so many different questions on many different topics and philosophy tries to explain them all. It tries to provide answers to the many questions that science and religion cannot explain. And from this it urges you to think about issues that may otherwise be ignored.   Ã‚  Ã‚  Ã‚  Ã‚  I agree with the goal of autonomy, that philosophy is having the freedom to make your own decisions and beliefs by using your own reasoning capabilities. I believe that we all have the God-like quality of reasoning ...

Education for Secondary Students With Mental Retardation Essay

Education is important for any young person. All secondary school students are looking forward to their futures and independence. This is the goal that mentally challenged students also look forward to. It is the challenge of the school system to give each young person the best possible chance at achieving the goal of independence or at the very least performing daily functions to the best of his or her ability. In order for a school or teacher to accomplish this, the teacher must determine the student’s level of academic and adaptive skills then find ways to help him successfully transition into an area of employment that matches his skills. Education for Secondary Students with Mental Retardation Teachers who work with students with disabilities face greater challenges in preparing their students for the world outside of school. Many mentally retarded students, however can be very functional and hold jobs, if they are properly prepared for the world and helped to find their strengths. One of the first things the special education teacher needs to know is that each disability is different and each disabled student has individual needs. Once the teacher has established that each student needs to be treated differently, then a plan can be developed for the student’s future. The first step in helping a student reach his full potential is to determine the skills he already has, such as his academic and adaptive skills. By using these skills, the teacher can help the student make a successful transition from the academic world into the adult world of employment. A final step in successfully educating special needs students involves matching the student’s strongest skills with potential employment opportunities and training the student for the job he would be most likely to succeed in. When a teacher gets a special needs student in her class, her first challenge is to find out what his natural skills are. The first set of skills that need to be evaluated are the student’s academic skills. Academic skills consist what is usually considered school knowledge or what the student learned in school. Academic skills include skills such as critical thinking, reading, writing and mathematical skills (Young, 2007). They are often considered the skills that can be taught. A teacher who wants to see a student succeed needs to determine how well developed the student’s academic skills are developed and what areas of strength the student has in the area of academics. Although it is important for a teacher to provide a well rounded education to students, it is equally important to focus on the student’s specific areas of strength. Once the teacher has determined where the student’s strengths lie, a specific curriculum can be designed for that student. A curriculum is a specific course of study either for an entire class or, with special education, a specific student. It provides a sort of blue print for the educational goals (Browder, 2001). A good reason for developing a curriculum for students with disabilities is to help ensure positive out comes from the information being taught (Browder, 2001). This essentially means that by designing a curriculum specifically for an individual student, it will help that student maximize his academic strengths. Adaptive skills are equally important to helping determine the best way to help students reach their full potential. Adaptive skills can be defined as â€Å"how well a person can deal with the tasks of everyday life. These tasks include the ability to speak and understand; home-living skills; use of community resources; leisure, self-care, and social skills; self-direction. † (Free Health, 2007). Adaptive skills are the kind of skills that allow the student to adapt the information he knows into actions that can help them in daily living. These skills are vitally important in combination with the academic skills in order for a person to effectively adapt to the world and be independent. It is very important for teachers of mentally disabled students to help them develop their adaptive skills to increase the student’s independence. Part of this includes helping the student gain access to community services that can assist in various areas in the community (such as rent assistance, adaptive equipment, or financial assistance). This is another area in which individual attention is needed in order to insure that each student reaches his maximum potential. A teacher needs to assess the social and daily survival skills that the student possess and then help the student develop the areas of strength. In order to develop the skills, the student must practice the skills repeatedly and build on them. The students, like people without disabilities desire to develop socially acceptable behavior and in order to develop this, they must try to maintain it (Wacker, 1984). Once the level of skills and the student’s ability to adapt have been determined, the teacher needs to find the best way to prepare the student for life outside of the school setting. Most mentally challenged people will require some outside assistance in order to be successful. Many students leaving high school go to group homes or spend time in adult day care (Thompson, 1987). In order to successfully transition a mentally disabled young person from the very structured school setting to the adult world, it will take the involvement of more than just the teacher. Family members and community assistance needs to be involved, when looking into helping a mentally challenged young person adapt to life outside of high school. For at least the last year of the student’s school career, the teacher, parents, and the community social service workers involved should meet to discover the most likely success plan for the student. The young person should be included in the process of planning, in order to make the plan more likely to succeed. The plan needs to be within the abilities and skills of the student, and include the student’s interest. The majority of the people classified as mentally retarded are considered to be high functioning enough to live alone and be employed if they are provided with some community assistance. If the student has successfully developed his strongest skills, then he is likely to become fairly well adjusted to functioning in the community. The teacher by the time of graduation needs to have taught the student such basic skills as money management, meal preparation, grooming and safety. In addition to the basic skills, the student needs to have developed some job skills, in order to obtain and maintain employment. The job skills are where the student’s individual areas of strength become important, as those strengths often correlate with the student’s interests. If the teacher and family members effectively helped the student develop the skills, the student is more likely to make a successful transition into the adult world. Those who choose to live on their own instead of with parents or family, often move into group home settings at least initially. Group homes are homes in which several mentally retarded people live together either with some full time supervision or occasional monitoring to provide assistance. Living in one of these homes can often help with the transition from school to independence. Employment opportunities for the mentally challenged vary widely based upon their skills and abilities. Many restaurants and grocery stores employ mentally challenged individuals for stocking shelves or greeting customers. In some cases they help in group environments specifically designed to employ mentally retarded people. Most of these places are set up to provide added support and structure for the disabled people. â€Å"Currently, only one-third of all disabled Americans with disabilities work, although the remaining two-thirds who are not working would like to have a job, but may or may not be looking for one† (Brodsky, 1990). Those who would like to have jobs, but are not actively seeking them may not have been properly prepared by their school systems, their communities or their families. These people need to be informed on the opportunities available to them and provided with assistance on finding suitable employment for their skill level and abilities. Most businesses now claim they are equal opportunity employers, which means that anyone can apply for positions in the company. Some jobs do have basic requirements either for specific position knowledge or for safety purposes, but the company can not turn down a qualified applicant simply because they have a diagnosis of mental retardation. This law has helped many disabled people have opportunities they might not have had available to them a number of years ago. In addition to this many businesses are providing special accommodations for wheelchairs and hearing impaired employees to make jobs more accessible. Everyone has some talent and skills that other people do not possess and everyone despite his or her disabilities has the right to reach his or her maximum potential. It is the job of society to see that every child is raised to reach that potential. No child should be left behind or written off as incapable of accomplishing anything. No one knows what a person is capable of until someone has helped the person achieve success. Everyone even the most intelligent people need some assistance to achieve his maximum potential. The new laws that have been passed in recent years have helped to ensure that the school systems provide the necessary assistance to help disabled children reach their maximum potential rather than just passing them on and counting them for the sake of the school census, until they reach the age of eighteen.Many schools today are legally obligated to provide a satisfactory education to every student. Resources: Beker, Jerome. (1988) Transitioning Exceptional Children and Youth Into the Community. Hawthorn Press/New York. Booth, Tony. (1983). Policies Towards the Integration of Mentally Handicapped Children in Education Oxford Review of Education. Vol. 9, No. 3, 1983. Brodsky, Melvin. (1990) Employment Programs for Disabled Youth: An International View. Monthly Labor Review, Vol. 113, 1990 Browder, Diane. (2001) Curriculum and Assessment for Students with Moderate And Severe Disabilities. Guilford Press/New York. Cambridge, Paul. (2005) Person Centered Planning and Care Management With People With Learning Disabilities. Jessica Kingsly Publishers/ London Connis, Richard T. (1981). Training the Mentally Handicapped for Employment: A Comprehensive Manual. Kluwer Academic Pub Free Health Encyclopedia. (2007). Advameg. Retrieved October 3, 2008 from: Mental Retardation – Definition, Description, Causes, Symptoms, Diagnosis, Treatment, Prognosis, Prevention President’s Committee on Mental Retardation- The President’s Committee on Employment of the Handicapped (1969). Rao, H. P. (1994). Employment opportunities for mentally handicapped individuals in rural area : a proposed model. Journal of the Indian Academy of Applied Psychology. 1994 Jul; 20(2): 131-7 Thompson, Angela. (1987). Mentally Handicapped School Leavers: Where do they Go? Child care: Health and Development. Wacker, David. (1984). Training Moderately and Severely Mentally Handicapped Children to Use Adaptive Social Skills. School Psychology Review, v13 n3 p324-30 Sum 1984 Young, John W. (2007). Validity of the Measure of Academic Proficiency and Progress. Educational Testing Service.

Essay on Future of Islam - 624 Words

The Future of Islam When first approached with the question â€Å"what the future of Islam is?† my mind raced around many places and had lots of different thoughts. I had no clue what the future of this religion would be I thought there are people for the American Gov. who are being payed a lot of money to figure this out and I don’t think they even know. So I decided to do research to figure out what my opinion on this matter was. I found that there could be different futures for different places, like Islam in the United States and Islam in the Middle East. I found that in the pre 9/11 days Muslims were a proud people and one of America’s largest populations. Post 9/11 there was a lot of ignorance and hatred towards Muslim people. Most†¦show more content†¦In the Middle East the population of Muslims is a lot higher and makes up the majority. There is also a lack of education and money which plays a big part in the future of Islam. There is much ignorance about western society and many people are educated by word of mouth believing what there peers say as fact. this is where a lot of the problems are started. When America invaded Iraq it gave ignorant people confirmation in there minds that western society was bad and was trying to defeat Islam. Some of the people assume that America is attacking them to take there religion and convert them to our ways, which is not true. Some Muslims take the Koran very literally and read it to say that anyone who kills a Muslim should be killed and anyone who gets in the way of their religion they may be killed also. However there are Muslims who know this is not the right interpretation and see that the radical philosophy is just hurting things. These for the most part are the rich and educated part of the population which is not very big. I feel that the future of Islam is in the hands of the upper class educated Muslims. I think that for the right ideas to be passed to everyone the upper class must lead by example. It is there responsibility to educate people the best they can. The upper class controls the economy, and the economy controls all the people. If they were to use there wealth and education to spread there knowledge I think Islam will have a very bright future. If they doShow MoreRelatedYoung Generation: Future Face of Islam1030 Words   |  5 PagesAl-Farisi. Today I would l like to talk about ‘Young Generation: F uture Face Of Islam’. The former president of Indonesia, Soekarno had once said, ‘give me ten youths and I will shake the world’. From his words we know that the young generation are the hope of the nation. They will be the one that carry the responsibilty for the sake of a brighter future of the country. At the same time, they are the one that hold the future of Islam. 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