• Title/Summary/Keyword: Patient blood management

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Perioperative Hypertension Management during Facelift under Local Anesthesia with Intravenous Hypnotics

  • Chung, Ki Ho;Cho, Myeong Soo;Jin, Hoon
    • Archives of Plastic Surgery
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    • v.44 no.4
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    • pp.276-282
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    • 2017
  • Perioperative hypertension is a phenomenon in which a surgical patient's blood pressure temporarily increases throughout the preoperative and postoperative periods and remains high until the patient's condition stabilizes. This phenomenon requires immediate treatment not only because it is observed in a majority of patients who are not diagnosed with high blood pressure, but also because occurs in patients with underlying essential hypertension who show a sharp increase in their blood pressure. The most common complication following facelift surgery is hematoma, and the most critical risk factor that causes hematoma is elevated systolic blood pressure. In general, a systolic blood pressure goal of <150 mm Hg and a diastolic blood pressure goal of >65 mm Hg are recommended. This article discusses the causes of increased blood pressure and the treatment methods for perioperative hypertension during the preoperative, intraoperative, and postoperative periods, in order to find ways to maintain normal blood pressure in patients during surgery. Further, in this paper, we review the causes of perioperative hypertension, such as anxiety, epinephrine, pain, and postoperative nausea and vomiting. The treatment methods for perioperative hypertension are analyzed according to the following 3 operative periods, with a review of the characteristics and interactions of each drug: preoperative antihypertensive medicine (atenolol, clonidine, and nifedipine), intraoperative intravenous (IV) hypnotics (propofol, midazolam, ketamine, and dexmedetomidine), and postoperative antiemetic medicine (metoclopramide and ondansetron). This article focuses on the knowledge necessary to safely apply local anesthesia with IV hypnotics during facelift surgery without the assistance of an anesthesiologist.

Viscoelastic Coagulation Test Guided Therapy for a Strategy to Reduce Transfusions (수혈 감소 전략을 위한 점탄성 응고 검사법의 유용성)

  • Park, Sun Young
    • The Korean Journal of Blood Transfusion
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    • v.29 no.3
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    • pp.240-252
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    • 2018
  • Viscoelastic coagulation tests provide simultaneous measurements of multiple aspects of whole-blood coagulation, including interactions between the plasma components and cellular components of the coagulation cascade. This can be carried out immediately using a point of care technique. Viscoelastic tests could predict the patient's outcome, including mortality, and detect coagulopathy more sensitively, resulted in reduced blood loss. The transfusion strategy based on the viscoelastic parameters rather than a conventional coagulation test has been shown to reduce the transfusion requirements. Although there are concerns about the reliability and accuracy of this method, viscoelastic tests, including ROTEM, would be a useful method to guide patient blood management strategies.

The Study of Critical Indicators Development for Establishing Patient Classification System in the ER (응급실의 환자분류체계 확립을 위한 결정지표 개발 연구)

  • Seong, Young-Hee;Seong, Il-Sun;Lee, Seung-Ja;Kim, Jeong-Ha;Moon, Yu-Jeong;Choe, Yeong-Mi;Lee, Jee-Hyang
    • Journal of Korean Academy of Nursing Administration
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    • v.12 no.3
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    • pp.444-453
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    • 2006
  • Purpose: The purpose of the study was to identify critical indicators for the development of efficient patient classification system in a emergency room. Method: This study involved following five steps. Step 1. Selection of the lists direct nursing services in the ER. Step 2. Measurement of the time of direct nursing services from Aug. 31st to Nov. 30th, 2005. Step 3. Classification of the patients according to the nursing care time. Step 4. The determination the critical indicators for different patient classes. Result: Determinate indicators were as follow: 3 items in the first group (vital sign checking, IV route starting, blood sampling), 3 items in the second group (vital sign checking, fluid infusion, blood sampling), 9 items in the third group (I/O checking, $O_{2}$ inhalation, suction, fluid infusion, IV bolus, Central catheter preparation & management, blood sampling, intubation preparation & management, postmortem management), 7 items in the fourth group (EKG monitoring, BP monitoring, $O_{2}$ inhalation, fluid infusion, using the specific drugs, CPR, postmortem management). Conclusion: This study can help future studies which measure nursing services standard time or assigns value to emergency nursing services.

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A Case of Korean-Western Medical Treatment of a Diabetic Patient Admitted with Lumbar Burst Fracture (요추 방출성 골절로 입원한 당뇨병 환자의 한양방 협진 치료 1례)

  • Kang, Ah-hyun;Han, Dong-kun;Seo, Hye-jin;Sung, Jae-yeon;Oh, Ju-hyun;Lee, Yu-ra;Lee, Hyung-chul;Um, Guk-hyun;Song, Woo-sub
    • The Journal of Internal Korean Medicine
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    • v.39 no.2
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    • pp.107-115
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    • 2018
  • Objectives: In the case of a diabetic patient diagnosed with lumbar burst fracture, we aim to present effective results in terms of pain management and blood glucose level stabilization. Methods: A patient was given combined traditional Korean medicine therapy, such as herbal medicine, acupuncture, and antidiabetic medications, during a hospitalization period. We measured the state and progress of this case with the NRS (Numeric Rating Scale) and ODI/NDI (Oswestry/Neck Disability Index). We also checked blood glucose levels regularly. Results: After treatment, the patient's pain was controlled, and the NRS score was decreased. Not only were the overall symptoms of the patient improved positively but the ODI/NDI scores were also improved. Blood glucose level was stabilized. Conclusions: One case of a diabetic patient diagnosed with lumbar burst fracture showed improvement of ODI, NDI, and NRS scores for back and neck pain. Further, the blood glucose level was stabilized.

Improving the Performance of Blood Transfusion Management Division (수혈관리실의 역할 수행에 따른 개선 효과)

  • Ho-Keun CHOI;Kyung-Suk CHOI
    • Korean Journal of Clinical Laboratory Science
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    • v.55 no.1
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    • pp.65-70
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    • 2023
  • The effect of improvement by keeping the former as the priority was examined through an evaluation of the role of the blood transfusion management (BTM) division. This division manages the status of blood for transfusion, evaluates the adequacy of blood transfusion (EABT), monitors and responds to the occurrence of transfusion-related side effects, and performs other tasks necessary for BTM. Although the establishment and operation of the BTM division can lead to the efficient evaluation of transfusion adequacy, there are disadvantages in that it takes time for EABT and it is difficult for the staff in charge of the BTM division to evaluate the adequacy of all the blood. In the future, it is essential to introduce a BTM division and committee specific to Korean patients to implement safe and appropriate BTM in medical institutions, and to assist medical institutions in training their personnel.

Effect of Case Management Intervention Program for Registered Clients with Home Health Care of Hypertension (고혈압 대상자의 방문간호 중재프로그램의 효과)

  • Oh, Suk-Hee;Kim, Yong-Soon;Park, Jee-Won;Yoo, Moon-Sook
    • Journal of Home Health Care Nursing
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    • v.17 no.1
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    • pp.28-35
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    • 2010
  • Purpose: The study compared the hypertension care efficacy of a case management intervention program for registered clients. Methods: The nonequivalent control group pretest-posttest design involved 53 registered hypertensive patients of a customized visiting health care service in S-city(n=28 experimental group, n=25 control group). Data collection and case management intervention were carried out from April to July, 2009. The experimental group had six home visits and two phone calls, and the control group had two home visits during the 8-week period. Outcome variables for test hypotheses were changes in physiologic index (blood pressure and total cholesterol) and degree of self-management performance and confidence. Results: Repeated measure ANOVA and t-test of means revealed significant differences before and after program for systolic and diastolic blood pressure and self-management performance and confidence, but no significant difference concerning total cholesterol. Conclusion: A case management program can have positive effects on blood pressure control and self management. However, research is needed to create a more effective case management for vulnerable patient populations.

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The Effects of Abdominal Relaxed Breathing Training on Stress response and Blood Pressure for Elderly Hypertensionve Patient (고혈압 노인에서 복식호흡 이완훈련이 혈압 및 스트레스 반응에 미치는 영향)

  • 유수정;송미순
    • Journal of Korean Academy of Nursing
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    • v.31 no.6
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    • pp.998-1011
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    • 2001
  • In order to improve self-management of elderly hypertensives in this study, the researcher examined the effect of blood pressure regulation by an abdominal relaxed breathing training which regulates physical response to stress and lessens the activity of the sympathetic nerve. Method: A quasi-experimental pre-test and post-test design was used. Thirty elderly hypertensive patient ; Sixteen in the abdominal breathing group and fourteen in the control group participated in this study. The abdominal relaxed breathing training consisted of eight sessions twice a week for four weeks. There was no intervention for the control group. Result: 1. There was a significant decrease in systolic and diastolic blood pressure between the experimental group and control group over three different times, and interaction by groups and over time. 2. There was no significant difference in the level of total stress response, physical stress response, behavioral-cognitive stress response between the experimental group and control group over three different times, and interaction by groups and over time. Conclusion: Findings indicate that this study will contribute to develop nursing strategies for the regulation of blood pressure for the elderly, which is easy for the elderly to learn as a nonpharmacologic approach.

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The Condition of Controlling Blood-pressure and the Use of Oriental Medical Services in Hypertensive Patients (고혈압(高血壓) 환자(患者)의 혈압관리실태(血壓管理實態)와 한방이용(韓方利用) 현황(現況))

  • Shin, Taek-Su;Yoo, Seong-Gi;Chong, Myong-Soo;Lee, Ki-Nam
    • The Journal of Traditional Korean Medicine
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    • v.15 no.1
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    • pp.128-144
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    • 2006
  • This Study aims at looking into the use of oriental medical services in treating hypertension. The first objective to be explored through this study is the morbidity caused by the disease, classifying them by age, gender, and occupation. The second is to determine the regular use of anti-hypertensive medicine and their efficacy in controlling blood-pressure. The third is to investigate the use-rate and satisfaction of oriental medical service. 838 households across the country, were asked to answer questionnaires for the period of time from Apr. to Jun. 2005. The conclusion from the survey can be summarized as following. The age of which the first medical diagnosis of hypertension were made showed lower in males, those with higher education and income. The study showed females were more active in blood-pressure control, with their frequent monitoring of blood-pressure for the past year. With age, people in under 50 age group proved to be less active. The management of high blood pressure was more effective in group with regular dosage compared to group with irregular use of anti-hypertensive medication, but their difference was minimal. Also, group with no medication showed signs of blood-pressure control. The use of oriental medical service for the past year, were more frequent in groups with lower education, either low or high income, old age, females and occupations in agriculture, forestry and fishing industry. Results were similar in both general population and high blood-pressure patient group. Females, people over 51 years old and with lower education showed more intentions in utilizing oriental medical services in the future. Results were similar in both general population and high blood-pressure patient group. It is necessary to offer a more accurate information on oriental medical treatments. Also, a systematic reform to reduce the patient's share of the treatment cost, as well as, heightening public awareness on the infirmity of present blood-pressure management system is crucial.

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A Qualitative Study on Management Behaviors about Blood Pressure of Participants in Moxibustion Clinical Trial for Hypertension (고혈압-뜸 임상시험 참여자들의 혈압 관리행동에 대한 질적연구)

  • Moon, A-Ji;Kim, Tae-Jung;Lee, Seoung-Geun;Kim, Nam-Kwen;Lee, Key-Sang
    • The Journal of Internal Korean Medicine
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    • v.33 no.4
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    • pp.543-557
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    • 2012
  • Objectives : The purpose of this study which adopted a qualitative method was to evaluate blood pressure management behaviors of pre- and stage 1 hypertension patients and to provide fundamental data for developing a strategy about proper oriental medical treatment through analyzing factors related to a moxibustion clinical trial. Methods : Semi-structured interviews that focused on personal experiences with hypertension and its management were conducted with 10 hypertensive patients. The interviews lasted for approximately 50 minutes. Results : Most participants recognized that the direct cause of high blood pressure was unhealthy behavior rather than inheritance. Thus, the hypertensive patient believed they could recover their blood pressure to a normal level through removing the direct cause of hypertension instead of taking drugs. The reasons for these statements were that the drugs for controlling hypertension are not natural and they may have side effects. On future management plan of patients, most of them will continue to keep moxibustion and healthy behavior in the well-controlled blood pressure group. However in the uncontrolled blood pressure group, there was an increasing tendency to begin medication. Conclusions : For developing a strategy for an individual approach to hypertension management, we need to develop a client-centered attitude and strategy. That is, we need to tailor our approach to individual cases to avoid generalizations and stereotyping when developing an adherence increasing strategy.

Development of a Patient Monitoring System Overall Architecture and Specifications (환자모니터링시스템의 개발 : 전체구조 및 기본사양)

  • 우응제;박승훈
    • Journal of Biomedical Engineering Research
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    • v.18 no.1
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    • pp.17-24
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    • 1997
  • We have developed a patient monitoring system including module-based bedside monitors, interbed network, central stations, clinical workstations, and DB servers. A bedside monitor with a color LCD can accommodate up to 3 module cases and 21 different modules. Six different physiological parameters of ECG, respiration, invasive blood pressure, noninvasive blood pressure, body temperature, and arterial pulse oximetry with plethysmoyaph are provided as parameter modules. In a single bedside monitor, modules and a module controller communicate with IMbps data rate through an intrabed network based on RS-485 and HDU protocol. At the same time, it communicates with other bedside monitors and central stations through interbed network based on 1 OMbps Ethernet and TCP/IP protocol. Central stations using 20" color CRT monitors can be connected with many bedside monitors and they display 18 channels of waveforms simultaneously. Clinical workstations are used mainly for the review of patient datE In order to accommodate more advanced data management capabilities such as 24-hour full disclosure, we have developed a relational database server dedicated to the patient monitoring system. Software for bedside monitor, central station, and clinical workstation fully utilizes graphical user interface techniques and all functions are controlled by a rotate/push button on the bedside monitor arid a mouse on the central station and clinical workstation. The entire system satisfies the requirements of AAMI and ANSI standards in terms of electrical safety and performances.nces.

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