FANTASTIC FOUR!!!
Lunch @ Chilis with friends from N4 and N5
Wednesday, May 23, 2007
Pics from the last day...
Congratulations to all. Our first year is over and done with. It has been a pleasure to meet so many wonderful people. I'm glad we are all sharing the experience together. May you all have a wonderful and relaxing summer, enjoy it because I'm sure it's a well needed break. Till Fall 2007.... ~much love Drea ~
FANTASTIC FOUR!!!
Lunch @ Chilis with friends from N4 and N5
FANTASTIC FOUR!!!
Lunch @ Chilis with friends from N4 and N5
Monday, May 21, 2007
Sunday, May 20, 2007
Saturday, May 19, 2007
Thursday, May 17, 2007
switch?
hey everyone,
i am posting for Shawna... she is at st. joes with peterson for 7, the first half of the semester. she was wondering if anyone who is at dameron with Antaran for 7, the first half would like to switch with her...if so email her at: sbrunmeier477@students.deltacollege.edu or talk to her on monday
i am posting for Shawna... she is at st. joes with peterson for 7, the first half of the semester. she was wondering if anyone who is at dameron with Antaran for 7, the first half would like to switch with her...if so email her at: sbrunmeier477@students.deltacollege.edu or talk to her on monday
Wednesday, May 16, 2007
Sunday, May 13, 2007
It will take just 37 seconds to read this and change your thinking.
>> Two men, both seriously ill, occupied the same hospital room.
>> One man was allowed to sit up in his bed for an hour each afternoon to
> help drain the fluid from his lungs.
> His bed was next to the room's only window.
>> The other man had to spend all his time flat on his back.
>> The men talked for hours on end.
> They spoke of their wives and families, their homes, their jobs, their
> involvement in the military service, where they had been on vacation.
>>> Every afternoon, when the man in the bed by the window could sit up, he
> would pass the time by describing to his roommate all the things he could
> see outside the window.
>> The man in the other bed began to live for those one hour periods where
> his world would be broadened and enlivened by all the activity and color
> of the world outside.
>>> The window overlooked a park with a lovely lake.
> Ducks and swans played on the water while children sailed their model
> boats. Young lovers walked arm in arm amidst flowers of every color and a
> fine view of the city skyline could be seen in the distance.
>>> As the man by the window described all this in exquisite details, the man
> on the other side of the room would close his eyes and imagine this
> picturesque scene.
>> One warm afternoon, the man by the window described a parade passing by.
>>> Although the other man could not hear the band - he could see it in his
> mind's eye as the gentleman by the window portrayed it with descriptive
> words.
>>> Days, weeks and months passed.
>> One morning, the day nurse arrived to bring water for their baths only to
> find the lifeless body of the man by the window, who had died peacefully
> in his sleep.
> She was saddened and called the hospital attendants to take the body away.
>> As soon as it seemed appropriate, the other man asked if he could be moved
> next to the window. The nurse was happy to make the switch, and after
> making sure he was comfortable, she left him alone.
>>> Slowly, painfully, he propped himself up on one elbow to take his first
> look at the real world outside.
> He strained to slowly turn to look out the window besides the bed.
>> It faced a blank wall.
>> The man asked the nurse what could have compelled his deceased roommate
> who had described such wonderful things outside this window.
>>> The nurse responded that the man was blind and could not even see the
> wall.
>> She said, "Perhaps he just wanted to encourage you."
>>> Epilogue:
>> There is tremendous happiness in making others happy, despite our own
> situations.
>> Shared grief is half the sorrow, but happiness when shared, is doubled.
>>> If you want to feel rich, just count all the things you have that money
> can't buy.
>>> "Today is a gift, that is why it is called The Present."
>> Two men, both seriously ill, occupied the same hospital room.
>> One man was allowed to sit up in his bed for an hour each afternoon to
> help drain the fluid from his lungs.
> His bed was next to the room's only window.
>> The other man had to spend all his time flat on his back.
>> The men talked for hours on end.
> They spoke of their wives and families, their homes, their jobs, their
> involvement in the military service, where they had been on vacation.
>>> Every afternoon, when the man in the bed by the window could sit up, he
> would pass the time by describing to his roommate all the things he could
> see outside the window.
>> The man in the other bed began to live for those one hour periods where
> his world would be broadened and enlivened by all the activity and color
> of the world outside.
>>> The window overlooked a park with a lovely lake.
> Ducks and swans played on the water while children sailed their model
> boats. Young lovers walked arm in arm amidst flowers of every color and a
> fine view of the city skyline could be seen in the distance.
>>> As the man by the window described all this in exquisite details, the man
> on the other side of the room would close his eyes and imagine this
> picturesque scene.
>> One warm afternoon, the man by the window described a parade passing by.
>>> Although the other man could not hear the band - he could see it in his
> mind's eye as the gentleman by the window portrayed it with descriptive
> words.
>>> Days, weeks and months passed.
>> One morning, the day nurse arrived to bring water for their baths only to
> find the lifeless body of the man by the window, who had died peacefully
> in his sleep.
> She was saddened and called the hospital attendants to take the body away.
>> As soon as it seemed appropriate, the other man asked if he could be moved
> next to the window. The nurse was happy to make the switch, and after
> making sure he was comfortable, she left him alone.
>>> Slowly, painfully, he propped himself up on one elbow to take his first
> look at the real world outside.
> He strained to slowly turn to look out the window besides the bed.
>> It faced a blank wall.
>> The man asked the nurse what could have compelled his deceased roommate
> who had described such wonderful things outside this window.
>>> The nurse responded that the man was blind and could not even see the
> wall.
>> She said, "Perhaps he just wanted to encourage you."
>>> Epilogue:
>> There is tremendous happiness in making others happy, despite our own
> situations.
>> Shared grief is half the sorrow, but happiness when shared, is doubled.
>>> If you want to feel rich, just count all the things you have that money
> can't buy.
>>> "Today is a gift, that is why it is called The Present."
Thursday, May 10, 2007
Come join us for Rootbeer Floats at the SNA meeting!!
Did you ask when and where???
Monday, May 14, 2007 @ 1:00pm in Locke 314
(It's the last meeting of the semester)
There will be lots of info from our Special Guest Speakers:
Rocky La Jeunesse, Guidance and Counseling
Topic: Requirements for Transfer (LVN/PT to RN, RN to BSN)
Shelba Durston, Kymn Trujillo and Dean Alin Ciochina
Topic: Work Experience/Internship/Apprenticeship Program
Hope to see you there!! Spread the word.
Monday, May 14, 2007 @ 1:00pm in Locke 314
(It's the last meeting of the semester)
There will be lots of info from our Special Guest Speakers:
Rocky La Jeunesse, Guidance and Counseling
Topic: Requirements for Transfer (LVN/PT to RN, RN to BSN)
Shelba Durston, Kymn Trujillo and Dean Alin Ciochina
Topic: Work Experience/Internship/Apprenticeship Program
Hope to see you there!! Spread the word.
Tuesday, May 08, 2007
Use of Seclusion and Restraint?
This is only part of the article....
Alternatives to Restraint and Seclusion in Mental Health Settings: Questions and Answers From Psychiatric Nurse Experts
Posted 05/03/2007
Laura Stokowski, RN, MS
from Medscape Website http://www.medscape.com/viewarticle/555686?src=mp
What Alternative Approaches Can Nurses Use to Avoid the Use of Seclusion and Restraint?
A reader asks, "What do you do when a 220-pound violent patient is throwing furniture or has already assaulted a staff member?" The first thing you should do is clear the area of others, and then remain quietly available at a safe distance until the peak of the crisis has passed. The risk of injury to both patients and staff is high when a direct verbal or physical intervention is attempted at the peak of a crisis. If a staff member has been assaulted, the staff member should be removed from the area and other staff must take the lead in intervening. A patient should not automatically be secluded or restrained following a staff assault, a response often born of fear or the conviction that the person needs "consequences." Seclusion or restraint should never be used to introduce consequences; instead, other approaches to supporting behavior change may be instituted once the crisis has passed.
Early identification of the problem and appropriate assessment of the situation are essential because different situations must be dealt with differently. Anger, fear, and frustration can all lead to violent behavior, and each calls for a specific approach. "Meet the patient where the patient is at" is a phrase commonly used to convey the need to match the approach to the patient's emotional state and to what has triggered that state.
An often overlooked but very simple crisis communication technique is to ask the patient "What would help you right now, at this moment?" It is surprising that this is a question we don't think of asking, yet it often yields a very specific and helpful response. A patient might just need clarification of a misunderstanding, some personal space, or might need to walk. Engaging the patient in the decision of how best to intervene can help them get through the situation without resorting to seclusion or restraint.
Chabora and colleagues[4] developed the Four S Model as a way of reducing the use of seclusion and restraint. The 4 S's are safety, support, structure, and symptom management. In brief:
Safety means assuring the individual's physical and emotional well-being via interventions such as modifying the environment to reduce stimuli and induce a calming ambiance.
Support involves listening and talking in a supportive way, offering comfort measures or whatever is needed according to the individual, and using verbal de-escalation.
Structure techniques, like limit setting, convey behavioral expectations and aid in constructive problem solving.
Symptom management is aimed at specific symptoms including stress and relaxation measures, diversionary activities, or medication.
The scenario described above (the 220-pound patient throwing furniture) is already an out-of-control situation. The question must be asked, what happened before this patient started throwing furniture or assaulted the staff member? At that point, engaging this patient might have led to a different outcome. When the patient is at the point of throwing furniture, the only option may be to clear the area and have everyone get out of the way until the patient winds down. This can be difficult and scary for staff to do, but it is likely to result in less injury than trying to physically contain the patient and apply restraints. When the patient is calmer, staff can proceed with crisis communication techniques that involve the patient, and the use of seclusion or restraints has been avoided.
Prevention is always easier and more effective than reacting to episodes of violent behavior. Careful patient assessments can identify risk factors for violence including triggers, previous restraint and seclusion history, and trauma and abuse history. At the same time, effective coping strategies previously used by the individual to safely manage behavior, as well as specific directions for what staff can do to help, should be elicited and documented in the treatment plan. Patients can be involved in developing their own de-escalation or safety and support plans (including psychiatric advance directives). Gathering this information at the point of admission provides a foundation for effective partnership when circumstances present that could give rise to a behavioral emergency. "I remember you saying...." is an opening statement that sets the stage for working together.
Alternatives to Restraint and Seclusion in Mental Health Settings: Questions and Answers From Psychiatric Nurse Experts
Posted 05/03/2007
Laura Stokowski, RN, MS
from Medscape Website http://www.medscape.com/viewarticle/555686?src=mp
What Alternative Approaches Can Nurses Use to Avoid the Use of Seclusion and Restraint?
A reader asks, "What do you do when a 220-pound violent patient is throwing furniture or has already assaulted a staff member?" The first thing you should do is clear the area of others, and then remain quietly available at a safe distance until the peak of the crisis has passed. The risk of injury to both patients and staff is high when a direct verbal or physical intervention is attempted at the peak of a crisis. If a staff member has been assaulted, the staff member should be removed from the area and other staff must take the lead in intervening. A patient should not automatically be secluded or restrained following a staff assault, a response often born of fear or the conviction that the person needs "consequences." Seclusion or restraint should never be used to introduce consequences; instead, other approaches to supporting behavior change may be instituted once the crisis has passed.
Early identification of the problem and appropriate assessment of the situation are essential because different situations must be dealt with differently. Anger, fear, and frustration can all lead to violent behavior, and each calls for a specific approach. "Meet the patient where the patient is at" is a phrase commonly used to convey the need to match the approach to the patient's emotional state and to what has triggered that state.
An often overlooked but very simple crisis communication technique is to ask the patient "What would help you right now, at this moment?" It is surprising that this is a question we don't think of asking, yet it often yields a very specific and helpful response. A patient might just need clarification of a misunderstanding, some personal space, or might need to walk. Engaging the patient in the decision of how best to intervene can help them get through the situation without resorting to seclusion or restraint.
Chabora and colleagues[4] developed the Four S Model as a way of reducing the use of seclusion and restraint. The 4 S's are safety, support, structure, and symptom management. In brief:
Safety means assuring the individual's physical and emotional well-being via interventions such as modifying the environment to reduce stimuli and induce a calming ambiance.
Support involves listening and talking in a supportive way, offering comfort measures or whatever is needed according to the individual, and using verbal de-escalation.
Structure techniques, like limit setting, convey behavioral expectations and aid in constructive problem solving.
Symptom management is aimed at specific symptoms including stress and relaxation measures, diversionary activities, or medication.
The scenario described above (the 220-pound patient throwing furniture) is already an out-of-control situation. The question must be asked, what happened before this patient started throwing furniture or assaulted the staff member? At that point, engaging this patient might have led to a different outcome. When the patient is at the point of throwing furniture, the only option may be to clear the area and have everyone get out of the way until the patient winds down. This can be difficult and scary for staff to do, but it is likely to result in less injury than trying to physically contain the patient and apply restraints. When the patient is calmer, staff can proceed with crisis communication techniques that involve the patient, and the use of seclusion or restraints has been avoided.
Prevention is always easier and more effective than reacting to episodes of violent behavior. Careful patient assessments can identify risk factors for violence including triggers, previous restraint and seclusion history, and trauma and abuse history. At the same time, effective coping strategies previously used by the individual to safely manage behavior, as well as specific directions for what staff can do to help, should be elicited and documented in the treatment plan. Patients can be involved in developing their own de-escalation or safety and support plans (including psychiatric advance directives). Gathering this information at the point of admission provides a foundation for effective partnership when circumstances present that could give rise to a behavioral emergency. "I remember you saying...." is an opening statement that sets the stage for working together.
Saturday, May 05, 2007
Honey could save diabetics from amputation
MADISON, United States (AFP) - Spreading honey on a diabetic ulcer could prevent the need to amputate an infected foot, researchers say.
A doctor at the University of Wisconsin who helped about half a dozen of her diabetic patients avoid amputation has launched a controlled trial to promote the widespread use of honey therapy.
The therapy involves squeezing a thick layer of honey onto the wound after dead skin and bacteria have been removed.
The honey kills bacteria because it is acidic and avoids the complication of bacterial resistance found with standard antibiotics, Jennifer Eddy, a professor at the University's School of Medicine and Public Health, told AFP.
"This is a tremendously important issue for world health," Eddy said.
Diabetics typically have poor circulation and decreased ability to fight infection and ulcers can be hard to treat. An amputation is performed every 30 seconds somewhere in the world, Eddy said.
"If we can prove that honey promotes healing in diabetic ulcers, we can offer new hopes for many patients, not to mention the cost benefit, and the issue of bacterial resistance. The possibilities are tremendous."
Honey therapy is already used to treat bed sores in New Zealand and as an alternative form of medicine in Europe, but has largely been relegated to history books in the United States.
Eddy first heard of it in medical school when a professor commented that of all the ancient remedies, honey actually seemed to work when he tried it out in the laboratory.
She tried honey therapy as a last resort six years ago with a 79-year-old diabetic patient who had developed foot wounds resistant to standard treatments.
"I tried it only after everything else had failed and... we had essentially sent him home to die," she said. "All antibiotics were stopped when we started honey, and his wounds rapidly healed."
Eddy hopes to have the trial completed and the results published by 2008 or 2009.
http://news.yahoo.com/s/afp/20070504/hl_afp/healthscience_070504213618
A doctor at the University of Wisconsin who helped about half a dozen of her diabetic patients avoid amputation has launched a controlled trial to promote the widespread use of honey therapy.
The therapy involves squeezing a thick layer of honey onto the wound after dead skin and bacteria have been removed.
The honey kills bacteria because it is acidic and avoids the complication of bacterial resistance found with standard antibiotics, Jennifer Eddy, a professor at the University's School of Medicine and Public Health, told AFP.
"This is a tremendously important issue for world health," Eddy said.
Diabetics typically have poor circulation and decreased ability to fight infection and ulcers can be hard to treat. An amputation is performed every 30 seconds somewhere in the world, Eddy said.
"If we can prove that honey promotes healing in diabetic ulcers, we can offer new hopes for many patients, not to mention the cost benefit, and the issue of bacterial resistance. The possibilities are tremendous."
Honey therapy is already used to treat bed sores in New Zealand and as an alternative form of medicine in Europe, but has largely been relegated to history books in the United States.
Eddy first heard of it in medical school when a professor commented that of all the ancient remedies, honey actually seemed to work when he tried it out in the laboratory.
She tried honey therapy as a last resort six years ago with a 79-year-old diabetic patient who had developed foot wounds resistant to standard treatments.
"I tried it only after everything else had failed and... we had essentially sent him home to die," she said. "All antibiotics were stopped when we started honey, and his wounds rapidly healed."
Eddy hopes to have the trial completed and the results published by 2008 or 2009.
http://news.yahoo.com/s/afp/20070504/hl_afp/healthscience_070504213618
Wednesday, May 02, 2007
Hey, there's a party.............and you all are invited!
Please come to the May 24th 2007 graduation of your upper classmen, from the RN program! Soon, you will be here at this point...and believe me, it comes on so quickly, you are there before you know it!
May 24th, 2007 at 7 pm, Atherton Auditorium, Delta College
No tickets required.
A little bit of advice for you all:
Take lots of pictures! Get your slide show person nominated now, so that he/she can begin collecting pictures....we got bombarded in the end...it is easier to do it as you go along, and sadly we missed alot of our "firsts" skills labs, IV day etc...dont forget the camera everyone.
Second...we made our own yearbook. I contacted the graphic art department and asked the instructor if one of her students would like to make us a cover...and he did, his name is Voltaire and he did an incredible job...THANK YOU DELTA GRAPHICS ART PROGRAM!
Third, and not lastly...guys, truly enjoy every second. There were so many times, I wanted to run away, cry, oh and did I cry. I look back, and see how far I have come, how far we all have come, and it is truly amazing, how much you grow into your own within this program. Take care of eachother, help eachother. Smile, laugh....become a solid team all 100 of you, can help eachother. Lift up your fellow student on their bad day...give them some advice, a little time...a little kindness will go a very long way guys. Love the moments you are in, while you are in them, they only come once in a lifetime. Make every bit of the time you have with your patients, a special time...some of your patients have no other support in their illness, except for the staff...remember that in report, you will hear things about the behavior of one of your patients, you will think, " can't I have another patient?" truly....these are the patients that need you the most...a little bit of listening, patience, kindness, empathy, compassion...can change someones' life...this is the truest gift one can give...of their time, of their ability to be "in the moment", and it will change you as well.
I, and our class, wish you all the very best that nursing has to offer you all. You will all become such close friends, confidants, nurses....together. Love nursing for all it is, all it can be, all that you make it to be. Discover yourself, you will be surprised to find all the gifts that you have inside your heart to share with others. Bless the world with your peace. That stethescope, that student nurse being that you are, symbolizes hundreds of years, as the most compassionate, selfless job in the world. Honor tradition, and be proud.
May you all be blessed with good health, 72 percents, and let the pathomapping God's be with you all.
Your fellow RN 2 B
Christine Moles
Graduating class May 2007
Please come to the May 24th 2007 graduation of your upper classmen, from the RN program! Soon, you will be here at this point...and believe me, it comes on so quickly, you are there before you know it!
May 24th, 2007 at 7 pm, Atherton Auditorium, Delta College
No tickets required.
A little bit of advice for you all:
Take lots of pictures! Get your slide show person nominated now, so that he/she can begin collecting pictures....we got bombarded in the end...it is easier to do it as you go along, and sadly we missed alot of our "firsts" skills labs, IV day etc...dont forget the camera everyone.
Second...we made our own yearbook. I contacted the graphic art department and asked the instructor if one of her students would like to make us a cover...and he did, his name is Voltaire and he did an incredible job...THANK YOU DELTA GRAPHICS ART PROGRAM!
Third, and not lastly...guys, truly enjoy every second. There were so many times, I wanted to run away, cry, oh and did I cry. I look back, and see how far I have come, how far we all have come, and it is truly amazing, how much you grow into your own within this program. Take care of eachother, help eachother. Smile, laugh....become a solid team all 100 of you, can help eachother. Lift up your fellow student on their bad day...give them some advice, a little time...a little kindness will go a very long way guys. Love the moments you are in, while you are in them, they only come once in a lifetime. Make every bit of the time you have with your patients, a special time...some of your patients have no other support in their illness, except for the staff...remember that in report, you will hear things about the behavior of one of your patients, you will think, " can't I have another patient?" truly....these are the patients that need you the most...a little bit of listening, patience, kindness, empathy, compassion...can change someones' life...this is the truest gift one can give...of their time, of their ability to be "in the moment", and it will change you as well.
I, and our class, wish you all the very best that nursing has to offer you all. You will all become such close friends, confidants, nurses....together. Love nursing for all it is, all it can be, all that you make it to be. Discover yourself, you will be surprised to find all the gifts that you have inside your heart to share with others. Bless the world with your peace. That stethescope, that student nurse being that you are, symbolizes hundreds of years, as the most compassionate, selfless job in the world. Honor tradition, and be proud.
May you all be blessed with good health, 72 percents, and let the pathomapping God's be with you all.
Your fellow RN 2 B
Christine Moles
Graduating class May 2007
Tuesday, May 01, 2007
Interesting Article
To Treat the Dead
The new science of resuscitation is changing the way doctors think about heart attacks—and death itself.
May 7, 2007 issue - Consider someone who has just died of a heart attack. His organs are intact, he hasn't lost blood. All that's happened is his heart has stopped beating—the definition of "clinical death"—and his brain has shut down to conserve oxygen. But what has actually died?
As recently as 1993, when Dr. Sherwin Nuland wrote the best seller "How We Die," the conventional answer was that it was his cells that had died. The patient couldn't be revived because the tissues of his brain and heart had suffered irreversible damage from lack of oxygen. This process was understood to begin after just four or five minutes. If the patient doesn't receive cardiopulmonary resuscitation within that time, and if his heart can't be restarted soon thereafter, he is unlikely to recover. That dogma went unquestioned until researchers actually looked at oxygen-starved heart cells under a microscope. What they saw amazed them, according to Dr. Lance Becker, an authority on emergency medicine at the University of Pennsylvania. "After one hour," he says, "we couldn't see evidence the cells had died. We thought we'd done something wrong." In fact, cells cut off from their blood supply died only hours later.
But if the cells are still alive, why can't doctors revive someone who has been dead for an hour? Because once the cells have been without oxygen for more than five minutes, they die when their oxygen supply is resumed. It was that "astounding" discovery, Becker says, that led him to his post as the director of Penn's Center for Resuscitation Science, a newly created research institute operating on one of medicine's newest frontiers: treating the dead.
Biologists are still grappling with the implications of this new view of cell death—not passive extinguishment, like a candle flickering out when you cover it with a glass, but an active biochemical event triggered by "reperfusion," the resumption of oxygen supply. The research takes them deep into the machinery of the cell, to the tiny membrane-enclosed structures known as mitochondria where cellular fuel is oxidized to provide energy. Mitochondria control the process known as apoptosis, the programmed death of abnormal cells that is the body's primary defense against cancer. "It looks to us," says Becker, "as if the cellular surveillance mechanism cannot tell the difference between a cancer cell and a cell being reperfused with oxygen. Something throws the switch that makes the cell die."
With this realization came another: that standard emergency-room procedure has it exactly backward. When someone collapses on the street of cardiac arrest, if he's lucky he will receive immediate CPR, maintaining circulation until he can be revived in the hospital. But the rest will have gone 10 or 15 minutes or more without a heartbeat by the time they reach the emergency department. And then what happens? "We give them oxygen," Becker says. "We jolt the heart with the paddles, we pump in epinephrine to force it to beat, so it's taking up more oxygen." Blood-starved heart muscle is suddenly flooded with oxygen, precisely the situation that leads to cell death. Instead, Becker says, we should aim to reduce oxygen uptake, slow metabolism and adjust the blood chemistry for gradual and safe reperfusion.
Researchers are still working out how best to do this. A study at four hospitals, published last year by the University of California, showed a remarkable rate of success in treating sudden cardiac arrest with an approach that involved, among other things, a "cardioplegic" blood infusion to keep the heart in a state of suspended animation. Patients were put on a heart-lung bypass machine to maintain circulation to the brain until the heart could be safely restarted. The study involved just 34 patients, but 80 percent of them were discharged from the hospital alive. In one study of traditional methods, the figure was about 15 percent.
Becker also endorses hypothermia—lowering body temperature from 37 to 33 degrees Celsius—which appears to slow the chemical reactions touched off by reperfusion. He has developed an injectable slurry of salt and ice to cool the blood quickly that he hopes to make part of the standard emergency-response kit. "In an emergency department, you work like mad for half an hour on someone whose heart stopped, and finally someone says, 'I don't think we're going to get this guy back,' and then you just stop," Becker says. The body on the cart is dead, but its trillions of cells are all still alive. Becker wants to resolve that paradox in favor of life.
© 2007 Newsweek, Inc.
By Jerry Adler
Newsweek
http://www.msnbc.msn.com/id/18368186/site/newsweek?GT1=9951
The new science of resuscitation is changing the way doctors think about heart attacks—and death itself.
May 7, 2007 issue - Consider someone who has just died of a heart attack. His organs are intact, he hasn't lost blood. All that's happened is his heart has stopped beating—the definition of "clinical death"—and his brain has shut down to conserve oxygen. But what has actually died?
As recently as 1993, when Dr. Sherwin Nuland wrote the best seller "How We Die," the conventional answer was that it was his cells that had died. The patient couldn't be revived because the tissues of his brain and heart had suffered irreversible damage from lack of oxygen. This process was understood to begin after just four or five minutes. If the patient doesn't receive cardiopulmonary resuscitation within that time, and if his heart can't be restarted soon thereafter, he is unlikely to recover. That dogma went unquestioned until researchers actually looked at oxygen-starved heart cells under a microscope. What they saw amazed them, according to Dr. Lance Becker, an authority on emergency medicine at the University of Pennsylvania. "After one hour," he says, "we couldn't see evidence the cells had died. We thought we'd done something wrong." In fact, cells cut off from their blood supply died only hours later.
But if the cells are still alive, why can't doctors revive someone who has been dead for an hour? Because once the cells have been without oxygen for more than five minutes, they die when their oxygen supply is resumed. It was that "astounding" discovery, Becker says, that led him to his post as the director of Penn's Center for Resuscitation Science, a newly created research institute operating on one of medicine's newest frontiers: treating the dead.
Biologists are still grappling with the implications of this new view of cell death—not passive extinguishment, like a candle flickering out when you cover it with a glass, but an active biochemical event triggered by "reperfusion," the resumption of oxygen supply. The research takes them deep into the machinery of the cell, to the tiny membrane-enclosed structures known as mitochondria where cellular fuel is oxidized to provide energy. Mitochondria control the process known as apoptosis, the programmed death of abnormal cells that is the body's primary defense against cancer. "It looks to us," says Becker, "as if the cellular surveillance mechanism cannot tell the difference between a cancer cell and a cell being reperfused with oxygen. Something throws the switch that makes the cell die."
With this realization came another: that standard emergency-room procedure has it exactly backward. When someone collapses on the street of cardiac arrest, if he's lucky he will receive immediate CPR, maintaining circulation until he can be revived in the hospital. But the rest will have gone 10 or 15 minutes or more without a heartbeat by the time they reach the emergency department. And then what happens? "We give them oxygen," Becker says. "We jolt the heart with the paddles, we pump in epinephrine to force it to beat, so it's taking up more oxygen." Blood-starved heart muscle is suddenly flooded with oxygen, precisely the situation that leads to cell death. Instead, Becker says, we should aim to reduce oxygen uptake, slow metabolism and adjust the blood chemistry for gradual and safe reperfusion.
Researchers are still working out how best to do this. A study at four hospitals, published last year by the University of California, showed a remarkable rate of success in treating sudden cardiac arrest with an approach that involved, among other things, a "cardioplegic" blood infusion to keep the heart in a state of suspended animation. Patients were put on a heart-lung bypass machine to maintain circulation to the brain until the heart could be safely restarted. The study involved just 34 patients, but 80 percent of them were discharged from the hospital alive. In one study of traditional methods, the figure was about 15 percent.
Becker also endorses hypothermia—lowering body temperature from 37 to 33 degrees Celsius—which appears to slow the chemical reactions touched off by reperfusion. He has developed an injectable slurry of salt and ice to cool the blood quickly that he hopes to make part of the standard emergency-response kit. "In an emergency department, you work like mad for half an hour on someone whose heart stopped, and finally someone says, 'I don't think we're going to get this guy back,' and then you just stop," Becker says. The body on the cart is dead, but its trillions of cells are all still alive. Becker wants to resolve that paradox in favor of life.
© 2007 Newsweek, Inc.
By Jerry Adler
Newsweek
http://www.msnbc.msn.com/id/18368186/site/newsweek?GT1=9951
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