Antibiotics Before Cultures in Septic Suspected Patients

Antibiotics Before Cultures in Septic Suspected Patients No More Waiting Antibiotics Before Cultures in Septic Suspected Patients Shannin Pierce Introduction Identifying the Issue September, 21 2013 was an abnormally busy day at Northeast Clark Hospital. At 6:45 AM, 63 year old Mr. Davis Jones, present to the emergency department with a fever of 102.6, heart rate of 110 beats per minute, and a respiratory rate of 22. His blood pressure is 91/63. He is weak and lethargic. His wife tells staff that during the past week he has been sleeping more than usual and not eating or drinking much. She suspects he has come down with the flu that has been going around. Mr. Jones is sent to a room and asked to put on a gown and informed that the doctor will be right in to see him. At 7:00, the night shift nurse reports off the dayshift nurse of all of her patients, but fails to inform the dayshift nurse that Mr. Jones has yet to have cultures collected. At 7:15, the dayshift nurse checks on Mr. Jones who is comfortably sleeping in the hospital bed with his wife by his side. Vital have not changed since admission. She continues to the next patient. At 7:30 AM she rechecks on Mr. Jones and realizes that he has yet to have cultures drawn and collects the supplies. Cultures are collected at 7:45 AM and sent to the lab. At 8:00 lab results show WBC 16,000. The nurse reports the findings immediately to the attending physician, who orders intravenous (IV) antibiotics and fluids. Pharmacy sends up the antibiotics at 8:30 AM and the nurse begins infusion at 8:45 AM. At 9:00 AM, Mr. Joness blood pressure drops to 58/42, heart rate soars to 160 beats per minute, and he is unconscious and unresponsive. The staff frantically rushes to infuse IV fluid into Mr. Jones but he goes into cardiac arrest. All resuscitation attempts are made, but at 9:45, Mr. Jones is pronounced dead. Sepsis and bloodstream infections have become a major cause of hospitalization and death in the United States. In these situations it is a standard protocol to collect blood cultures before administration of antibiotic, however, this can often delay the treatment needed to reduce the chance of death of patients with septicemia. With new advances in culture collection technology, blood culture collection containers now contain antimicrobial removal media, which makes it no longer necessary to delay treatment of antibiotics in order to wait for untreated blood specimens to be collected. By using the antimicrobial removal media enriched blood collection containers for all patients with suspected sepsis, antibiotic treatment can be initiated faster, hospital stays will be shorter, cost of care will be decreased, and fewer people will die due to septicemia. Analysis of the Current Situation Currently, standard protocol for septic suspected patients is for blood cultures to be collected from two different ventipuncture sites before the initiation of any antibiotic therapy using aseptic technique. It is also recommended that antibiotic therapy be initiated within one hour of onset of septicemia. According to a research study by Anand Kumar (2006), every hour of delay in antimicrobial therapy result in an increase in mortality of 7.6%. While the majority of hospital facilities strive to achieve the goal of cultures and antimicrobial therapy within the one hour time frame, the reality is that very few are actually successful. It is estimated that only about 12% of patients actually receive the antimicrobial therapy within the first hour (Daniels, 2011). To make matters worse, emergency departments struggle with overcrowding. According to hospitalstats.org, the median emergency department wait time in the Clark County Valley is 3 hours 25 minutes (Hospital Stats, 2014). Identifying the signs and symptoms of sepsis is a huge barrier to providing timely treatment. Another huge problem with the standard protocol for cultures before antibiotic therapy is that 50% to 82% of patients presenting to the emergency or intensive care facilities with suspected septicemia have already been given an antibiotic before admission and culture collection (Zadroga et al., 2013). However, with the initiation of facilities using antimicrobial removal resin blood culture containers, such as BACTEC PLUS, many of the barriers to providing timely care to septic suspected patients can be overcome. BACTEC PLUS has been proven to recover 95.1% of bacterial pathogens in blood culture samples with therapeutic levels of antimicrobial agents present, and 100% of strains in control bottles (Flayhart, Borek, Wakefield, Dick, Carroll, 2007). Leading Change It is estimated that 20,000 people die worldwide every day from sepsis (Daniels, 2011). While the use of blood culture analysis is and always will be one of the most important evidence-based microbial testing procedures for determining diagnosis of septicemia, the need to wait for cultures to be drawn before administering life saving antimicrobial therapy is unnecessary. Patients with suspected septicemia need to be receiving antimicrobial therapy within the one hour time frame, whether or not cultures have been drawn. It needs to become standard protocol that the antimicrobial therapy be initiated in that one hour time frame, and move away from the standard being cultures first. To initiate this change, it is proposed that implementation of antimicrobial therapy be initiated immediately in septic suspected patients. The Process of Change Change will being in the emergency department. All medical staff, including physicians, nurses, LPNs, CNAs, and technicians will be informed of the change to take place by having multiple conferences and training sessions over a period of time, no less than four weeks, with a minimum of three different time slots occurring near shift change to accommodate all shifts for all employees to be able to attend. All attending staff will sign an agreement contract, including the understanding of the new policy to be implemented. Once they have been fully informed and have had the opportunity to express all misunderstanding and concerns with the new policy, implementation of the policy in the department will ensue. The emergency department will be fully stocked with BACTEC blood collection containers. Quality control agents will monitor compliance of the policy to record all valid data associated, including time frames of initiation of the antimicrobial agent and blood culture analysis using the antimicrobial removal media. Most importantly, infection control will assess the outcome of patients with confirmed septicemia and will closely evaluate the new treatment plan to verify if the policy is proving to be helpful in improving the outcome of patient survival rates. Impact of Change If outcomes are positive, the facility can being to implement the policy, following the same steps already stated, to more departments and continue to evaluate the effectiveness of the policy on each department until the entire facility is using the policy. In order to initiate the change it will take a team effort. All staff will need to comply in ensuring that all septic patients are receiving the antimicrobial therapy within the one hour time frame, regardless if cultures have been drawn first or not. This will be imperative for analysis as to if the new policy is effective in reducing the mortality rate of septic patients. Conclusion Sepsis infections are going to continue to be a major cause of hospitalization, but with new protocols including ensuring administration of antibiotics in septic suspected patients within the one hour time frame of onset regardless if cultures have been collected first, we can reduce the chance of death for these patients. As medical staff, we need to use the advances in culture collection containers like BACTEC to initiate faster treatment, which will make hospital stays shorter, decrease cost of care, and most importantly, save more lives. References Daniels, R. (2011). Surviving the first hours in sepsis: getting the basics right an intensivist’s perspective. Journal of Antimicrobial Chemotherapy, 66(2), ii11-ii23. Retrieved from http://jac.oxfordjournals.org/content/66/suppl_2/ii11.full#ref-36 Flayhart, D., Borek, A., Wakefield, T., Dick, J., Carroll, K. (2007). Comparison of BACTEC PLUS blood culture media to BacT/Alert FA blood culture media for detection of bacterial pathogens in samples containing therapeutic levels of antibiotics. Journal of Clinical Micrbiology, 45(3), 816-821. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1829095/?report=reader Hospital Stats (2014). ER wait times in Clark County hospitals. hospitalstats.org. Retrieved from http://www.hospitalstats.org/ER-Wait-Time/Clark-County-NV.htm Kumar, A., Roberts, D., Wood, K., Light, B., Parrillo, J., Sharma, S. (2006, June). Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Critical Care Medicine, 34(6), 1589-1596. Retrieved from http://cel.webofknowledge.com/InboundService.do?product=CELSID=2DqQrrN9uYLqpUXhgpgUT=000237884300001SrcApp=Highwireaction=retrieveInit=YesSrcAuth=HighwirecustomersID=HighwireFunc=FrameIsProductCode=Yesmode=FullRecord Uzodimma, C., Njokanma, F., Ojo, O., Falase, M., Ojo, T. (2013, ). Bacterial isolates from blood cultures of children with suspected sepsis in an urban hospital in Lagos: a prospective study using BACTEC blood culture system. The Internet Journal of Pediatrics and Neonatology, 16(1). Retrieved from http://ispub.com/IJPN/16/1/1623 Zadroga, R., Williams, D., Gottschall, R., Hanson, K., Norberg, V., Deike, M., Hansen, G. (2013). Comparison of 2 blood culture media shows significant differences in bacterial recovery for patients on antimicrobial therapy. Oxford Journals Clinical Infectious Diseases, 56(6), 790-797. Retrieved from http://cid.oxfordjournals.org/content/56/6/790.full

Broad-Based Oppositions in Hungary and Yugoslavia :: Communism Governmental Political Essays

Broad-based Oppositions in Hungary and Yugoslavia No two countries in East Central Europe share the same experience of Communism. Parallels can be drawn between countries, groupings can be made and put into tiers, and data can be compared. But each country has a unique past which continues to make itself felt in the present day, despite the common direction the countries are taking towards a free market economy and multi-party democracy. Hungary, for example, has a more westward-leaning tradition than Yugoslavia does. Though their alliance with the Hapsburg Monarchy may have hindered the development of institutions of self-governance and a modern economy, that same tradition with Austria probably also helped it usher in the changes of 1989 more swiftly than many of its neighbors. The debate is still going on as to whether the Austrians did more harm than good for the country, but one thing is clear: Hungary has enjoyed a far less painful transition than many of its neighbors, including Yugoslavia. A comparison of the overall transit ion since 1989 in the two countries lies well beyond the scope of this paper; I intend, however, to look at the election systems, the most recent election outcomes and the major political powers in place in Hungary and Yugoslavia and draw some similarities between the opposition coalitions were formed. In Hungary, all citizens above the age of 18 are eligible to vote. Though there are no controversial language requirements, voters must be in the country on the day of the election in order to participate. Hungarians traveling abroad for business or on vacation are excluded, as are those temporarily living in another country; there is no system in place similar to the American absentee ballot system that allows them to cast their vote if they find themselves beyond Hungary's borders on election day. Prisoners and those permanently residing in medical institutions are also excluded. Only those citizens making a positive and active contribution to society, then, have the privilege of casting a vote. The implication inherent in this law that Hungarians living or working overseas at the time of the election are not making any such contribution. The outcome of national elections for Hungary's legislature is determined by a complex combination of simple majority and proportional representation systems. Of the 386 seats in the unicameral legislature, 176 are chosen from single-member constituencies and 152 are chosen from 20 distinct territorial multi-member constituencies, which follow the administrative county lines (in Hungarian megye, county).

Chemical Reactions in Our Daily Life Essay

Science being a subject of common interest, it is very intriguing to analyze visual experiments happening in day-to-day life. There are a plethora of products that you use everyday, which are formulated with application of chemical reaction. Say for example; toothpaste, soap, shampoo, cleaning agent, etc. are all results of chemical reactions. Following are some of the most profound chemical reactions, which we encounter in everyday life : Aerobic Respiration Do you know indulging in physical movements is associated with a chemical reaction? The process requires energy, which is yielded by aerobic respiration. Over here, respiration helps breaks down glucose (an energy source) into water, carbon dioxide and energy in form of ATP (adenosine triphosphate). The balanced cellular respiration equation is represented as: C6H12O6 + 6O2 → 6CO2+ 6H2O + Energy (36 ATPs) Anaerobic Respiration Due to overexercising, sometimes our body cells run out of oxygen and respire anaerobically. This cause synthesis of lactic acid and cause muscle cramps. Anaerobic respiration is observed in some bacteria, yeast and other organisms. In contrary to the aerobic type, it breaks down glucose in the absence of oxygen, resulting in production of ethanol, carbon dioxide and energy. Anaerobic respiration equation is: C6H12O6 → 2C2H5OH + 2CO2 + Energy Photosynthesis Photosynthesis is the process by which green plants manufacture their own food. This occurs in presence of sunlight and other raw materials, namely carbon dioxide and water. The chlorophyll pigment harvests the light energy from sunlight, which is then converted into glucose by the phenomenon of photosynthesis. In short, it is the opposite of aerobic respiration. The equation for photosynthesis is: 6 CO2+ 6 H2O + Light energy → C6H12O6 + 6 O2 Rusting of Iron Very often, you notice a coating of rust over unpainted iron surfaces, which gradually leads to disintegration of iron. This is nothing, but a chemical phenomenon called rusting. In this case, iron (a very reactive metal) combines with oxygen in presence of water (more precisely, atmospheric moisture), resulting in formation of iron oxides. The chemical reaction behind rusting can be simply represented as: Fe + O2 + H2O → Fe2O3. XH2O Propane Grill Have you ever prepared meat in a propane grill? The meat placed over the burner is cooked with the help of heat energy released after burning of propane gas. Thus, propane is the reactant which when burnt with the help of oxygen gives heat energy and other byproducts. Check out the balanced equation for the combustion reaction that take place in a propane grill: C3H8 + 5O2 → 4H2O + 3CO2 + energy Whether you consider cooking, souring, fermenting or burning, there is a chemical reaction accompanying these everyday processes. Thus, it won’t be wrong to say learning chemistry and chemical reactions start at home.

United States Oil Consumption †Macroeconomics Essay

United States Oil Consumption – Macroeconomics Essay Free Online Research Papers United States Oil Consumption Macroeconomics Essay The United States consumes about 131 billion gallons of gasoline per year. That equates to about 118 million barrels of oil daily. Considering there is about 100 million households in the United States, that is 3.6 gallons per household daily. This amount of gasoline cannot be supplied for an extended amount of time. It is also not safe to rely so heavily on such a scarce resource. This is the reason alternative fuels are being designed and tested to take the place of petroleum based fuels. One of the most promising alternative is electric motors. This is often done by converting a normal gasoline powered car into an electric powered car. Electric motors are near silent and drastically reduce emissions. The electric motor is powered by a controller which is powered by fifty lead-acid rechargeable batteries. These are wired into two sets of fifty which creates three hundred volts of direct current. Additional electric motors are needed to run accessories that would otherwise be run by the gasoline engine. These accessories include air conditiong, power steering pump, and water pump. The power brakes which relied on the vacuum created by the intake stroke of the piston in the four stroke gasoline engine are now supplied vacuum with a vacuum pump. Heating the cabin is now done by an electric water heater instead of having engine coolant routed to the cab. It costs one dollar to fully charge the vehicle, which equates to two cents per mile. If a gasoline powered c ar gets thirty miles per gallon and gasoline costs $1.20 per gallon, the cost per mile is about four cents. The major drawbacks to this design would be the limited range of the vehicle on a single charge (50 miles) and slow accelleration (0-60mph in 15 seconds). You can increase the range of the vehicle, but you also sacrifice accelleration. As it is now, the batteries weigh about 1,100 pounds and last roughly 20,000 miles. To replace the batteries it would cost $2000, so the batteries equate to about ten cents per mile. A slight modification to this design is the fuel cell. Instead of batteries, it gets its electricity from a fuel cell powered by pure hydrogen. The fuel cell is an electrochemical conversion device that converts hydrogen and oxygen into water, creating electricity and heat. Fuel cells are usually classified according to the type of electrolyte used. The most promising type of fuel cell is the proton exchange membrane fuel cell (PEMFC). Each cell only produces 0.7 volts, so many cells must be connected in series to increase the output to a useable voltage. These cells operate at about 176 degrees fahrenheit, which is in the ballpark of the operating temperature of a conventional gasoline engine. Gasoline engines normally operate from 160-210 degrees fahrenheit, so heat isnt an issue. The power density of a PEMFC lets a fuel cell the size of a suit case to properly power an automobile. The only drawback to fuel cells is the availability of hydrogen. It is very hazardous to tr ansport and store, so a hydrogen refueling station is not practical. Other fuels can power fuel cells when they are converted into hydrogen by a reformer with less efficiency than pure hydrogen, but have much greater availability. These fuels include natural gas, propane, and methanol. When pure hydrogen is used, the fuel cell operates at 80% efficiency. When methanol is used to power the fuel cell, this number drops to 30-40%. Knowing that a gasoline engine operates at about 20% efficiency, these numbers are very good. Another alternative is the air-powered car. These cars convert compressed air into mechanical energy. The two cylinder compressed air engine can run on either compressed air or internal combustion. The compressed air is stored in carbon fiber wrapped tanks at a pressure of 4,351 pounds per square inch. The air travels through an injector which is aimed at the piston. The expanding air pushes the piston down, turning the crankshaft and moving the car. The only emission from this engine is air, so it is considered a zero pollutant engine. Internal combustion is used at high speeds to save the compressed air for low speed driving where engines produce the most pollutants. The range of these cars is about 125 miles and have a top speed of about 60 miles per hour. Using a household electrical source, it takes about four hours to refill the tanks. A rapid three minute refill can be done with a high pressure pump. The engine still requires oil to lubricate the piston and cranksha ft, but only 0.8 liters that has to be changed every 31,000 miles. This is considerably less than gasoline powered cars which use about 5 liters of oil every 3000 miles. Many have recognized our over reliance on petroleum and are trying to think of ways to preserve this non renewable resource with ones that are renewable. If we wait until all the petroleum is gone before we seek a solution, we will no longer be able to make plastics as they are petroleum based. Plastics are vital to our everyday life, from pens to computers to life saving hospital equipment. Plastic is also used for specialty purposes such as bullet proof vests and glass where there are no materials suitable to replace it for the application. Without plastic, there may be an even fewer amount of possible solutions to petroleum. All of the alternatives discussed have used plastic in one way or another because it would be extremely difficult to cut out the use of petroleum all together. The focus is to control the consumption of petroleum by the vehicle instead. I am excited to see what the future holds in store for transportation. Bibliography How much gasoline does the United States consume in one year? by Marshall Brain http://auto.howstuffworks.com/question417.htm How Fuel Cells Work by Karim Nice http://auto.howstuffworks.com/fuel-cell.htm How Air-Powered Cars Will Work by Kevin Bonsor http://auto.howstuffworks.com/air-car.htm Research Papers on United States Oil Consumption - Macroeconomics EssayRiordan Manufacturing Production PlanBionic Assembly System: A New Concept of SelfThe Effects of Illegal ImmigrationGenetic EngineeringAnalysis of Ebay Expanding into AsiaNever Been Kicked Out of a Place This NiceOpen Architechture a white paperIncorporating Risk and Uncertainty Factor in CapitalPETSTEL analysis of IndiaTwilight of the UAW

Zara Market Segment Essay Example

Zara Market Segment Essay Example Zara Market Segment Paper Zara Market Segment Paper Founded in 1975 in Spain, the clothing company Ezra owns over 2000 stores in 88 countries. Its parent company, Inedited, one of the worlds biggest fashion retailers with eight brands and more than 6390 stores worldwide, made a net profit of over 2. 3 billion euros last year. Ezra builds its global success on speed, which allows it to deliver the new designed product to different stores around the world within fourteen days. Ezra strategically opened its stores in leading cities with high population. Obviously it is related to Saras market segment. Though Inedited designs various similar fashion clothing brands like PullBear, Shoo and Strabismus, their targeted customers and market segments are not the same, but complementary. Ezra targets its own market segment and accordingly has separate design, production and positioning strategy. Demographic segmentation plays a vital role. Saras market segment focuses on women rather than men. Specifically, its targeted customers are between 18-40 with mid-range income. Most of them are interested in fashion and hold a hectic lifestyle. Though they are fashion freaks they might not be affordable to the luxury couture and they may not focus on the quality. Based on this, what they expect particularly from the market is the fancy and trendy clothing with medium-priced and rapid replacement, which means the speed of design, producing and delivery is crucial. In order to satisfy their needs, Saras designers get their inspiration and design and then stylish clothes can be presented in every Ezra store only fourteen days later, whilst, most fashion brands sell their clothes in four seasons. Lower price, moderate quality, fast and reliable delivery, wide range of fashionable products are the competitive factors of Ezra. Such competitive advantages rely on the continuous creation and fast speed of shipping new products. To achieve these, Saras young designers design around 40000 new clothes per year and launch 10000 of them. Most new designs are the latest trend but with a lower price, which helps Ezra beat its luxury fashion brands who provide the similar design products. Thus, lower cost, fast speed and reliable delivery are all order winners.

Respond to classmate Essay Example | Topics and Well Written Essays - 250 words - 1

Respond to classmate - Essay Example Indeed as Brandi Barnes puts it, his college education paid for by his employer has not only increased his capacity to perform in private undertakings, but has also helped a great deal in increasing the employers’ general work performance [output]. It is evident from the information gleaned from the two articles that the outcome of an individual employee’s performance is but the result of numerous factors that include inert as well as acquired. To perform is, however, far much part from optimal performance. It takes a well-developed culture; a culture that enables individual employees to interact and share information; a culture that balances the individual interests with that of the organization; a culture that provides resources to enable things get done; and a culture that incentivizes employees, to achieve optimal performance, which, by modern standards, is very much sensitive to time. Quite frankly, it is the culture within an organization that confers the very necessary competitive advantage in modern day business world. That very culture should, however, be modeled in such a way that it does not overburden profit; for this is the sole reason why businesses are set

Phineas Taylor Barnum's American Museum 1842 to 1868 Research Paper

Phineas Taylor Barnum's American Museum 1842 to 1868 - Research Paper Example While in New York, Barnum purchased a museum and renamed it after himself. With the museum, Barnum found a platform which he used to promote hoaxes and human curiosities. Barnum began his entertainment career in New York. Barnum gets credited for revolutionizing and legitimizing spectacle. Barnum purchased and exhibited the Joice Heth. Joice Heth was an almost paralyzed and blind slave woman (Barnum and Cook 108). Barnum claimed the woman to have been over 160 years old and a supposed nurse to George Washington. Thousands got drawn to view Heith by paying an admission price. He toured the south with a small circus between 1836 and 1837. This circus tour appeared to be preparation for him to purchase his own museum with which he made a fortune. In 1841, he bought the Scudder American museum which he renamed to Barnum American museum. Barnum upgraded the museum building and added more exhibits making the museum a popular showplace in the process. Barnum added flags to the roof edge of the museum, and this helped attract attention during the day. A strolling garden got made out of the roof during the upgrade. The place then got lit up with limelight, which had just become invented then. His main idea revolved around making the museum an advertisement in itself. In the museum, Barnum filled it with a surfeit of exhibits and activities. Exhibits and activities within the museum revolved around panoramas, dioramas, scientific instruments and modern appliances. Through the museum, Barnum got to introduce his first major hoax which became known as the Feejee mermaid (Barnum 56). The Feeje mermaid was a creature that had the tail of a fish and a monkey’s head. Barnum justified hoaxes such as this claiming they were advertisements used to draw attention to the museum. The museum also exhibited a dwarf named general Tom Thumb. The dwarf got claimed to be the smallest person walking the earth, and he got used to amuse the public. The museum also exhibited a number o f exotic animals that included beluga whales, a hat claimed to be worn by Ulysses Grant, a tree trunk where Jesus and his disciples sat, giants, fat boys, a dog that could knit, flea circus and performances by magicians and fortune tellers, Uncle Tom’s cabin and minstrel adaptations of biblical tales. The museum gets reported to have received over 38milion visitors between 1841 and 1865. Visitors got charged a twenty five cent admission charge. The visitors got to view a revolving set of attractions at the museum (Cottrell 19). Barnum’s credit to show business gets associated with professionalism, public relations through advertisements and quality. Characters that provided dubious shows got thrown out of Barnum American museum. Barnum defended his hoax shows by claiming that the public had to first get attracted to the museum, and then later get provided with sensational entertainment while in the museum building. Barnum used newspaper advertisements and handbills to promote the museum (Barnum and Cook 88). The museum not only provided shows but also educational teachings. The museum’s theater which got known as the ‘lecture room’ got used by Barnum in providing temperance reforms and Shakespearean dramas. Barnum gets recognized by early historians as instrumental in the development of urban culture in the nineteenth century. The museum became the first of its kind in offering entertainment and amusement together with moral uplift and