Electrical hospital patients

The cornerstone of therapy for ventricular fibrillation is electrical deflbrillation. In the acute setting, defibrination is first-line therapy. Intravenous bretylium can occasionally contribute to conversion, but this is infrequent. In the management of out-of-hospital cardiac arrest, high-dose epinephrine (5 mg intravenously) improves the rate of successful resuscitation in patients with asystole, but not in those with ventricular fibrillation, when compared with the standard dose of 1 mg. Vasopressin (40 U intravenously) may more effective than 1 mg intravenous epinephrine in out-of-hospital patients with ventricular fibrillation that is resistant to electrical defibrillation. The OPTIC smdy (see Connolly et al., 2006) showed that amiodarone plus jS-blocker is superior than sotalol or jS-blocker alone for reducing ICD shocks in patients with reduced left ventricular function and history of sustained VT, VF, or cardiac arrest. 

Although death may be attributable to many tmderlying conditions, the final common pathway remains the cessation of the heart electrical activity. With hospitalized patients, cardiac arrest is usually manifested by ventrieular fibrillation, from which the patient may or may not be resuscitated. Sudden eardiae death, which claims over 350,000 lives annually in the United States, results from abrupt disruption of heart rhythm, also primarily in the form of ventricular fibrillation. Death in those instances is due not to extensive cardiac injury, but rather, to transient triggers that impinge on the electrically unstable heart (65-67). Identification of individuals at risk for sudden cardiac death remains a major objective in cardiology. Similarly, the specific mechanism linking ambient air particle exposure to death is unknown. 

Price discrimination refers to the practice of selling identical products to different sets of customers at different prices. Expressed another way, different customers pay different markups over the identical incremental cost of producing an identical product. Price discrimination is widely practiced in the hotel and airline industries, by universities in the United States that can vary their tuition through scholarships, by electric power companies, and in the health care industry. Hospitals in the United States, for example, routinely charge different payers different prices for the same services. In the U.S. pharmaceutical market, different prices are charged to different insurance carriers and to self-paying patients. Worldwide, the same pharmaceutical firms sell the identical product to different countries at different prices. 

A 7-year retrospective Australian study of 182 industrial bums found that 5.5% were ocular bums due to chemicals, gas explosions, and electric flashes (percentages not specified) [13]. In another Australian study of 159 cases of hospital-admitted alkali ocular bum patients from 1972-1981, the majority of bums were Grade 1 or 2 and none of these resulted in vision loss [14]. 

In a retrospective study of 148 cases of occupational eye injuries in Germany, ocular bums (not specified as chemical or other etiology) comprised 15.5% of the total [10]. In another German study of 101 patients with 131 severely burned eyes, 72.3% of the injuries were work-related, 84.2% were chemical injuries, and 79.8% of these were due to alkalis [11], Of 42 cases of alkali ocular bums admitted to a German eye clinic between 1985 and 1992, 73.8% involved industrial accidents [19]. In Finland in 1973,11.9% of all industrial accidents were ocular injuries and bums comprised 3.6% of these (chemical or other injury mechanism not specified) [12]. A 7-year retrospective Australian study of 182 industrial bums found that 5.5% were ocular bums due to chemicals, gas explosions, and electric flashes (percentages not specified) [30]. In a 4-year hospital-based study in Taiwan, of 486 patients with eye injuries, 39.9% were work-related [20]. Chemical ocular bums accounted for 19.6% of these injuries [20],... 

In a retrospective study of patients admitted to the Royal Brisbane Hospital in Australia over a 7-year period, eye bums comprised 5.5% of the total (and included chemical exposures, gas explosions, and electric flashes) [13]. Eye bums were present in 4 (3.7%) patients and eyelid bums were present in 4.6% of patients [13]. 

There have been some patients who did not respond to treatment and had to be sent to state hospitals for longterm care. One young girl who took LSD was on a bad trip for four months. We were finally able to stop her unpleasant experiences by giving her fifteen electroconvulsive treatments, in which electrodes are attached to the scalp, and the patient is given electrically induced seizures. 

The hospital became a safe haven for extended facility patients and home-bound patients that needed electricity for their care. Units that normally did not care for admitted patients became patient care areas such as the Cardiac Cath Lab and Same Day Surgery areas. SOMC opened their banquet facility as a respite area for staff and their families for sleeping and personal care. Electricity was restored at this location so staff could sleep or take a shower. 

It is common to find a pharmacist as a member of the hospital cardiopulmonary resuscitation (CPR) team, which responds to emergent situations that may require immediate patient care. These scenarios usually involve a patient who suddenly becomes nonresponsive, ceases spontaneous respirations, and/or experiences a life-threatening cardiac arrhythmia. The CPR team responds to such patients by implementing advanced cardiac life support (ACLS), which involves quick provision of an airway and electrical (defibrillation) and/or pharmacologic interventions to sustain cardiac function. The pharmacist s role on such a team involves the preparation of intravenous infusions needed in an emergent situation, dose calculations, and consultation regarding appropriate medication use. 

Recent studies demonstrate that cardiac resynchronization therapy (CRT) offers a promising approach to selected patients with chronic heart failure. Delayed electrical activation of the left ventricle, characterized on the ECG by a QRS duration that exceeds 120 ms, occurs in approximately one-third of patients with moderate to severe systolic heart failure. Since the left and right ventricles normally activate simultaneously, this delay results in asynchronous contraction of the left and right ventricles, which contributes to the hemodynamic abnormalities of this disorder. Implantation of a speciahzed biventricular pacemaker to restore synchronous activation of the ventricles can improve ventricular contraction and hemodynamics. Recent trials show improvements in exercise capacity, NYHA classification, quality of life, hemodynamic function, and hospitalizations. A device that combined CRT with an implantable cardioverter-defibrillator (ICD) improved survival in addition to functional status. CRT is currently indicated only in NYHA class ni-IV patients receiving optimal medical therapy (ACE inhibitors, diuretics, -blockers, and digoxin) and... 

Cardiac resynchronization therapy (CRT) for systolic congestive heart failure (CHF) represents a new paradigm in cardiology the use of an electrical therapy (cardiac pacing) to treat a mechanical problem. Multiple randomized clinical trials have proven that resynchronization therapy improves symptoms and functional status, increases quality of life, reduces hospitalizations, and prolongs survival in appropriately selected patients. As a result, this therapy has been quickly established as a standard treatment for patients with severe left ventricular dysfunction, moderate-to-severely symptomatic CHF despite optimal medical therapy, and prolonged QRS duration (1,2). 

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