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Noteworthy references
Noleworfhy referen
'The Recognition and Management o i Massive Pulmonary Embolism," Dennis A Bloomfield. Heart & Lung, 3 (March-April 1974) 241-246. Massive pulmonary embolism obstructs more than half of the pulmonary arterial bed and is compounded by reflexive arterial spasm which further reduces the number of patent vessels. The subsequent rise in pulmonary artery pressure can induce right ventricular failure. Almost half the patients who sustain massive pulmonary embolus die within ten minutes. The remainder may eventually recover if a second embolic episode can be prevented. The clinical manifestations include profound shock, cyanosis, tachypnea, and anxiety. Sympathetic stimulation may produce near-normal blood pressure; however, this can result in underestimating the severity of the embolus. Ventricular arrhythmias may also be present. It i s imperative that confirmatory investigations be made. The electrocardiogram (ECG), helpful in ruling out other cardiac disease, may show some changes such as atrial arrhythmias, T-wave inversion, and right bundle branch block which occur with pulmonary embolus. The chest x-ray may be normal or may show a prominent pulmonary artery and decreased vascular markings. Lung scans with a radio-active tracer may show areas of poor perfusion. Blood-gas analysis will indicate hypoxemia and -hypocapnea. A definite diagnosis can only be made with right heart catheterization and pulmonary angiography. This is particularly indicated
when active methods of treatment are being considered. The pulmonary artery and wedge pressures should be measured and the vessels can b e visualized with radiopaque dye. The three common forms of treatment are embolectomy with cardiopulmonary bypass, vena caval interruption, and thrombolysis. Emboledomy on bypass carries a, high mortality rate but offers the only chance for survival for patients with severely impaired circulatory and gas exchange. Vena caval interruption is done to prevent recurrent pulmonary emboli and may be the only treatment required for those patients who survive the first few hours after the initial embolus. The use of active thrombolysis is still experimental and is not indicated for massive pulmonary emboli because of the number of days required before significant improvement is seen. It is effective treatment, however, for less serious emboli. The best approach seems to b e fibrinolysis and insertion of an umbrella filter.
Elizabeth A Reed, R N Philadelphia
"Biomedical Experts Penetrate the Operating Room," Edward F McGinnis. Hospital Topics, 52 (April 1974) 30. Biomedical electronic technicians (BMET) are needed as members of the health care team to maintain complicated electronic equipment. Specifically trained for the job, they act as trouble shooters in technological matters of sophisticated equipment. They can assess safety, make repairs on site, train per-
& 152
AORN Journal, J u l y 1974, Vol 20, No 1
in the selection and evaluation of new
edema, aspiration pneumonia, tetanous, and the withdrawal syndrome. There also are
equipment.
some rare complications
sonnel in correct use of equipment, and help
The BMET's knowledge of equipment may
such as hyper-
glycemia and transverse myelitis.
result in financial savings and selection of
Helen Wolk
A recent study showed 40% of 2,000 new instruments bought by hospitals did not meet minimal manufac-
Hackensack, N I , RN
better equipment.
turer's specifications. inhouse
service also
means having a
"Particle Therapy New Weapon Against Cancer," James S Trefil, Science Digest, (April 1974) 80-83.
regular program of checking and repairing equipment resulting i n less down time. It
Scientists have developed two new treat-
i s less expensive than a contractual service and more reliable in maintaining records.
proton
Of the 8,600 technicians in the country, less than half are employed in hospitals. By 1975, 1,900 new technicians will be needed.
Gertrude KohloffI RN Grand Haven, Mich "Narcotic
Overdosage," Edward S Kersh. Hospital Medicine, 10 (March 1974)
ments for cancer using atomic beam
therapy
and
particles: pi
meson
therapy. Protons, positively charged particles in the atom's nucleus, have unusual characteristics when radiated into living tissue. The primary damage inflicted
by a proton
OC-
curs just before it i s absorbed. For example, if a proton i s moving fast enough to penetrate ten inches into the body before it is
8-24.
absorbed, the most damage to tissue will be
Every emergency room must be alert in
in the last inch or so of its path. Thus, the
recognizing
a
patient
with
a
narcotic
radiologist can aim a proton beam a t a
overdosage. Approximately one-fourth of overdose victims seen in the ER have also
tumor inside the body, and
taken other drugs such as alcohol, metha-
a known depth.
done, barbituates, and sedatives.
The new technique
The classic symptoms of overdosage are
by adjusting the
energy, concentrate the tissue damage a t
is being used a t
coma, miosis, and respiratory depression.
beam of protons is produced
Additional
celerator.
diagnostic
clues
are
needle
The by an ac-
Harvard and Berkeley research centers.
tracks, cigarette burns of chest and hands,
The pi meson particle exhibits the same
liquids in the pharynx, and equipment to administer drugs. Any young adult admitted to the ER with cerebral or respiratory depression should be considered a probable overdosage and treated with the following emergency
behavior as the proton. However, after it i s absorbed in the tumor, it continues to work b y disappearing in a burst of energy, disrupting the atom in which it finds itself.
procedures: assist ventilation with 100% oxygen, evaluate circulation, administer a narcotic antagonist, and analyze blood gas. Although many hospitals discharge patients after the initial emergency is over, i t i s essential that these patients be admitted since relapse is not uncommon after the administration of a narcotic antagonist. Major complications include pulmonary
Particle therapy may be a significant step in the treatment of many cancers now treated b y more conventional radiation such
154
Although p i meson therapy holds great promise, more research is required.
as cancer of the cervix and bone. Proton therapy has been used successfully in the treatment of cancer of the pituitary gland since 1967.
Sister Kane, RHSJ, RN Amherst View, Ont
AORN Journal, July 1974, Vol 20, N o 1
"Stopping Backaches Withouf Surgery,#' Charles Folds. Science Digesf, (December 1973), 67-70. Backaches caused b y certain spinal problems which do not respond to conservative treatment may not require surgery. Chemonucleolysis with infiltration of the enzyme chymopapain has been developed by Lyman Smith, MD, assistant professor of surgery, Northwestern University. The patient with a ruptured, slipped, sliding or protruding disc which does not respond to conservcltive treatment usually undergoes laminectomy or discectomy, resulting in more back pain and a need for prolonged bed rest. Although chemonucleolysis i s an experimental process, more than 9,000 patients have been treated by this method. Dr Smith has trained more than 30 orthopedic surgeons in the technique. The procedure involves inserting long needles into the patient's back. Chymopapain injected through the needles dissolves disc cartilage in 30 seconds but reportedly does not affect surrounding tissues or nerves. The needles are left in place for an additional five minutes. Special x-ray techniques and television monitoring control proper placement of the needles. Patients receive general anesthesia. Although the success rate approaches 75%, several untoward effects may appear, including minor allergies, paraplegia, infarction of the spinal cord, shock and infection. Dr Smith suggests that his procedure should be used in all cases of severe low back pain and sciatica after conservative treatment has failed and before surgery i s considered.
Sister Kane, RN, RHSJ Amherst View, Ontario
"Nursing and Women's Lib-A Parallel." Heide, W S. American Journal of Nursing, 73 (May 1973), 824-827.
the feminist movement. The author, who is a feminist and a nurse, feels that nursing suffers in much the same way as women in today's society. She says nurses are hindered b y society's expectations tho+ women display only feminine traits and men exhibit only masculine characteristics. This prevents nursing from achieving its fullest potential. Ms Heide refers to the double standard in the attitude of mental health practitioners. Feminine traits found in adult males are considered as signs of emotional immaturity. This attitude hinders the male in experiencing the fulfillment of nurturing others. Nursing should not be an exclusively feminine profession. Nurses may hare contributed to the inadequacy of our health care system by guarding tenderness and compassion as their exclusive property. The doctor-nurse relationship i s comparable to the stereotyped male-female game, Ms Heide says. This might explain why physicians react so negatively to nursing's desire for autonomy. The author says the liberation of nurses would result in many economical, professional and personal benefits, including control over nursing budgets and salaries, full representation of nurses on hospital and advisory boards, a,nd the recognition of nursing as an independent academic discipline which i s complementary, not subordinate, to medicine.
Nurses should try to raise their consciousness and apply insights to the practice of their profession so that patients might be approached in a more positive way, Ms Heide says. Thus, health rather than illness could become the focus of nursing. Nurses must also become independent thinkers, Ms Heide says. As such, they can contribute to humanizing the health care system a s well as society.
Elizabeth A Reed, RN
Because of its traditional "feminine" traits, nursing appears to have the same goals as
156
AORN Journal, July 1974, Vol 20, N o 1
Philadelphia, Pa
0
'The Recognition and Management o i Massive Pulmonary Embolism," Dennis A Bloomfield. Heart & Lung, 3 (March-April 1974) 241-246. Massive pulmonary embolism obstructs more than half of the pulmonary arterial bed and is compounded by reflexive arterial spasm which further reduces the number of patent vessels. The subsequent rise in pulmonary artery pressure can induce right ventricular failure. Almost half the patients who sustain massive pulmonary embolus die within ten minutes. The remainder may eventually recover if a second embolic episode can be prevented. The clinical manifestations include profound shock, cyanosis, tachypnea, and anxiety. Sympathetic stimulation may produce near-normal blood pressure; however, this can result in underestimating the severity of the embolus. Ventricular arrhythmias may also be present. It i s imperative that confirmatory investigations be made. The electrocardiogram (ECG), helpful in ruling out other cardiac disease, may show some changes such as atrial arrhythmias, T-wave inversion, and right bundle branch block which occur with pulmonary embolus. The chest x-ray may be normal or may show a prominent pulmonary artery and decreased vascular markings. Lung scans with a radio-active tracer may show areas of poor perfusion. Blood-gas analysis will indicate hypoxemia and -hypocapnea. A definite diagnosis can only be made with right heart catheterization and pulmonary angiography. This is particularly indicated
when active methods of treatment are being considered. The pulmonary artery and wedge pressures should be measured and the vessels can b e visualized with radiopaque dye. The three common forms of treatment are embolectomy with cardiopulmonary bypass, vena caval interruption, and thrombolysis. Emboledomy on bypass carries a, high mortality rate but offers the only chance for survival for patients with severely impaired circulatory and gas exchange. Vena caval interruption is done to prevent recurrent pulmonary emboli and may be the only treatment required for those patients who survive the first few hours after the initial embolus. The use of active thrombolysis is still experimental and is not indicated for massive pulmonary emboli because of the number of days required before significant improvement is seen. It is effective treatment, however, for less serious emboli. The best approach seems to b e fibrinolysis and insertion of an umbrella filter.
Elizabeth A Reed, R N Philadelphia
"Biomedical Experts Penetrate the Operating Room," Edward F McGinnis. Hospital Topics, 52 (April 1974) 30. Biomedical electronic technicians (BMET) are needed as members of the health care team to maintain complicated electronic equipment. Specifically trained for the job, they act as trouble shooters in technological matters of sophisticated equipment. They can assess safety, make repairs on site, train per-
& 152
AORN Journal, J u l y 1974, Vol 20, No 1
in the selection and evaluation of new
edema, aspiration pneumonia, tetanous, and the withdrawal syndrome. There also are
equipment.
some rare complications
sonnel in correct use of equipment, and help
The BMET's knowledge of equipment may
such as hyper-
glycemia and transverse myelitis.
result in financial savings and selection of
Helen Wolk
A recent study showed 40% of 2,000 new instruments bought by hospitals did not meet minimal manufac-
Hackensack, N I , RN
better equipment.
turer's specifications. inhouse
service also
means having a
"Particle Therapy New Weapon Against Cancer," James S Trefil, Science Digest, (April 1974) 80-83.
regular program of checking and repairing equipment resulting i n less down time. It
Scientists have developed two new treat-
i s less expensive than a contractual service and more reliable in maintaining records.
proton
Of the 8,600 technicians in the country, less than half are employed in hospitals. By 1975, 1,900 new technicians will be needed.
Gertrude KohloffI RN Grand Haven, Mich "Narcotic
Overdosage," Edward S Kersh. Hospital Medicine, 10 (March 1974)
ments for cancer using atomic beam
therapy
and
particles: pi
meson
therapy. Protons, positively charged particles in the atom's nucleus, have unusual characteristics when radiated into living tissue. The primary damage inflicted
by a proton
OC-
curs just before it i s absorbed. For example, if a proton i s moving fast enough to penetrate ten inches into the body before it is
8-24.
absorbed, the most damage to tissue will be
Every emergency room must be alert in
in the last inch or so of its path. Thus, the
recognizing
a
patient
with
a
narcotic
radiologist can aim a proton beam a t a
overdosage. Approximately one-fourth of overdose victims seen in the ER have also
tumor inside the body, and
taken other drugs such as alcohol, metha-
a known depth.
done, barbituates, and sedatives.
The new technique
The classic symptoms of overdosage are
by adjusting the
energy, concentrate the tissue damage a t
is being used a t
coma, miosis, and respiratory depression.
beam of protons is produced
Additional
celerator.
diagnostic
clues
are
needle
The by an ac-
Harvard and Berkeley research centers.
tracks, cigarette burns of chest and hands,
The pi meson particle exhibits the same
liquids in the pharynx, and equipment to administer drugs. Any young adult admitted to the ER with cerebral or respiratory depression should be considered a probable overdosage and treated with the following emergency
behavior as the proton. However, after it i s absorbed in the tumor, it continues to work b y disappearing in a burst of energy, disrupting the atom in which it finds itself.
procedures: assist ventilation with 100% oxygen, evaluate circulation, administer a narcotic antagonist, and analyze blood gas. Although many hospitals discharge patients after the initial emergency is over, i t i s essential that these patients be admitted since relapse is not uncommon after the administration of a narcotic antagonist. Major complications include pulmonary
Particle therapy may be a significant step in the treatment of many cancers now treated b y more conventional radiation such
154
Although p i meson therapy holds great promise, more research is required.
as cancer of the cervix and bone. Proton therapy has been used successfully in the treatment of cancer of the pituitary gland since 1967.
Sister Kane, RHSJ, RN Amherst View, Ont
AORN Journal, July 1974, Vol 20, N o 1
"Stopping Backaches Withouf Surgery,#' Charles Folds. Science Digesf, (December 1973), 67-70. Backaches caused b y certain spinal problems which do not respond to conservative treatment may not require surgery. Chemonucleolysis with infiltration of the enzyme chymopapain has been developed by Lyman Smith, MD, assistant professor of surgery, Northwestern University. The patient with a ruptured, slipped, sliding or protruding disc which does not respond to conservcltive treatment usually undergoes laminectomy or discectomy, resulting in more back pain and a need for prolonged bed rest. Although chemonucleolysis i s an experimental process, more than 9,000 patients have been treated by this method. Dr Smith has trained more than 30 orthopedic surgeons in the technique. The procedure involves inserting long needles into the patient's back. Chymopapain injected through the needles dissolves disc cartilage in 30 seconds but reportedly does not affect surrounding tissues or nerves. The needles are left in place for an additional five minutes. Special x-ray techniques and television monitoring control proper placement of the needles. Patients receive general anesthesia. Although the success rate approaches 75%, several untoward effects may appear, including minor allergies, paraplegia, infarction of the spinal cord, shock and infection. Dr Smith suggests that his procedure should be used in all cases of severe low back pain and sciatica after conservative treatment has failed and before surgery i s considered.
Sister Kane, RN, RHSJ Amherst View, Ontario
"Nursing and Women's Lib-A Parallel." Heide, W S. American Journal of Nursing, 73 (May 1973), 824-827.
the feminist movement. The author, who is a feminist and a nurse, feels that nursing suffers in much the same way as women in today's society. She says nurses are hindered b y society's expectations tho+ women display only feminine traits and men exhibit only masculine characteristics. This prevents nursing from achieving its fullest potential. Ms Heide refers to the double standard in the attitude of mental health practitioners. Feminine traits found in adult males are considered as signs of emotional immaturity. This attitude hinders the male in experiencing the fulfillment of nurturing others. Nursing should not be an exclusively feminine profession. Nurses may hare contributed to the inadequacy of our health care system by guarding tenderness and compassion as their exclusive property. The doctor-nurse relationship i s comparable to the stereotyped male-female game, Ms Heide says. This might explain why physicians react so negatively to nursing's desire for autonomy. The author says the liberation of nurses would result in many economical, professional and personal benefits, including control over nursing budgets and salaries, full representation of nurses on hospital and advisory boards, a,nd the recognition of nursing as an independent academic discipline which i s complementary, not subordinate, to medicine.
Nurses should try to raise their consciousness and apply insights to the practice of their profession so that patients might be approached in a more positive way, Ms Heide says. Thus, health rather than illness could become the focus of nursing. Nurses must also become independent thinkers, Ms Heide says. As such, they can contribute to humanizing the health care system a s well as society.
Elizabeth A Reed, RN
Because of its traditional "feminine" traits, nursing appears to have the same goals as
156
AORN Journal, July 1974, Vol 20, N o 1
Philadelphia, Pa
0