Cardiac-arrest Team: From 1 Different Sources
a designated team of doctors in a hospital who attend *cardiac arrests as they occur and administer protocol-driven treatment according to the latest guidelines. See also medical emergency team.
Absence of a palpable pulse, and thus of circula tion of blood around the body by the heart contraction. The cause may be asystole or ventricular fibrillation.... cardiac arrest
Relating to the heart... cardiac
Cessation of breathing, often caused by envenomation (or poisoning).... respiratory arrest
The volume of blood pumped out per minute by the ventricles of the heart. It is one measure of the heart’s e?ciency. At rest, the heart of a healthy adult will pump between 2.5 and 4.5 litres of blood every minute. Exercise will raise this to as much as 30 litres a minute but, if this ?gure is low, it suggests that the heart muscle may be diseased or that the person has suffered severe blood loss.... cardiac output
Consists of members of different disciplines, involved in the same task (assessing people, setting goals and making care recommendations) and working along side each other, but functioning independently. Each member undertakes his or her own tasks without explicit regard to the interaction. These teams are traditionally led by the highest ranking team member.... multidisciplinary team
Drugs whose main actions are to increase the force of myocardial contraction and reduce the conductivity of the nerve ?bres in the atrioventricular node of the heart. They are useful in treating supraventricular tachycardias (rapid heart rhythm) and some forms of heart failure. Glycosides are a traditional group of cardiac drugs, originally derived from the leaves of foxglove plants and used as digitalis. The active principle has long been synthesised and used as DIGOXIN. They are potentaially toxic and their use, especially during initial treatment, should be monitored. Side-effects include ANOREXIA, nausea, vomiting, diarrhoea and abdominal pain; drowsiness, confusion and DEPRESSION may occur. An abnormally slow heart rate may develop. The glycosides should be used with special care in the elderly who are sometimes particularly susceptible to their toxic effects.... cardiac glycosides
The procedure used to restart the action of the heart if it is suddenly arrested. In many cases the arrested heart can be made to start beating again by rhythmic compression of the chest wall. This is done by placing the patient on a hard surface – a table or the ?oor – and then placing the heel of the hand over the lower part of the sternum and compressing the chest wall ?rmly, but not too forcibly, at the rate of 60–80 times a minute. At the same time arti?cial respiration must be started by the mouth-tomouth method. (See APPENDIX 1: BASIC FIRST AID.) Open heart massage is sometimes undertaken if an arrest occurs during a chest operation – the heart being directly handled by the resuscitator.... cardiac massage
The muscle, unique to the heart, which comprises the walls of the atria and ventricles. It consists of long broadening cells (?bres) with special physiological characteristics which enable them to keep contracting and expanding inde?nitely.... cardiac muscle
Obsessional fear about the state of the heart. It tends to occur after a heart attack and may result in the patient’s experiencing the symptoms of another attack.... cardiac neurosis
Compression of the heart due to abnormal accumulation of ?uid within the ?brous covering of the heart (PERICARDIUM). The result is irregular rhythm and death if the ?uid is not removed.... cardiac tamponade
Consists of members who work together interdependently to develop goals and a common treatment plan, although they maintain distinct professional responsibilities and individual assignments. In contrast to multidisciplinary teams, leadership functions are shared.... interdisciplinary team
In this team, each member becomes so familiar with the roles and responsibilities of the other members that tasks and functions become interchangeable to some extent. This type of team is difficult to operationalize.... transdisciplinary team
Multidisciplinary team of health professionals that is responsible for comprehensive assessments of the needs of older persons, including their suitability for hospital, home or institutional care.... aged care assessment team
Abnormal rhythm of the heartbeat. Most commonly seen after someone has had a myocardial infarction, but also present in some normal individuals – especially if they have taken a lot of co?ee or other stimulant – and in those with a congenital abnormality of the heart-muscle conducting system. The cause is interference in the generation or transmission of electrical impulses through the heart’s conducting system. Occasional isolated irregular beats (ectopic beats) do not necessarily mean that conduction is faulty. Arrhythmias can be classi?ed as tachycardias (more than 100 beats a minute) or bradycardias (slower than 60 beats a minute). Heartbeats may be regular or irregular. (See HEART, DISEASES OF.)... cardiac arrhythmia
A diagnostic procedure in which a tube is inserted into a blood vessel under local anaesthetic and threaded through to the chambers of the heart to monitor blood ?ow, blood pressure, blood chemistry and the output of the heart, and to take a sample of heart tissue. The technique is used to diagnose congenital heart disease and coronary artery disease. Another application is in the diagnosis and treatment of valvular disease in the heart.... cardiac catheterisation
Slowing the action of the heart... cardiac depressant
See HEART, ARTIFICIAL.... cardiac pump
Compression of the outside of the sternum and ribs, effectively emptying and filling the heart to push blood through arteries to supply oxygen to the body - particularly to the brain.... external cardiac compression
See “aged care assessment team”.... geriatric assessment team
A group comprising a variety of professionals (medical practitioners, nurses, physical and occupational therapists, social workers, pharmacists, spiritual counsellors), as well as family members, who are involved in providing coordinated and comprehensive care. There are three types of health care team, defined by the degree of interaction among members and the sharing of responsibility for care:... health care team
Intended as a key part of the NHS’s local comprehensive mental health services serving populations of around 50,000, these multidisciplinary, multi-agency teams have been less e?ective than expected, in part due to varying modes of operation in di?erent districts. Some experts argue that the services they provide – for example, crisis intervention, liaison with primary care services and continuing care for long-term clients – could be delivered more e?ectively by several specialist teams rather than a single, large generic one comprising psychiatrists, psychologists, community mental health nurses, occupational therapists, support and (sometimes) social workers.... community mental health teams
(Irish) In mythology, a place where kings met Teamhaire, Teamhare, Teamharre... teamhair
The process whereby a group of people work together (often by dividing tasks among members, based on relative skills) to reach a common goal, to solve a particular problem, or to achieve a specified set of results.... teamwork
Dropsy of heart origin is distinguished from renal dropsy by an increase in oedema as the day proceeds. In the morning there may be no swelling but by the evening legs become swollen from the ankles upwards. Fluids stagnate in the tissues from inability of the heart to perform efficiently as a pump. The condition is a symptom of heart failure with increasing breathlessness which may lead to general dropsy.
Symptoms: worse after exercise, breathlessness, headache, general weakness, feeble pulse, pale face, skin cold, swollen tissues pit on pressure.
Treatment. Alternatives:– Teas. Black Cohosh, Broom tops, Buchu, Dandelion, Hawthorn, Parsley root. Tea. Formula. Equal parts: Broom tops, Motherwort, Yarrow. 2 teaspoons to each cup water brought to boil and simmered 5 minutes in covered vessel. 1 cup 3-4 times daily.
Tablets/capsules. Buchu, Dandelion, Hawthorn, Juniper, Motherwort.
Formula. Dandelion 2; Hawthorn 2; Stone root 1. Mix. Dose: Powders: 750mg (three 00 capsules or half a teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Thrice daily.
Practitioner. Lily of the Valley, BPC 1934: 5-20 drops, 2-3 times daily.
Squills, tincture: resembles Digitalis in action. Dose: 1-3 drops, as prescribed.
Tinctures. Dandelion 2; Lily of the Valley 2; Stone root 1; Cayenne (tincture) quarter. Mix. Dose: 1 to 2 teaspoons thrice daily.
Popular formula. Tincture Scilla 5.0; Tincture Crataegus 10.0; Tincture Valerian to make 30.0. 15 drops thrice daily. (German Extemporaneous Formulae)
Diet. High protein. See: DIET – HEART AND CIRCULATION. ... cardiac dropsy
Breathing difficulty in which bronchospasm and wheezing are caused by accumulation of fluid in the lungs (pulmonary oedema). This is usually due to reduced pumping efficiency of the left side of the heart (see heart failure) and is not true asthma. Treatment is with diuretic drugs.... asthma, cardiac
One of a group of tests used to assess the function of the heart in people who experience chest pain, breathlessness, or palpitations during exercise. The test establishes whether the patient has coronary artery disease. An ECG machine records the patterns of the heart’s electrical activity while the heart is stressed. This is usually achieved by the patient exercising on a treadmill or cycling. Specific changes in the electrical pattern as exercise levels increase indicate angina. Cardiac stress testing may be used in conjunction with radionuclide scanning to identify damaged areas of heart muscle.... cardiac stress test
A diagnostic test in which a fine, sterile catheter is introduced into the heart via a blood vessel. It is used to diagnose and assess the extent of congenital heart disease (see heart disease, congenital) and coronary artery disease, and to diagnose and treat some disorders of the heart valves (see valvuloplasty). During the procedure, the pressure within the heart’s chambers can be measured, samples of blood and tissue can be taken, and a radiopaque substance can be injected to allow the heart’s cavities to be X-rayed.... catheterization, cardiac
Screening and surveillance uncover problems which then need careful attention. Most NHS districts have a CDT to carry out this task – working from child development centres – usually separate from hospitals. Various therapists, as well as consultant paediatricians in community child health, contribute to the work of the team. They include physiotherapists, occupational therapists, speech therapists, psychologists, health visitors and, in some centres, pre-school teachers or educational advisers and social workers. Their aims are to diagnose the child’s problems, identify his or her therapy needs and make recommendations to the local health and educational authorities on how these should be met. A member of the team will usually be appointed as the family’s ‘key worker’, who liaises with other members of the team and coordinates the child’s management. Regular review meetings are held, generally with parents sharing in the decisions made. Mostly children seen by CDTs are under ?ve years old, the school health service and educational authorities assuming responsibility thereafter.
Special needs The Children Act 1989, Education Acts 1981, 1986 and 1993, and the Chronically Sick and Disabled Persons Legislation 1979 impose various statutory duties to identify and provide assistance for children with special needs. They include the chronically ill as well as those with impaired development or disabilities such as CEREBRAL PALSY, or hearing, vision or intellectual impairment. Many CDTs keep a register of such children so that services can be e?ciently planned and evaluated. Parents of disabled children often feel isolated and neglected by society in general; they are frequently frustrated by the lack of resources available to help them cope with the sheer hard work involved. The CDT, through its key workers, does its best to absorb anger and divert frustration into constructive actions.
There are other groups of children who come to the attention of child health services. Community paediatricians act as advisers to adoption and fostering agencies, vital since many children needing alternative homes have special medical or educational needs or have behavioural or psychiatric problems. Many see a role in acting as advocates, not just for those with impairments but also for socially disadvantaged children, including those ‘looked after’ in children’s homes and those of travellers, asylum seekers, refugees and the homeless.
Child protection Regrettably, some children come to the attention of child health specialists because they have been beaten, neglected, emotionally or nutritionally starved or sexually assaulted by their parents or carers. Responsibility for the investigation of these children is that of local-authority social-services departments. However, child health professionals have a vital role in diagnosis, obtaining forensic evidence, advising courts, supervising the medical aspects of follow-up and teaching doctors, therapists and other professionals in training. (See CHILD ABUSE.)
School health services Once children have reached school age, the emphasis changes. The prime need becomes identifying those with problems that may interfere with learning – including those with special needs as de?ned above, but also those with behavioural problems. Teachers and parents are advised on how to manage these problems, while health promotion and health education are directed at children. Special problems, especially as children reach secondary school (aged 11–18) include accidents, substance abuse, psychosexual adjustment, antisocial behaviour, eating disorders and physical conditions which loom large in the minds of adolescents in particular, such as ACNE, short stature and delayed puberty.
There is no longer, in the UK, a universal school health service as many of its functions have been taken over by general practitioners and hospital and community paediatricians. However, most areas still have school nurses, some have school doctors, while others do not employ speci?c individuals for these tasks but share out aspects of the work between GPs, health visitors, community nurses and consultant paediatricians in child health.
Complementing their work is the community dental service whose role is to monitor the whole child population’s dental health, provide preventive programmes for all, and dental treatment for those who have di?culty using general dental services – for example, children with complex disability. All children in state-funded schools are dentally screened at ages ?ve and 15.
Successes and failures Since the inception of the NHS, hospital services for children have had enormous success: neonatal and infant mortality rates have fallen by two-thirds; deaths from PNEUMONIA have fallen from 600 per million children to a handful; and deaths from MENINGITIS have fallen to one-?fth of the previous level. Much of this has been due to the revolution in the management of pregnancy and labour, the invention of neonatal resuscitation and neonatal intensive care, and the provision of powerful antibiotics.
At the same time, some children acquire HIV infection and AIDS from their affected mothers (see AIDS/HIV); the prevalence of atopic (see ATOPY) diseases (ASTHMA, eczema – see DERMATITIS, HAY FEVER) is rising; more children attend hospital clinics with chronic CONSTIPATION; and little can be done for most viral diseases.
Community child health services can also boast of successes. The routine immunisation programme has wiped out SMALLPOX, DIPHTHERIA and POLIOMYELITIS and almost wiped out haemophilus and meningococcal C meningitis, measles and congenital RUBELLA syndrome. WHOOPING COUGH outbreaks continue but the death and chronic disability rates have been greatly reduced. Despite these huge health gains, continuing public scepticism about the safety of immunisation means that there can be no relaxation in the educational and health-promotion programme.
Services for severely and multiply disabled children have improved beyond all recognition with the closure of long-stay institutions, many of which were distinctly child-unfriendly. Nonetheless, scarce resources mean that families still carry heavy burdens. The incidence of SUDDEN INFANT DEATH SYNDROME (SIDS) has more than halved as a result of an educational programme based on ?rm scienti?c evidence that the risk can be reduced by putting babies to sleep on their backs, avoidance of parental smoking, not overheating, breast feeding and seeking medical attention early for illness.
Children have fewer accidents and better teeth but new problems have arisen: in the 1990s children throughout the developed world became fatter. A UK survey in 2004 found that one in ?ve children are overweight and one in 20 obese. Lack of exercise, the easy availability of food at all times and in all places, together with the rise of ‘snacking’, are likely to provoke signi?cant health problems as these children grow into adult life. Adolescents are at greater risk than ever of ill-health through substance abuse and unplanned pregnancy. Child health services are facing new challenges in the 21st century.... child development teams (cdts)
A group of persons working together, where each member of the team contributes, in accordance with his or her competence and skill and in coordination with the functions of the others, in order to achieve the maximum benefit for the care recipient.... health team
An abnormality of the rhythm or rate of the heartbeat. Arrhythmias, which are caused by a disturbance in the electrical impulses in the heart, can be divided into 2 main groups: tachycardias, in which the rate is faster than normal, and bradycardias, in which the rate is slower.
In sinus tachycardia, the rate is raised, the rhythm is regular, and the beat originates in the sinoatrial node (see pacemaker). Supraventricular tachycardia is faster and the rhythm is regular. It may be caused by an abnormal electrical pathway that allows an impulse to
circulate continuously in the heart and take over from the sinoatrial node. Rapid, irregular beats that originate in the ventricles are called ventricular tachycardia. In atrial flutter, the atria (see atrium) beat regularly and very rapidly, but not every impulse reaches the ventricles, which beat at a slower rate. Uncoordinated, fast beating of the atria is called atrial fibrillation and produces totally irregular ventricular beats. Ventricular fibrillation is a form of cardiac arrest in which the ventricles twitch very rapidly in a disorganized manner.
Sinus bradycardia is a slow, regular beat. In heart block, the conduction of electrical impulses through the heart muscle is partially or completely blocked, leading to a slow, irregular heartbeat. Periods of bradycardia may alternate with periods of tachycardia due to a fault in impulse generation (see sick sinus syndrome).
A common cause of arrhythmia is coronary artery disease, particularly after myocardial infarction. Some tachycardias are due to a congenital defect in the heart’s conducting system. Caffeine can cause tachycardia in some people. Amitriptyline and some other antidepressant drugs can cause serious arrhythmias if they are taken in high doses.
An arrhythmia may be felt as palpitations, but in some cases arrhythmias can cause fainting, dizziness, chest pain, and breathlessness, which may be the 1st symptoms.
Arrhythmias are diagnosed by an ECG. If they are intermittent, a continuous recording may need to be made using an ambulatory ECG.
Treatments for arrhythmias include antiarrhythmic drugs, which prevent or slow tachycardias.
With an arrhythmia that has developed suddenly, it may be possible to restore normal heart rhythm by using electric shock to the heart (see defibrillation).
Abnormal conduction pathways in the heart can be treated using radio frequency ablation during cardiac catheterization (see catheterization, cardiac).
In some cases, a pacemaker can be fitted to restore normal heartbeat by overriding the heart’s abnormal rhythm.... arrhythmia, cardiac
A medical term meaning disturbance of heart rhythm, sometimes used as an alternative to arrhythmia (see arrhythmia, cardiac).... dysrhythmia, cardiac
(AOT) a multidisciplinary psychiatric team specialized in the treatment of patients with severe mental illness who are difficult to engage. Most AOTs will only see patients who have had a number of recent hospital admissions (‘revolving door’ patients). Recently, in many areas of the UK AOTs have been subsumed into *community mental health teams.... assertive outreach team
a form of education in resuscitation skills using a *resuscitation mannikin wired up to a heart rhythm simulator that can mimic all common cardiac arrest situations. Candidates may be expected to perform basic life support as well as advanced life support and display skills in airway maintenance and team leadership. This form of teaching and assessment is widely used in advanced life support courses.... cardiac arrest simulation
the volume of blood pumped from the heart’s left ventricle divided by body surface area, expressed as litres per minute per square metre (l/min/m2). It is determined by heart rate and stroke volume index (the volume of blood pumped by the heart with each beat), and provides a normal range (2.5–4.0 l/min/m2) regardless of the size of the patient.... cardiac index
reflex control of the heart rate. Sensory fibres in the walls of the heart are stimulated when the heart rate increases above normal. Impulses are sent to the cardiac centre in the brain, stimulating the vagus nerve and leading to slowing of the heart rate.... cardiac reflex
a programme of staged exercises and lifestyle classes designed for people recovering from a heart attack and run through the local hospital by dedicated health care professionals, who may include specialist nurses, occupational therapists, and physiotherapists.... cardiac rehabilitation
(CRT) a treatment for heart failure that involves ventricular pacing with multiple *leads. The aim is to restore coordinated ventricular contraction and hence improve cardiac function.... cardiac resynchronization therapy
(CMHT) a multidisciplinary team consisting of psychiatrists, psychiatric nurses, psychologists, social workers, and occupational therapists who treat patients with severe mental illness in the community.... community mental health team
(CCF, congestive heart failure) see heart failure.... congestive cardiac failure
(CRHT) (in psychiatry) a multidisciplinary team in psychiatric services specialized in the treatment of severely mentally ill patients in their home environment. An additional remit of CRHTs is to try and avoid acute hospital admissions.... crisis resolution and home treatment team
mechanical obstruction of labour in which the fetal head is unable to rotate from occipitotransverse to occipitoanterior position (see occiput).... deep transverse arrest
(MET) a team, usually consisting of a group of physicians, anaesthetists, and senior nurses, that can be summoned urgently to attend to patients with deteriorating medical conditions. The aim is to prevent further deterioration and to decide if enhanced levels of care are appropriate (e.g. on the high-dependency or intensive care units). The team will also assume the role of the *cardiac-arrest team.... medical emergency team
the recognized period, either just before or just after a full *cardiac arrest, when the patient’s condition is very unstable and care must be taken to prevent progression or regression into a full cardiac arrest.... peri-arrest period
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