Cardiac Catheterization Essay Example | Topics and Well Written Essays - 2500 words

Cardiac Catheterization - Essay Example In 1947, Louis Dexter expanded the clinical use of right heart catheterization with studies in patients with congenital heart disease and identified the pulmonary capillary wedge pressure as a useful clinical measurement. By this point, the value of homodynamic measurements was being fully realized, and further developments came rapidly" (Roger, 2008). The technique and safety profile of the instruments used for bringing homodynamic stability though has been evolving over the time. Initial there used to be compression techniques to stop the vessels from bleeding which was and still is the main complication of angiography and angioplasty. Post op bleeding from the intervention site is the main reason of keeping patients in bed for a couple of hours which is very cumbersome for the patients. Cardiac catheterization can be done through different access points but the window to work in becomes an issue. Using upper extremity vessels will be a very good alternative to have a controlled bl eeding because of the diameter of the vessel and their easy access but the window of access gets compromised and the choice of catheters for maximum access and manipulation becomes a problem so, the preferred access rout is still femoral arty and mainly the common femoral artery neither above non below it. "The main advantages to this method are its ease and substantial safety record. The main disadvantage is the need for an extended (2-6 h) period of bed rest after completion of the procedure. Several types of arterial closure devices now are available that provide rapid homeostasis and shorten the period of bed rest considerably. However, complication rates with these closure devices are similar to conventional manual compression". (Roger, 2008). "Reductions in sheath size, intensity and duration of anticoagulation with heparin, and procedure time were observed. Adverse outcomes of major femoral bleeding included prolonged hospital stay, and increased requirement for blood transfu sion. Major femoral bleeding and blood transfusion are both associated with decreased long-term survival, driven by a significant increase in 30-day mortality" (Brendan, 2007). Manual or mechanical compression as the name itself explains it is to be done by the surgeon or any other volunteer in the surgical team to provide compression with the pressure through the pulp of three or four fingers in the downward direction without releasing it for a microsecond for at least for 10-15 minutes at the site of the intervention. (Shaffer, 2005).Vascular closure devices are a very nice and safe alternative to the mechanical compression methods in terms of vascular complication, surgeon's factors and patient's factors. In percoutaneous intervention intra vascular complication which includes "ecchymosis (37%), hematoma (20%), and oozing (15%)" are major complications. These complications occur more frequently with mechanical and device assisted compression. The main reason for these complications is the way mechanical or device assisted compression is applied and unless it is applied exactly the same way it does not fulfill the purpose. Apart from these commonly happening but comparatively less dangerous issues there is a another major complication of leg ischemia which occurs due to prolonged deprivation of blood supply. Post-operatively some patients do

Mock Trial Case Study Example | Topics and Well Written Essays - 1500 words

Mock Trial - Case Study Example When she broke up with her fiance just shortly before meeting my client, she suffered several depression and, by her own account, the breakup was very bad. Now, following her breakup with my client, she is seeking legal recourse - she is using the court as an instrument of revenge. The Crown has quite obviously allowed this perversion of the law and the court and is charging my client with entry into sexual relationships via the "exercise of authority." According to the Crown, consent was vitiated by the imbalance of authority in the relationship. Miss McAdams, on the other hand, has stated the opposite - there was never any undue exercise of authority, the was a balance of power in the relationship and she was never, at any point, overwhelmed by Dr. Matheson's authority. So, who are we to believe A woman with a history of less than reasoned reactions to the breakup of relationships or a successful professional who does not have such a history The affair between Miss Soudoski and Dr. Matheson was consensual; it occurred outside my client's office and lasted for four months. We should not be here today and my client should, most definitely, not be standing trial for the exercise of his civil rights; a right which he exercised within the confines of its legal limitations. Do not allow for this perversion of the law. Chief Examination Dr. Matheson Q1: Dr Matheson, are you aware of the severity of the charges brought against you by the Crown A1: Yes I am. If proven guilty, I could loose my license and, hence, my livelihood. Q2: Did you or did you not engage in an affair with Miss Soudoski A2: Yes I did. Our professional relationship had ended by that time, however. As soon as I realized that our interest in one another was more than professional, I proposed that Miss Soudoski seek treatment elsewhere Q3: Did she A3: No she didn't but, from a professional point of view, she really did not need to. Q4: Are you claiming that she was well, that you had cured her from her depression in a handful of sessions A4: No I am not. I am just saying that her depression was an exaggerated reaction to her fiance's having broken up their engagement and cancelling their wedding. It would take time to pass but she did not need a psychologist for that. As I told her in our first meeting, this was something she had to work out for herself - work out by accepting the reality. Q5: What was her response A5: She insisted that she need professional help to get through this period. Q6: When did the relationship move from the professional to the personal A6: Maybe within a month or six weeks. Miss Soudoski began to take a personal interest in me and began asking me personal questions. What type of women I liked Whether I was single or involved in a relationship Questions of that type. At first I tried to avoid answering but to tell you the truth, I found her quite attractive. Therefore, I suggested that we end our professional relationship. Q7: Who initiated the affair A7: Miss Soudoski did. She invited me to her home for drinks and matters escalated from there. Q8: Did you, at any time, meet with her in your office after that A8: Yes I did - several times in fact. But never in a professional capacity and I always told her that she shouldn't come