septale

Atrial Septal Defect

Classified as a congenital heart defect, an atrial septal defect is when blood flows between the atria – the upper chambers – of the heart, instead of the normal blood pathway:

Superior vena cava > right atrium > tricuspid valve > right ventricle > pulmonary valve > pulmonary artery > lungs > pulmonary vein > left ventricle > bicuspid/mitral valve > left ventricle > aortic valve > aorta

A result of an ASD is lower than usual oxygen levels in arterial blood, due to oxygenated blood can flow and mix with deoxygenated blood in the right atria. ASD usually go undetected due to the asymptomatic nature. When applying an EKG, usually is what is seen is a first degree heart block (seen from a prolonged PR interval).

Source:

http://www.nlm.nih.gov/medlineplus/ency/article/000157.htm

http://www.cdc.gov/ncbddd/heartdefects/atrialseptaldefect.html

Biggest Lessons in Medicine

#1. TRUST your team members

#2. Document your ass off.

Let me explain.

Last night, I was working EMS and we ran a call for chest pains. Guy had all of the risk factors for coronary artery disease-obese, high cholesterol, smoker, hypertensive as hell-you name it. He said his pain started suddenly, while laying down and that it felt like ‘something was sitting on his chest’(this statement btw should ALWAYS raise your suspicions). It took us quite some time to get him to the ambulance because he was very anxious about finding his shoes, socks, keys…Fire department had done a 12 lead but it was unreadable due to artifact.

Once in the truck, we repeated the EKG and boom. ST segment elevation of 1mm and greater in the anterior-septal leads WITH reciprocal depression in inferior leads. The monitor interpretation did NOT scream STEMI and they looked like very early, almost…difficult to distinguish, changes to me. All the same, I felt really uncomfortable about the EKG and decided to work it as a STEMI. Aspirin, Nitro, IV lines, lights and sirens to the ER. 

(It should be noted that we transmit our EKGs so hypothetically, someone at the ER looked at it already). I’ve kind of…given up on the formal ‘STEMI alert’ phone call because frankly the ER always waits to call it until they look at their own EKG anyway(again. TRUST YOUR TEAM. but thats a whole other issue), however I did speak very pointedly with the charge nurse that there was 1mm elevation in the septal leads. She kind of ‘ehhh. okay. lets put him in *insert room very far away from the trauma rooms, nurses station, everything* when you get here. 

Upon arrival, he was put in his room, and this time I went up to his personal nurse who kind of half ass glanced at the 12 lead and shrugged it off. I also went to the ER doctor and pointed out the changes I saw. She too, went ‘ehhh’ and proceeded to ask the patient if he had experienced any emotional upset before developing the pain. It was 100% clear that they were looking at the patient, who was very anxious, at face value and completely disregarding the clinical assessment and intuition of the providers who had spent the past 20 minutes with him. 

Today, I was called up to the office, where our director told me that the patient DID have a heart attack after all-and that it took the ER about 45 minutes to actually CALL a STEMI alert and activate the cath lab. Thankfully, the patient was going to be just fine however the delay could very well have been fatal. The hospital was now trying to deflect blame from themselves and put the blame on us for our extended scene time. 

(What should have happened is that the moment I called, someone should have interpreted that EKG and a trauma room should have been cleared. A cardiologist should have been paged to evaluate, and the patient SHOULD have only spent minutes in the ER before going to the cath lab. Then the patient would have easily been within the 90 minute window…but I digress)

Here is where Lesson 2 comes in-I documented the every living daylights out of the call. I documented that we tried to get him to leave the house sooner but that he was insistent on finding his shoes and keys first. I documented that we gave him a lower dose of aspirin BECAUSE he had already taken some at home. I documented with names EVERY SINGLE TIME, ER staff was informed that he had ST changes. As a result of our documentation, my agency(and my license) were in the clear. The blame was very much on them.

Now, I understand that the ER is very busy. I understand that as a nurse, you may have multiple very sick patients(in fact, they were all super concerned about a patient with a grossly dislocated shoulder that had just come in). I understand that the grand majority of your cases are horses-not zebras and that it takes a while to get things done.

However(and this applies to everyone-nurses to EMS, physicians to nurses, ect)-you HAVE to trust the judgement and education of your team members. Its the team mentality that picks up the slack where you otherwise get overwhelmed and catch things like little early ST changes that you might otherwise miss. 

2

This is a letter I started two days ago to express my emotions towards him and how thankful I had come across him in my life. It was properly written in pencil and very nice looking.
But two hours ago when he said what he said, I knew I had to finish it. I did finish it. However, I finished it was a crayola fine point marker and in no form really. If you know me, you know that’s unusual.
People can try to knock me down, but I have grown so much stronger than that. I am the girl who has been abuses nonstop for my entire life. I do not take this out on others. I am honest, caring, and only wish to help people. I am still alive. A closed PDA, a small open atrial septal defect, and a failing valve. I am still alive
There is a reason for that. Do not be hard on yourself when you reach you’re breaking point.
I am alive for a reason.

Tag 10 people you want to know more about!

tagged by noisybrainstuff

Name: Daman

Average Hours of Sleep: 4, I pull way too many all nighters

The Last Thing You Googled: coronary sinus atrial septal defect

Nicknames: Doctor, Devil, Demon (My friends are really unimaginative)

Birthday: January 29, 1998

Sexual Orientation: Demisexual

Height: 5'6

Favorite Color:  Plum

One Place That Makes You Happy: Anywhere along the Niagara Escarpment

How Many Blankets Do You Sleep With: 0-2

Favorite Films: Lord of the Rings (Including the hobbit) Harry Potter and Dilwale Dulhania Le Jayenge  

What I’m Wearing Right Now: Grey sundress

Last Book I Read: A Dance With Dragons (The fifth Game of Thrones book)

Most Used Phrase: Fucking Hell

Last Thing You Said To A Family Member: “Bring me home some sushi if you can” to my mum

Favorite Beverage: Cranberry Harvest Tea with Apple Cider

Favorite Food: Samosas

Last Film I Watched in Theaters: Fast and Furious 7

Dream Vacation: Back packing around the world

Dream Pet: A husky, preferably Alaskan Klee Kai or Alaskan

Dream Job: Trauma Surgeon

I’m tagging kaijuno mud-over-snow evan-singer-b cursedkennedy nefepants official-roti and sliceofbri

A Hotflowers, uma das maiores empresa de produtos sensuais do Brasil, listou os benefícios de uma vida sexual ativa para a saude.

O sexo saudável e de qualidade é quando ambos os parceiros o realizam com prazer e felicidade. Para isto é necessário envolvimento e prazer físico e emocional. Qualquer atividade que realizamos e sentimos prazer ativa em nosso cérebro a área septal, responsável pelos resultados prazerosos que vivenciamos diante de algo que nos faz feliz.

O importante é não sentir desconforto ou dor durante as atividades sexuais, assim como fazer sexo sem desejo e excitação. O casal precisa sentir prazer e felicidade em ter intimidade.

Quando uma pessoa faz sexo sem vontade e sem prazer por um longo período ela ocasiona para seu corpo e mente um sofrimento físico e emocional. Esta atitude não é saudável e será prejudicial para a sexualidade do casal.

Na vida sexual do casal é necessário o equilíbrio entre a vontade e frequência desejada para ambas as partes, e um proporcionar um para o outro excitação e prazer durante as preliminares, assim o casal terá uma sexualidade saudável.

Os benefícios do sexo saudável

  • O sexo regular e realizado de forma saudável faz muito bem em nossas vidas. Segundo pesquisadores os benefícios são:
  • O corpo libera endorfina durante o orgasmo, o que causa euforia, prazer e humor. Aumenta a tolerância à dor e sensação de bem estar;
  • O orgasmo libera vários hormônios, como a ocitocina que reduz a ansiedade, depressão e previne o câncer de mama;
  • A atividade sexual com preliminares de qualidade queima muitas calorias, em média de 3 a 10 calorias por minuto;
  • Após o orgasmo o corpo e mente relaxam instantaneamente, favorecendo melhora na qualidade do sono;
  • O sexo aumenta a circulação do sangue e transporta oxigênio para o cérebro, irriga a região responsável pela memória e aprendizagem. Favorece a capacidade do sistema imunológico, melhora as dores musculares, revitaliza células, músculos e pele;
  • O sexo frequente estimula a produção de testosterona, este hormônio atua no desejo, desempenho sexual, protege coração e ossos;
  • O sexo saudável aumenta a autoestima e favorece a longevidade, criatividade, memória, rendimento intelectual, aumento das percepções corporais e felicidade.

O que fazer para ter um sexo saudável

O importante é não sentir desconforto ou dor durante as atividades sexuais, assim como fazer sexo sem desejo e excitação. O casal precisa sentir prazer e felicidade em ter intimidade.

Sugere uso de produtos eróticos durante as preliminares para favorecer a excitação e prazer do casal.
Dicas para o casal: use produtos eróticos nas preliminares, como vibradores, cremes, geis, óleos, lingeries, fantasias e outros objetos. Desenvolva sua criatividade, intimidade e felicidade sexual.

Créditos:

Fabiane é sexologia desde 2002. Realiza Cursos e Palestras em Sexualidade Humana desde 2010.

FABIANE DELL`ANTÔNIO

  • Graduada em Fisioterapia, com Mestrado em Ciências da Saúde Humana (UnC-SC) e nas seguintes Especializações:
  • Neuropsicologia e Aprendizado (PUC-PR);
  • Fisioterapia em Uroginecologia (CBES-PR);
  • Sexualidade Humana (USP-SP).
  • Professora Universitária desde 1999. Atua em consultório na área de Sexologia desde 2002. Realiza Cursos e Palestras em Sexualidade Humana desde 2010

A HotFlowers disponibiliza um espaço para que você possa enviar suas dúvidas a Fabiane. Clique aqui.

O post Empresa de produtos eróticos lista os benefícios de uma vida sexual ativa apareceu primeiro em Blog do Clube 4 Paredes.net.

An Overview of Ventricular Septal Defects

A member of the American College of Cardiology, Dr. Rajan Bhatt has co-authored numerous articles for peer-reviewed journals such as the Journal of the American Society of Echocardiography. During his long career, Dr. Rajan Bhatt has gained experience with a wide range of ventricular defects, including ventricular septal defects.

Often referred to as a “hole in the heart,” a ventricular septal defect is a birth defect. This hole, which occurs between the heart’s lower chambers, is present in every fetus but usually closes before the child is born. Those born with VSD may only have a very small hole, which usually causes no problems and may even close on its own over time. However, large VSDs cause the heart and lungs to work overtime, and children with the condition typically present with symptoms at birth or shortly thereafter. These symptoms may include rapid breathing, rapid heart rate, poor eating, and a bluish tint to the lips, nails, and skin.

A small VSD may never cause any health issues and only require close observation rather than surgical repair. A larger one, however, can lead to severe heart and lung damage. Medications can control the symptoms and keep the heartbeat regular in the short term, but surgical repair is often the only way to achieve long-term relief. The surgical procedure usually involves closing the hole by stitching a patch of synthetic material over it.

The prognosis for this procedure is generally excellent, although patients who undergo cardiac surgeries such as this are at risk of an infection of the heart lining called endocarditis.