Rostrum of Asclepius Vol 12, No. 2 (2013): April - June 2013

Cardiopulmonary resuscitation (CPR) is as old as humankind. The evolution of CPR represents a combination of human errors and discoveries. Aim: The present study reviews the most important moments in the history of resuscitation, from the first attempts of CPR until now. Methods: The methodology followed included bibliography research from review literature, through databases PubMed, Medline, Scopus, with the use of keywords, such as cardiopulmonary arrest, cardiopulmonary resuscitation, history, evolution and combinations of them. Complementary bibliography was found through the library of the National and Kapodistrian University of Athens. Results: The first historical references on CPR go back to the era of Ancient Egypt (3100 B.C.). Although the technique for mouth to mouth ventilation was known in ancient times, its efficacy was demonstrated just in 1958. The ease and efficacy of chest compressions were demonstrated in 1960. Electrical defibrillation may have begun in 1775, but it was applied to a victim of cardiac arrest in the 1950s. Conclusion: CPR is currently a rapidly evolving field of medical science. According to latest data, there is evidence that high quality chest compressions, prompt defibrillation if applicable and treatment of reversible causes improve Cardiopulmonary resuscitation (CPR) is as old as humankind. The evolution of CPR represents a combination of human errors and discoveries. Aim: The present study reviews the most important moments in the history of resuscitation, from the first attempts of CPR until now. Methods: The methodology followed included bibliography research from review literature, through databases PubMed, Medline, Scopus, with the use of keywords, such as cardiopulmonary arrest, cardiopulmonary resuscitation, history, evolution and combinations of them. Complementary bibliography was found through the library of the National and Kapodistrian University of Athens. Results: The first historical references on CPR go back to the era of Ancient Egypt (3100 B.C.). Although the technique for mouth to mouth ventilation was known in ancient times, its efficacy was demonstrated just in 1958. The ease and efficacy of chest compressions were demonstrated in 1960. Electrical defibrillation may have begun in 1775, but it was applied to a victim of cardiac arrest in the 1950s. Conclusion: CPR is currently a rapidly evolving field of medical science. According to latest data, there is evidence that high quality chest compressions, prompt defibrillation if applicable and treatment of reversible causes improve neurologically intact long term survival of cardiac arrest victims.

Keywords: Heart, cardiac arrest, cardiopulmonary resuscitation, history, brain, brain resuscitation

Rhabdomyolysis is caused by muscle breakdown resulting in the release of myoglobin into the systemic circulation. Acute renal failure results from the nephrotoxicity of myoglobin. Heroin use is one of the causes of rhabdomyolysis and acute renal failure. Aim: The aim of this literature review was highlight the importance of early recognition and treatment by a nurse of acute renal failure from rhabdomyolysis after heroin. Method: The method followed in this review was based on retrospective studies and research, conducted during the period 2000-2012 and retracted from the international databases Medline, Pubmed, Cinahl and the Greek database Iatrotek on acute renal failure from rhabdomyolysis after heroin use. Key-words were used: acute renal failure, rhabdomyolysis, heroin, international guidelines, based-evidence nursing care. Results: The clinical presentation occurs with muscle pain, muscle weakness, and brown-redish urine. High values of CPK and myoglobin make the diagnosis. Toxicology tests confirm heroin use. For the treatment is required naloxone administration, the rapid hydration of the patient, alkalinization of urine, good diuresis, regulation of electrolyte disturbances and dialysis if necessary. Conclusions: Early recognition and treatment of acute renal failure from rhabdomyolysis after heroin use is vital for the survival of the patient. It is necessary to educate nurses on specific issues such as acute renal failure from rhabdomyolysis after heroin use and the implementation of protocols for the treatment and cure.

Keywords: Acute renal failure, rhabdomyolysis, heroin, international guidelines, evidence – based nursing care

Childhood experiences of living in a world of sweeping changes and unpredictable extreme events can be very stressful and are often traumatic and children are not able to mobilize the defense mechanisms necessary for adaptation. Traumatic experiences for a child can include exposure to natural disasters, circumstances such as war and terrorism, situations of victimization (physical or sexual abuse), accidents resulting in serious injury and disability, loss of loved one, a life-threatening illness and hospitalizations, painful situations, as well as domestic and interfamily violence. The aim of this literature review was to explore the nursing care of children after a traumatic incident through a critical review of the existing literature. Material and Methods: A literature search was performed in Medline, Cinahl, BNI, PsycINFO, and Scopus databases with keywords relevant to the subject of this review. Results: From the literature review it was found that the published resources with respect to the nursing care of children after a traumatic event are very limited and they do not provide clear nursing care plans. Nursing care of children after a traumatic incident involves the prevention of trauma, the detection of early symptoms, the protection of the child from self-destructive and suicidal behavior, the restoration of confidence in self and others, the enhancement of the expressiveness, covering child's emotional needs, the family counseling and reconnection with their peers and childhood activities, as well as ensuring follow-up of their therapeutic progress. Conclusions: Traumatic experiences directly influence a child at physical, mental and emotional levels, making an impact on the smooth psycho-emotional development, the formation of his personality and the quality of childhood and future adult life. It is vital that nurses are aware of therapeutic techniques, in order to approach and nurse traumatized children in the community or in clinical settings. Moreover, it is necessary for programs to be created with nursing care plans based on evidence from systematic reviews.

Keywords: Traumatic incident, trauma, child, nursing care, Post-Traumatic Stress Disorder (PTSD)

Thalassemia is an inherited blood disorder characterized by anomalies in the synthesis of the beta chains of hemoglobin resulting in variable health problems. The chronicity and the nature of the disease impose significant limitations on individuals' life and as a result they frequently experience anxiety and depression. Aim: The aim of the present study was to review the literature about factors associated with psychiatric disorders that experience patients with thalassemia. Method: The method of this study included bibliographic research of the literature from reviews and researches, mainly in the PubMed data base, which referred to the factors associated with psychiatric disorders in patients with thalassaemia. PubMed was searched using the following key search terms: "anxiety", "depression", "thalassaemia" while the research covered the period 1996-2011. Results: Though the developments in the treatment and prognosis of thalassemia have dramatically altered the approach to the care of patients, however the psychological aspects of the disease have received little attention since the number of relevant studies are generally limited. According to the literature, patients with thalassemia frequently experience psychiatric disorders (anxiety and depression) due to various reasons, out of which the main are the chronicity of disease, the disease complications, the financial, social and personal problems, the lack of family and social support, the change in body image and the reduction of self-esteem level. Symptoms of anxiety and depression may influence negatively the outcome of the disease including low adherence to treatment, increased morbidity and poor quality of life. Conclusions: A regular screening for anxiety and depression symptoms and identification of individuals at high risk should be an integral part of medical therapy. Early screening implies early treatment and provides valuable information for the planning of intervention programs that have as an ultimate goal to improve emotional and physical health of patients with thalassemia.

Keywords: Thalassemia, anxiety, depression

The applications of emission x- g- and b- rays in Medicine give solution to everyday diagnostic and therapeutic problems, but expose the Medical staff in radiation risk and its consequences. Aim: The purpose of this article was the review of literature relating to the risk of radiation exposure and radiation protection instructions for doctors, technologists and nurses during their contact with patients who have or had performed studies using ionizing radiation. Method and Material: The methodology οf this study included bibliography research from both the review and the research literature, between 2000-2012 mainly in the Pubmed data base which referred radiation protection and risk of radiation exposure for practitioners of Medicine, using the key words: radioprotection, radiation exposure, practitioners of medicine, ionizing radiation. Results: According to the literature, professional places such as Radiology laboratories, Nuclear Medicine departments, Invasive and Radiotherapy departments should carry special lead cover for surfaces and machines to prevent aimless radiation exposure of the staff and visitors, but also appropriate stamping of the restricted areas. Every worker (doctor, technologist, nurse) in place with ionizing radiation should follow the suggested radiation protection instructions. The worker is obliged, apart from maintaining the maximum possible distance from the source of radiation and the decrease of stay close to the radiation source, to carry his personal dosimeter and all the supplied means like, lightweight aprons, nippers and containers for small bottles, lead glasses, barriers, etc. Conclusions: Functionaries of Medicine nursing and taking care radiated patients should be informed from the responsible physicist about the means of their radioprotection. In case of exceed of the maximum radiation dose for workers in places with ionizing radiation, according the current Low there is radiation protection days off.

Keywords: Ionizing radiation, radiation protection, physicians, nurses

The fact that nursing is a difficult profession which lacks of social recognition results in being abandoned by many nurses and not being selected by young people. Αim: The aim of the present study was to investigate the perceptions of nurses, other health care professionals and students about the nursing profession and to determine the factors that influence their attitude towards it. Material and Method: 949 students of nursing and medical schools and health care professionals participated in the study. The data was gathered by the means of two structured questionnaires, the composition of which was based on the nursing database. The data's statistical analysis was fulfilled by the SPSS 12. Results: Τhe 89,2% of the sample believes that nursing practice requires knowledge, skills, and critical thinking. The 82,4% also believes that the quality of care provided depends on the quality of the nurses' education and lifelong learning is nurses' duty (94,4%). Moreover, the 82,6% of the participants thinks that the nurses do not lose their interest in the patient's care as much as they become more educated. Factors such as religion and frequency of sick leave do not influence the attitude towards the profession, but the reality shock, the lack of nursing staff and the experience of negative bias adversely influence the attitude towards it. Conclusions: The confrontation of factors that influence negatively the image of the profession combined with a better and continuing education for nurses will lead to increase the social status of the nursing profession.

Keywords: Perceptions, attitude, nursing profession, nursing students, social recognition

Nurses' views on the provided nursing care and patients' satisfaction constitute important evaluation criteria of its quality and contribute its improvement. Aim: The aim of the present study is to explore and compare nurses' and patients' views regarding the quality of care provided in surgical departments of Cretan public hospitals. Methods and Material: A correlational descriptive study design was used. The study questionnaire was completed by 270 surgical patients and 140 registered and assistant nurses working in surgical departments of public hospitals in Crete. Purposive non-random sampling was used through an anonymous self-reference questionnaire. Data analysis included statistical package SPSS 17. Results: Patients and nurses appeared to share similar views on the effectiveness of hospital care and the level of satisfaction regarding the nursing care provided in Cretan hospitals. Two hundred and seventy patients 270 participated in the study. Most of them 95.3% declared satisfied from nurses' capacity to provide care, while 97.7% and 98.1% were satisfied from staff manner and continuity of care, respectively. Patients referred also to lack of information regarding patient education during hospitalisation 67.7% and lack of information giving to family members and significant others 70.1%. Out of the 140 nurses and nurse assistants who participated in the study, 98.5% and 94.9% were satisfied from continuity of care and staff manner, respectively. Furthermore, 66.7% and 85.3% stated satisfied from meeting patients' personal needs and information giving to family and significant others. Finally, 64.6% were dissatisfied with the food quantity, while 73.6% were appeared unhappy with food quality. Conclusion: The provided nursing care has been considered satisfactory by nurses and patients. Issues such as information giving and hospital facilities are regarded as less satisfactory and require further improvement. Keywords: Nursing care, quality evaluation, information giving, patients' satisfaction. Methods and Material: A correlational descriptive study design was used. The study questionnaire was completed by 270 surgical patients and 140 registered and assistant nurses working in surgical departments of public hospitals in Crete. Purposive non-random sampling was used through an anonymous self-reference questionnaire. Data analysis included statistical package SPSS 17. Results: Patients and nurses appeared to share similar views on the quality of services Conclusion: The provided nursing care has been considered satisfactory by nurses and patients. Issues such as information giving and hospital facilities are regarded as less satisfactory and require further improvement.

Keywords: Nursing care, quality evaluation, information giving, patients satisfaction

Emergency Department (ED) is an autonomous part of the hospital's immediate readiness. Acute abdominal pain is the most frequent reason why patients seek medical help in the ED. Aim: The purpose of the present study was to explore the management of acute abdominal pain in the ED of a provincial hospital. Material and Methods: The sample studied included 933 patients aged> 14 years who visited the ED of provincial General Hospital, with abdominal pain from January 2010 to January 2011. In every patient the sex, age, physical examination findings and laboratory and imaging results, treatment and outcome were recorded. The data were analyzed with the statistical package SPSS, version 13.00. Results: 44. 2% (n = 413) of the studied population were men with mean age 42.3 ± 21.6 years. There were no differences in clinical presentation, laboratory results and medication administered in relation to sex or age, (p<0.05). The comparison between elderly and younger patients showed no differences regarding the clinical picture and treatment. Although elderly patients were at a significantly higher percentage subjected to ultrasonography and CT scan of the abdomen and had significantly higher rates of hospitalization (p<0.05), no differences were found in the need for immediate surgery. The patients admitted to the hospital were men, elderly, febrile and tachycardic, had leukocytosis and signs of peritoneal irritation (p<0.05). There were no statistical differences in the management and outcome in terms of ethnicity or insurance status. Conclusions: Abdominal pain management in ED is an important process for patients' outcome. Conducting laboratory and paraclinical examinations is the basis for the correct diagnosis, the proper patients' treatment and good patient's outcome.

Keywords: Acute abdomen, emergency department, pain, emergency surgery