Tuesday, February 24, 2015

Care After Return of Spontaneous Circulation: TABLE

Care after ROSC - Think TABLE Acronym
After performing emergency basic life support and perhaps advanced life support, the person has regained spontaneous circulation. Although a good sign, the goal of emergency care shifts to supporting the person's status with the hopes of regaining function that he or she had before the arrest interval.

I tend to remember information better through the use of acronyms, so I created the acronym TABLE to help me to remember how to care for someone who has regained spontaneous circulation after emergency care. This is not a step-by-step linear guide. In reality, many of these actions are performed simultaneously by various members of the team.

After ROSC...think TABLE!

T
Transport to appropriate level of care
  • In hospital - transfer to ICU
  • Out of hospital - transfer to appropriate hospital via land, air, water as appropriate
Assist survivors emotionally and provide information they need to make wise decisions regarding care.
A
Advanced Airway
  • Titrate to keep O2 Sats >94% 
  • Avoid overbagging & secure tube properly
  • Capnography: 10-12 BPM; PetCO2 35-40 or PaCO2 40-45
  • Elevate HOB 30°
B
BP
  • If you have a pulse, you have a BP - monitor all VS
  • SBP at least 90; MAP at least 65
  • Fluid Bolus (NS, LR)
  • Consider cooled fluids with hypothermia protocol if questionable neurological status - no meaningful response to commands
  • Meds: DA 5-10 mcg/kg/min, Norepinephrine/Epi 0.1-0.5 mcg/kg/min
L
Labs
  • Look at Hs/Ts
  • Glycemic control
  • Consider history and interview family or other witnesses to determine reversible causes and possible treatment
E
ECG - 12 lead
  • Assess & treat STEMI (ST elevation, NEW BBB)
  • Consider PCI
  • Watch for arrhythmias and treat appropriately

I have had the great privilege of knowing several people who had CPR performed on them who survived and enjoyed several healthy years after the incident. These are the exception rather than the rule. If you happen to be assisting with resuscitation efforts, I hope you have the opportunity to play a role in helping someone to have that second chance!

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Wednesday, November 26, 2014

Cooking with the Kids? How to Enjoy the Holidays With Children in the Kitchen

Kids Cooking in the Kitchen © Katrena
Cooking with the kids can be quite an interesting experience! Teaching children how to cook can be an invaluable experience as this skill can help them function more independently and can give them a great sense of accomplishment. Yes, you'll probably have lots of messes and a few goofs here and there, but many kids are highly motivated to help in the culinary department, especially if they get to assist with devouring the treats later.

Practical Skills Taught in the Kitchen © Katrena
Involve the kids in selecting a menu. This can give you the opportunity to talk about healthy choices, the cost of ingredients, safe foods for anyone with allergies, and much more. Stress safety issues and ensure the kids understand that the kitchen can be a dangerous place. When getting supplies ready you may wish to talk about the names of the various culinary implements you are using and perhaps throw in some math skills with measurements. Having the kids participate in cleaning up after cooking can teach responsibility and teamwork.

Fun Family Times Learning How to Cook © Katrena
My kids' ages are varied, from a teenager to a first grader, but all of them know they are welcome in the kitchen. They are becoming great helpers, and I love to see how each one leans toward different interests while cooking. My 7-year-old arranged the oranges, lemons, and limes into various shapes today – perhaps she will become an amazing culinary decorator! My second oldest was like a whirlwind as she gathered supplies and created lists for packing food for Thanksgiving. Who knows...she might manage a restaurant some day! My oldest had a great eye for seeing if something might tip over and was quick to entertain everyone with her talent for accents and singing, nice qualities for someone who loves to perform.

Those early experiences in the kitchen might make for some great memories to enjoy in the future....and perhaps some tasty meals too!

Mama's Kitchen Rules

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Thursday, August 14, 2014

Katrena's Retro Cardio Exercise Playlist #2

Retro Cardio Exercise Playlist #2
This retro cardio playlist features songs that were popular years ago. I went way back for a few and then only a couple of years in the archives for a few songs. Mixing up the speeds lends itself well to interval training, which can be quite effective. You are more likely to work harder on those faster songs if you know the next one is going to be slower rather than simply pacing oneself if all the songs on a playlist are faster.

Here is my retro cardio exercise playlist #2
  • Johnny B. Goode
  • Maybelline
  • Addicted to Love
  • She Drives Me Crazy
  • Money
  • The Story of Us
  • Cuando Cuando
  • Let the Music Play
  • Straight Up
  • Pump Up the Jam
  • Party Rock Anthem
  • Car Wash
  • Piano Man
I hope you enjoy this playlist. What are your favorite older songs? Perhaps some of them might land on one of my future lists!

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Wednesday, July 23, 2014

Katrena's Retro Cardio Exercise Playlist #1

Katrena's Retro Cardio Playlist #1
I love music and enjoy dancing. Although I am serious about exercising and strive to exercise for my health's sake, I do not feel like it has to be all grunts, groans, and miserable movement. I find exercise to be enjoyable! I can exercise with a good playlist for an hour or longer and wonder where the time went, even though the sweat is dripping off.

I tend to alternate faster and slower songs so that I can incorporate a little interval training. You often work harder on that tough kickboxing jump rope segment if you know that you'll be dancing the Cha Cha on the next clip.

Here is one of my favorite playlists full of retro music that lends itself well to a cardio workout:
  1. In the Mood
  2. Whole Lotta Shakin' Goin' On
  3. Big Girls Don't Cry
  4. We Are a Part of a Better Nation
  5. Pinball Wizard
  6. Greased Lightening (it helps to do imagine doing this one in the garage!)
  7. Old Time Rock and Roll
  8. Thriller
  9. Twist & Shout
  10. We Are Family
  11. Respect
  12. Celebration
There you have it - find these songs on your favorite music purchase site, load them up and you've got a fabulous, energetic workout! Before starting or changing any workout routine, check with your healthcare provider to ensure that the exercise is safe for your health condition.

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Thursday, July 3, 2014

Psychiatric Disorder Symptoms Linked to Gluten Intolerance: Epilepsy, Anxiety, Depression, Schizophrenia

Gluten May be Linked to Epilepsy, Anxiety, Depression & Schizophrenia - Photo by Sander van der Wel
Celiac disease is known by many as the "Great Mimic" because symptoms associated with the condition vary so wildly. Gluten now ranks as one of the top ten causes of disability in the world. Celiac disease, also known as celiac sprue, is known to affect approximately 1% of the population. The number rises to approximately 6% when considering people who are sensitive to gluten without the obvious intestinal damage associated with celiac disease but who test positive for antibodies to gliadin. These statistics do not include those who are allergic to gluten who test positive with IgE mediated responses.

A myriad of symptoms can result as some people ingest the protein found in wheat, rye, and barley or grains and other products that are cross-contaminated with any of these proteins. Currently, completely avoiding gluten is the only treatment for celiac disease. Research indicates that gluten may affect the central nervous systems of some people with celiac disease or gluten intolerance.

Several studies on psychiatric disorders and how a gluten-free diet affects symptoms have revealed some promising results for those who suffer from these disorders. It is interesting to note that a link between celiac disease and psychiatric complications has been observed for more than 40 years, yet many people who suffer from these conditions for years are never tested for celiac disease or gluten sensitivity.

Studies are referenced at the bottom of this article for those who wish to learn more about this topic. Collaborate with one's healthcare provider before changing one's diet.

Gluten Sensitivity and Epilepsy or Seizure Disorders

Several studies have shown that a gluten-free diet may decrease the incidence of seizures in certain populations. Some of those studied who had seizures, celiac disease, and cortical calcifications experienced a significant improvement of symptoms after adopting a gluten-free diet. One case study followed a person with intractable epilepsy who experienced complete resolution of symptoms after adopting a gluten-free diet. Those with temporal lobe epilepsy and hippocampal sclerosis in one study were more likely to have celiac disease or gluten intolerance.

Gluten Sensitivity and Anxiety

According to studies, people who have anxiety disorders, including social phobia and panic attacks, are more likely to have a sensitivity to gluten. After being on a gluten-free diet for one year, those with a gluten sensitivity reported a significant reduction in anxiety. Some people find that anxiety related to one's health is replaced with anxiety related to social interactions, particularly those that involve food. Adopting a completely gluten-free diet can be quite difficult in social situations in which food choices almost invariably contain gluten.

Gluten Sensitivity and Depression

Several mood and depressive disorders were studied, including major depression, dysthymic disorder (less severe, chronic type of depression), and adjustment disorders. Older people with a gluten sensitivity were more than twice as likely to have depression than those who did not have a gluten sensitivity. Those who have type 1 diabetes in addition to celiac disease may be more likely to suffer from clinical depression. Many described improvement in depressive symptoms after adopting a gluten-free diet.

Gluten Sensitivity and Schizophrenia

Studies indicate that children with schizophrenia who ate a milk- and gluten-free diet experienced a faster decrease in symptoms and about 1/3 experienced a return of symptoms if gluten were added back to the diet. Some adults in several studies experienced significant improvement in schizophrenia symptoms, some to the point of being able to discontinue medications after six months on a gluten-free diet. Some of those who were studied experienced return of schizophrenia symptoms after a challenge of a normal diet after being on a gluten-free diet.

Challenges of Researching the Topic

Research regarding gluten sensitivity is currently evolving as more specific tests are being developed to help identify those who are negative for celiac disease yet have a sensitivity to gluten; much of the research may not identify groups who are gluten sensitive without having celiac disease, which can complicate analysis of study data. To further complicate matters, a completely gluten-free diet is often hard to achieve as some restaurants may advertise foods as gluten-free that may have cross-contamination. Some countries, including the United States, may not have clear definitions and product label requirements regarding gluten, resulting in tedious research as many consumers have to contact manufacturers and inquire about gluten content on specific products. Even tiny amounts of gluten may lead to symptoms in those with celiac disease or gluten sensitivity.

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Sources
  • Abstract, Resistant Myoclonic Epilepsy Associated with Asymptomatic Gluten Sensitivity: A Case Report, Epilepsia, October 2005.
  • Garud, S. et. al. Interaction between psychiatric and autoimmune disorders in coeliac disease patients in the Northeastern United States, Alimentary Pharmacology & Therapeutics, April 2009.
  • Jackson, Jessica R. et. al. Neurologic and Psychiatric Manifestations of Celiac Disease and Gluten Sensitivity, Psychiatric Quarterly, March 1, 2012.
  • Pillay, Srini, Gluten-free Diets and Anxiety, Psychology Today, June 3, 2011.

Friday, May 30, 2014

Sports Circuit Training – Fitness for Those Who Get Bored Easily!

Fun Sports Workout - Photo by Massimo Finizio
Circuit training can be a great way to get a good workout, especially when participants are self-motivated and perhaps get bored easily. Many of my PE students benefit from practicing basic sports drills that incorporate hand-eye coordination, tips for proper technique, etc. before participating in a game. Circuit training is a great way to accomplish that goal without competing and can encourage a team building spirit.

This circuit training workout includes ten sports-themed stations and works best with at least ten participants and does not take a huge amount of set-up time. It helps to walk through each station and explain what to do at each before starting the workout.

Supplies
  • Timer (stopwatch, timer on cell/Smart phone, etc.)
  • 4 Bases (can substitute cones or other objects if necessary)
  • Cones
  • Basketball(s)
  • Whiffleball(s)
  • Football(s)
  • Soccer Ball(s)
  • Kickball(s)

Stations

With large groups, set up all ten stations and have participants rotate after six minutes at each station. It helps to have one ball for every two participants in each station. With smaller groups, set up the first five stations and have participants rotate after six minutes (60 minute workout) or 3 minutes (30 minute workout) at each station, then have all participants do each of the last five stations together, rotating as one big group. If you are short on time or want to have longer times at each station, split the workout by doing less stations.

Play upbeat music and stop the music when participants rotate to add variety. Check for safety issues and provide modifications for any participants who might need special accommodations.


Basketball Bounce Pass
·        Pairs face one another
·        Bounce pass back & forth
·        Start close and back up one step after 5 successful bounce passes in a row to add variety
Whiffleball Throw
·        Pairs face one another
·        Throw the whiffleball back & forth
·        Start close and back up one step after 5 successful passes in a row to add variety
Football Toss
·        Pairs face one another
·        Throw the football back & forth
·        Start close and back up one step after 5 successful passes in a row to add variety
Soccer Pass
·        Pairs face one another
·        Kick the soccer ball back & forth
·        Start close and back up one step after 5 successful passes in a row to add variety
Kickball Chest Pass
·        Pairs face one another
·          Pass the kickball back & forth
·        Start close and back up one step after 5 successful passes in a row to add variety
Basketball Dribble
·        Place 5 cones evenly spaced in a straight line
·        Split the group so that half are at each end (at least 2 on one side and 1 on the other side)
·        Dribble the basketball while weaving in and out through the cones
·        Hand off to the first person on the other side who repeats in the opposite direction
Whiffleball Base Run
·        All players stand in a line behind home plate
·        1st player runs or speed walks to 1st base
·        2nd player runs or speed walks to 1st base as 1st player runs or speed walks to 2nd base
·        Continue until player reaches home plate, where he/she will go to the back of the line
Football Lateral Pass Run
·        Place 4 cones in a long rectangular pattern with half of participants at one short end and half at the other
·        Participants work in pairs to pass the football laterally while walking or running to the other side & then hand the football to the next pair who will work in the opposite direction
Soccer Dribble
·        Place 5 cones evenly spaced in a straight line
·        Split the group so that half are at each end (at least 2 on one side and 1 on the other side)
·        Dribble the soccer ball while weaving in and out through the cones
·        Pass to the first person on the other side who repeats in the opposite direction
Kickball Kick
·        Place 4 cones in a long rectangular pattern with half of participants at one short end and half at the other
·        Participant at the front of the line kicks the kickball to the first person on the other side
·        After kicking, participant walks/runs to the back of  the line or add another exercise element by having the kicker to run outside the cones to the back of the line on the other side

Before beginning or changing any fitness routine, check with one's healthcare provider to determine safe exercises for you.

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Thursday, May 8, 2014

Have a Child on a Special Diet? What I Wish I Had Known Years Ago

Tips for Raising Happy Healthy Kids with Food Allergies - Photo by Southern Foodways Alliance
Whether a child has food allergies and/or sensitivities or perhaps a physical or mental condition that requires a special diet, parents often face many tough decisions and dilemmas as they begin to search for what works. The diagnosis might have been made quickly or perhaps the process is taking years, with many puzzle pieces still lying on the side because they do not quite fit at the moment. Regardless of the situation, I wish you the best as you travel down this often bumpy, curvy, uncomfortable, frustrating, and perhaps even scary at times road. Hang in there!

With three children who have multiple allergies and food sensitivities, I can honestly say I have probably run through every possible emotion related to special diet issues. It is a continuous process that may need tweaking multiple times, but hopefully you will find a new normal that will become the comfort zone.

Here are a few of the lessons I learned that I would like to share in the hopes of helping someone else.

#1 Examine a variety of ways to educate yourself

I remember reading a letter to an editor in a magazine in which a woman mentioned that her child had allergies to about five different foods. At the time I thought that mother must have been overly protective and that nobody could really be allergic to all that stuff. I am now humbled to be in a similar situation with my children. I have begun to gain a whole new appreciation for the complexities of special diets, but I also try to remember my thoughts before it hit home with me. When someone is rude or hurtful, I try to remind myself that I did not "get" it years ago either.

When I was in a 4-year nursing school program, we had a total of one paragraph that mentioned food allergies. That paragraph included one or two sentences on celiac disease. Frankly, I didn't give it much thought because I figured this might be something I would rarely see in clinical practice. I was wrong. The incidence of reports of food allergies in children has risen 18% from 1997 to 2007, affecting about 1/25 children (4%) with numbers rising. These children also tend to have a significantly higher incidence of asthma and other allergies.

I had a lot to learn and am still learning years later. Once we began to suspect food as a culprit, the physician had very little specific information for us, so he referred me to a nutritionist. Each idea I tried as a result of that meeting was a total disaster. Although mainstream healthcare professionals are more educated now than they were years ago, they may not have all the answers. Children who have one food allergy or sensitivity may have or develop additional allergies and sensitivities. What worked one month may need more tweaking in future weeks.

I have found it very helpful to communicate with other people who are experiencing similar diet-related issues. They are often willing to share what has worked and failed for them, along with helpful, specific suggestions. Books, magazines, web sites, and cookbooks with a focus on special diets may provide a wealth of useful information. Some of that information may be helpful and timely. Glean what you can. A lot of knowledge comes through trial and unfortunately a lot of error.

Food labels are improving, but they have a long way to go. Although the top eight food allergies are identified, many of us must engage in time-consuming research just to determine whether or not an item is safe for our children. I have been known to call manufacturers in the grocery store while shopping for ingredients if their labels are not clearly marked. Unfortunately, some manufacturers do not provide an immediate answer or have phone trees that are so branched that you might feel comatose before you ever manage to get connected with someone who knows the answers to your questions.

Educating your child regarding his special needs and encouraging him to help with food preparation can empower him to advocate for himself if needed and to help him hone life skills for the future. Many people learn best by actively participating. Learning about how to find safe foods is an important skill to learn.

#2 Share your knowledge with others

Arm yourself with a list of what the child can and cannot eat and a specific plan for ensuring that she is safe. Creating a computer document can be very helpful if changes need to be made. Ensure that those caring for your child, including teachers, daycare workers, those who work in before/after school programs, gym childcare, religious child programs, etc. are educated about any special needs related to the diet and have a clear plan in place.

Ensure that this information is properly communicated to those who need to know. If you would like to be notified ahead of time if special food will be served at a school party, for example, discuss how to alert other parents of the need to give prior notification before bringing in food. Have a clear plan A and a plan B if the original plan is not followed. Don't be shocked if neither plan A nor plan B is followed in your absence, but be prepared to calmly and professionally educate those special needs again if necessary. You may find it helpful to develop a 504 plan, if appropriate, if your child is school-aged.

Verbalize your needs – very few people are adept at reading minds accurately. Your children will learn how to verbalize their needs by watching you in those early years.

#3 Explore various ways to find specialty foods

After arming myself with a wealth of information about special ingredients and recipes, I felt much more sure of myself...until I realized that few to none of our local grocers actually carried those ingredients. I had never even heard of Whole Foods or Trader Joe's at that time. The internet does make searching for hard-to-find ingredients much easier. Some people order specialty food online. A few small grocers may be willing to special order a case at a time, and you might look to local farmers who sell foods that are safe for your child. Having a network of friends who need the same items might be particularly helpful if you can split the cost of a case.

It helps to plan ahead and keep the specialty staples on hand at all times in the event that you need to make something at a moment's notice. Consider storing those extra quantities in airtight containers, and rotate them out to ensure that your ingredients are fresh. Having a ready supply of specialty foods, cooking supplies, necessary medications, and a backup power supply in one specific location can be a huge help in the case of a natural disaster in which you need to evacuate your home unexpectedly. Many emergency relief organizations may not have specialty ingredients and allergy-friendly foods immediately available, making a stressful situation even more stressful.

#4 Be prepared to have increased expenses

One might think if you leave out an ingredient that a food item would cost less...but that is usually not the case when purchasing specialty food items. Sometimes it seems as though for everything left out of an item, you could just add another dollar to the price. If you do not have to purchase specialty foods, this might be a reason to stand up and rejoice! If you have to make those high-priced purchases, I feel your pain.

The increased price of food is only a part of the added expenses. Add to that physician visits, special medical equipment and medications, special camps, extra time off work, the possibility of a career change or relocation due to medical needs of the child, and the expenses can skyrocket. According to some sources, the average cost related to food allergy is over $4,000. Keep in mind that children are priceless. You may need to repeat that to yourself in the check-out line.

#5 Love and encourage your child

Although discovering food allergies and sensitivities and making appropriate adjustments may be a huge turning point toward a healthier and happier way of life, not everyone else will embrace those changes. It helps to have a thick skin, to find healthy ways to vent, and to recognize each child's special qualities, strengths, and interests while encouraging each child to enjoy life and to interact well with others. Avoid the tendency to shower the child with special needs with loads of attention at the expense of siblings who may feel less loved and appreciated. Nobody said being a parent is easy.

As others become aware of the special diet, prepare yourself for a wide variety of reactions, from the caregiver who decides to sneak food to your toddler to the person who gives you a big hug and asks what she can do to help when she sees you are having a bad day. You and your kids might have to deal with bullying or you may discover that kind friend who wants to purchase something special that your child can actually eat for the Valentine's Day exchange. You might encounter those who say something like "Oh...so you are STILL doing that weird diet thing?" or remarks that maybe you didn't let your kids play in the dirt enough to a friend who comes to you asking for advice about her own child who seems to be experiencing food-related sensitivities. Ironically some of those people may be the same person as he or she begins to learn more about those special health concerns in a more personal way.

#6 Find the blessing in the situation

Every situation is different. Some children may outgrow allergies or medical conditions while others may experience years of tests, treatments, and special needs. Changing one's lifestyle just might have some unexpected good qualities, even if the good in the situation is hard to recognize. I have gained more empathy and have learned to communicate more effectively in the hopes that my kids will learn to stand up for themselves with grace and professionalism.

If you are traveling the road of a special diet in the family, don't give up! Keep evaluating what works and what does not work and continue to move forward. Hang in there – you are not alone. Be patient. Be kind. Find what works and continue moving in a positive direction!

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