Educational needs of nurses in intensive care unit for poisoned patients

Poisoned patients are at risk of impaired ventilation in many situations. The purpose of this descriptive study was to investigate the impact of educational workshops on nurses' knowledge, confidence, and attitude in taking care of poisoned patients. This descriptive study was performed on 60 nursing staff in the intensive care unit [ICU] for poisoned patients in Imam Reza [p] hospital, Mashhad, Iran. Data was gathered by a researcher-designed questionnaire. Studied scales included perceived importance and novelty of educational meeting, matching with professional and educational needs, illustration of practical and knowledge weaknesses and strength and finally satisfaction in holding regular workshops annually. Two, half day workshops were held and various items were taught with various methods. The knowledge of participants was assessed by pretests and post-tests consisting of 12 items related to workshop topics. The impact of these educational meetings was evaluated and the results were analyzed by the SPSS software. According to the results, workshops improved awareness of nurses about their weakness and strength points, professional knowledge and their interest and attention; likewise all participants had the same opinion about a strong need to hold similar workshops more than once and preferably 2 to 3 times annually. It seems that short educational courses in small groups for reviewing the old data and recent findings in the context of critical care are useful in order to promote the knowledge and skills of ICU staff in taking care of poisoned patients.

effect of intravenous tranexamic acid on blood loss in lumbar hernial disc resection under inhalation and total intravenous anesthesia

Tranexamic acid is a synthetic antifibrinolytic drug that reduces bleeding and transfusion requirements in cardiac surgery and total knee arthroplasty. In this study, we evaluated the efficacy of the prophylactic tranexamic acid on intraoperative bleeding in patients undergoing lumbar hernial dics resection. Eighty patients in ASA class I and II were randomized into 4 groups. In group 1, anesthesia was achieved by total intravenous anaesthesia and also the administration of tranexamic acid. The other groups were group 2, anesthetized by total intravenous anaesthesia without tranexamic acid; group 3, anesthetized by halothane and the administration of tranexamic acid and group 4, anesthetized by halothane without tranexamic acid. Blood loss and surgeon's satisfaction were registered. The amount of blood loss in group 1 was 267.1 177.3 ml; in group 2: 656 411.6 ml; in group 3: 357 307.2 ml and in group 4: 550 406.7 ml. The least bleeding was recorded in group 1 which had a significant difference with groups 2 and 4 for which tranexamic acid was not administered. Blood loss in groups 2 and 4 was more or less similar with no significant difference. The surgeon's highest satisfaction was with group 1. No complications were recorded in the 4 groups. We concluded that administration of prophylactic tranexamic acid in patients undergoing hernial disc resection has the potential to reduce intraoperative bleeding and improving visualization of the surgical field especially when administered with total intravenous anesthesia

Combination of propofol and tranexamic acid as a protocol of providing optimal surgical condition in comparison with halothane during tympanoplasty

Tympanoplasty is accomplished under general anesthesia. One major drawback of general anesthesia is the increased bleeding encountered, which can interfere with optimal visualization of the microscopic surgical field. We performed a prospective study to compare the effect of combination of propofol and tranexamic acid as a protocol versus halothane on blood loss and the surgeon's subjective assessment of operating conditions during tympanoplasty. 40 patients undergoing tympanoplasty were randomly assigned to receive the mentioned protocol or halothane [n=20]. One surgeon, who was blinded to the anesthetic agent, performed all the operations, and assessed surgical condition, using a grading system of score as follow: 1. minimal or no bleeding 2. modest bleeding 3. significant bleeding 4. severe bleeding. Results were compared in the two anesthetic groups using appropriate statistical tests. There was no difference between the duration of surgery or the intraoperative mean arterial pressure when comparing the two groups. Mean bleeding scores were less over time with above protocol. 80% of the patients had a satisfactory visualization of the surgical field in protocol group, while it was 45% in halothane group. General anesthesia, based on the combination of propofol and tranexamic acid may have the advantage of decreased bleeding compared with conventional inhalation agents, making tympanoplasty technically easier and safer by improving visualization of surgical field. This anesthetic technique may have other applications in otolaryngology, when bleeding within a confined space frequently can interfere with visibility