ABSTRACT
Perioperative bleeding as conceived in this review refers to the clinical scenario whereby there is impairment of blood coagulation leading to prolonged or excessive bleeding, accompanying trauma or surgical exposure. Aetiology of bleeding disorders could be classified under the following subheadings: vascular disorders, Thrombocytopenia, Platelet function defects, Coagulation factors disorder(s). Primary haemostasis is initiated or triggered by the release of tissue factor at the site of injury leading to generation of small quantity thrombin, sufficient to activate platelets leading to the formation of prothrombin complex. The ability of FXa to activate FVII creates a link between the extrinsic and intrinsic coagulation pathways; leading to the generation of sufficient thrombin to convert fibrinogen to fibrin which organizes platelet plug to indissoluble clots (Secondary haemostasis) or thrombus formation. A balance is required between haemostasis, thrombosis and fibrinolysis to prevent perioperative coagulopathy. Whenever positive findings in the history and physical examination suggests an increased risk of significant bleeding, then it is more cost effective to carry out routine screening tests of coagulation. Specific coagulation tests used routinely has longer turnaround times and is not appropriate in the perioperative setting. Current recommendations for the prevention of massive bleeding in the perioperative setting; requires communication of appropriate treatment plans in a multidisciplinary setting, intraoperative monitoring, the treatment of underlying disorder, and replacement therapy with blood products. As point-of-care diagnostics becomes available in emergency areas, timely targeted intervention for haemorrhage control will result in better patient outcomes and reduced demand for blood products.
ABSTRACT
Background: Cardiopulmonary resuscitation (CPR) is an emergency intervention aimed at re-starting the heart in the event of cardiac arrest. In the state-under our investigation, there is no institution on the ground, providing CPR training and certification for health care professionals prior to study. CPR training or re-certification was not undertaken for at least the previous 2 years preceding this study. Therefore, the researcher felt the need to conduct the study to investigate the effectiveness of teaching CPR, on the knowledge of CPR among doctors in the state. Methods: The study used a one-group quantitative pre-test – post-test, quasi-experimental design. Participants were presented with 12 multiple-choice questions before and after the course. The correct responses (pre-test and post-test) were marked against standard answers and the final scores were recorded as percentages. The data generated, including demographics were entered into spss computer spreadsheet and analyzed. Main outcome measure: The difference between mean percentage scores on the pre-test and post-test. Further effectiveness (of the teaching program) was tested using ‘paired’t-test. Results: The mean percentage in the pre-test for all doctors was 45.43%, SD of 14.83% and the mean percentage in the post-test was 68.31%, SD of 13.83%. The mean percentage difference between the scores was 22.88%. The difference between pre-test and post-test score was statistically significant (t=-13.23; p<0.0001). Conclusion: The significant difference between the pre-test and post-test scores was due to the CPR education program. Therefore, the teaching program was effective in improving the knowledge of the participating doctors in 2010UK-CPR-GUIDELINE in a state.