Cardiac Care and Informatics Technology

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The human heart is an amazing structure.  Serving as a pump for the approximately 5.5 liters of blood, it sends nutrients, oxygen electrolytes, and blood cells throughout the body and removes carbon dioxzide and wastes, beating approximately 60-100 beats per minute, every minute of our lifetime starting at about the fourth week after conception – all this without us ever having to think about it!  Technology has given us insight as to the normal and abnormal function of the heart.  When someone comes into the ER with crushing chest pain, we immediately think IV, O2, monitor – and proceed, if appropriate, with MONA – morphine, oxygen, nitroglycerin and aspirin.  The monitor can give us information on rate and rhythm, conduction, angina or AMI,  indigestion, anxiety or cardiac event. Without the monitor, we would just be guessing and perhaps delay treatment which would increase  progression of cardiac damage (i.e. time=muscle).  Other studies we can expect the physician to order are CBC, CMP, PT/INR, chest xray, possibly CT or prep for cardiac cath.  All these studies are based on technology and informatics with the promise of rapid retrieval of information, therefore preserving cardiac function and life.  Bedside charting via electronics in the ER can also help maintain cardiac function.  While waiting for labs and further orders, the nurse can remain at the bedside and not be fumbling through papers, therefore monitoring the patient and cardiac monitor constantly.  Some technological programs are checklists, which can also serve as cues for the nurse, plus allow easy access to information as needed.   If the MI progresses to Vtach or Vfib, the nurse is at the bedside and can initiate defibrillation immediately.  If it progresses to asystole, the nurse can start CPR without delay.  It is both calming and reassuring to the patient and family to have the nurse present continuously.  Prior to advances in technology, delay in care was a major contributing factor to cardiac loss and death.  While delays in care still occur, medical technology has definitely improved the outcome of cardiac events.  Many patients proceed to rapid cardiac cath with subsequent bypass surgery if appropriate and are discharged within several days with a much more positive prognosis than in the past.  While AMI is still a very serious health problem, informatics and technology have improved the outcome both in the acute phase and the post MI period.

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