Case Study Of Meningococcal disease Essay

Case Study Of Meningococcal disease Essay As a paramedic attending a patient it is important that all presenting conditions, signs and symptoms are adequately assessed using the tools available to paramedics. Along with the assessment a thorough history must be obtained to identify the main presenting problem so appropriate management and treatment can be implemented. Through the limited information provided it has been determined that the patient is presenting with signs and symptoms of meningococcal disease. Patient presentation of meningococcal disease will generally present with typical triad of symptoms such as fever, intense headache and altered conscious state. However one of the clearest and most important signs of meningococcal is the petechial or purpuric rash on the trunk and limbs. Other signs and symptoms of meningococcal are joint pain, photophobia, general malaise and lethargy, hypotension and/or tachycardia (Victorian Department of Health, 2009). Meningococcal disease has two main clinical presentations which are meningitis which is an inflammation or infection of the meninges and affects the cerebrospinal fluid within the subarachnoid space. The second presentation is septicaemia which is a systemic infection present in the blood caused by an infection which started in another part of the body (Harris, Nagy Vardaxis, 2006). Meningococcal disease can occur at any age with babies and young children under the age of five at most risk, it should be noted that susceptibility decreases with age however there can be a secondary peak of infection which occurs in adolescents and young adults aged between 15 24 years of age (Victorian Department of Health, 2009). As our patient is presenting with the classic signs and symptoms of meningococcal disease and is within the relevant age group for increased susceptibility it is important that as paramedics we treat the patient in accordance with the clinical practice guidelines keeping the pay off principle in mind. Meningococcal disease can result in death from cardiovascular failure or increased intracranial pressure. Treatment of meningococcal in accordance with Ambulance Victoria Clinical Practice Guidelines is to confirm meningococcal septicaemia by confirming a purpuric rash, headache, fever, joint pain, altered conscious state, hypotension and/or tachycardia. Ceftriaxone is to be given either intramuscularly or intravenously and is considered as a chemoprophylaxis for meningococcal as it has excellent activity against Neisseria species. Neisseria meningitides is the bacteria which causes meningococcal infection (Ambulance Victoria, 2009). Differential Diagnoses Encephalitis is a viral infection of the brain which may occur after an infection such as chickenpox, measles or influenza. Clinically there is little difference between encephalitis and meningococcal disease as they both present with a headache, fever and altered conscious state, however a patient with encephalitis will have seizures and paralysis and no purpuric rash. Further investigations at hospital such as a CT scan, lumbar puncture and spinal fluid analysis is required to definitively diagnose a patient with suspected encephalitis. (Cameron, Jelinek, Kelly, Murray, Brown, 2009) Subarachnoid haemorrhage a patient presenting with a subarachnoid haemorrhage will be complaining of a severe headache and may present with an altered conscious state with lucid intervals, neck stiffness and abnormal pupils. Syncope and seizures are common along with hypertension and bradycardia. As our patient is not presenting with seizures, abnormal pupils, hypertension or bradycardia then as paramedics we may be able rule out a subarachnoid haemorrhage however it is strongly recommended that further investigations at hospital occur to definitively rule out a subarachnoid haemorrhage (Caterino Kahan, 2003). Heat Stroke is when the bodys core temperature is above 40Â °C. A patient will present with an altered conscious state, high body core temperature, tachycardia and anhidrosis. A rash may be present due to the blockage of sweat glands. Based on the information provided our patient is exhibiting a fever and further investigation such as obtaining a detailed history of activities (prolonged heat exposure) and taking a tympanic temperature would need to undertaken to rule out possible heat stroke (Caterino Kahan, 2003). CVA/Stroke there are two classifications of stroke. The most common stroke is the ischemic stroke which occurs when cerebral blood flow is interrupted and the second most common is hemorrhagic stroke. The patient will present with a headache, decreased conscious state, progressive deficits such as parethesias, visual disturbances and numbness. Information provided indicates that our patient does not have progressive deficits however as paramedics we would rule out stroke by referring to using the FAST stroke assessment on the patient (Kahan Ashar, 2009). Anaphylaxis is a severe overwhelming systemic allergic reaction which presents with urticaria, angiodema, nausea and vomiting, respiratory distress, poor perfusion and altered conscious state leading to loss of consciousness. A thorough history from the patient would indicate any past history of allergies or anaphylactic reactions. As our patient has no past history and limited clinical presentations of anaphylaxis, then treatment of the patient should be in accordance with the main presenting problem (Caterino Kahan, 2003). Migraine/headache a patient suffering from a migraine will present with dull and deep pain which is exacerbated during movement of the head. The patients conscious state is not affected and the patient will often have a past history of the illness (Cameron et al., 2009). Assessment Tools Kernigs sign and Brudzinskis sign are to be used in conjunction with each other in determining meningism. However it should be noted that these signs are only present in 50% of suspected adult cases. Kernigs sign is performed with the patient lying supine with legs raised and the knee is to be extended. Failure to extend the knees is considered to be a positive sign of meningism due to the spasming of the hamstrings. Brudzinskis sign is when the head is flexed causing the thighs and knees to also flex. These signs are thought to be caused by irritable motor root nerves which pass through the inflamed meninges causing tension in the roots (Cameron et al., 2009). The Meningitis Research Foundation and the Joint Royal Colleges Ambulance Liaison Committee in the United Kingdom have developed an identification and management protocol of meningococcal septicaemia for ambulance personnel. The protocol starts with the assessment of airway, breathing, circulation and conscious state and then includes exposure and observation which is a simplistic secondary survey that primarily looks for a rash. The protocol states that the rash will be purpuric and will not fade or blanche if a glass is pressed firmly against rash, the rash will remain visible through the glass. Other signs and symptoms are given such as raised respiratory effort, tachycardia, poor capillary refill, vomiting/nausea, painful joint and limbs as often not all signs and symptoms will be present. Management of the patient with suspected meningococcal septicaemia in accordance to the protocol is as follows: High flow oxygen (assisted ventilations as required) Load patient and transport to nearest hospital. Give benzylpenicillin in transit (Infant 300mg, small child 600mg, large child adult 1200mg) Treat for shock during transport with a bolus of crystalloid (children 20ml/kg and adult 250ml bolus). Re-assess vital signs before repeating dose. It should be noted that no more than 3 boluses of crystalloid for children and a maximum of 2 litres for adults. Alert hospital of patient and give relevant history. Benzylpenicillin commonly known as penicillin G is used as it is an antibiotic considered to be the gold standard of penicillin to be used for the treatment of group B streptococci, non- ÃŽÂ ² lactamase producing staphylococci (Meningitis Research Foundation, 2008). Conclusion As paramedics this assignment highlights the importance of obtaining a thorough past history, current history and chief complaint, vital sign statistics and any other relevant information such as temperature, medications and secondary surveys to ensure that an accurate assessment of the patient can occur. A thorough assessment allows the paramedic to implement the right management and treatment for the patient until they reach definitive care and treatment at a hospital.

Cross Cultural Issues Essay

With hot topics like globalization and cross-cultural opportunities in the Asia Pacific rim, one might think it would be easy to research the implications of cross cultural issues. Rather, what the writer found was a significant discussion all around the periphery but little in-depth analysis. Discussion prevailed on the socio-economic and technological ramifications. Others resources focused on the language issues but little work was intuitively available on the subtleties of cross cultural issues one may encounter. Based on experience working in the Asia Pacific rim for two years as a PMO Manager, and training PM’s in many European countries, I decided that understanding international socio-cultural issues encountered in business is essentially at the heart of the issues companies will encounter in globalizing operations. Therefore, the writer will approach the crosscultural issues from a personalized understanding based on his many months of first hand mistakes in understanding cultural issues encountered in Asia Pacific. I will base my observations of cross-cultural issues on my experiences in working most closely with individuals from China, Hong Kong, Malaysia, Taiwan, Singapore, Japan, and India. Naturally there are more countries in the Pacific Rim but these mentioned provided the most opportunity for interaction. I want to also acknowledge the contributions of my wife, Helena Shiu Leung Chow Ballow, whom I initially met in Asia. Her wisdom, coaching, and meaningful insights on the many differences between Western and Eastern business and cultural practices were, and remain till this day, illuminating, helpful and daunting. Introduction Clearly we all understand to some degree the impact of cultural issues in communications. If nothing else, we have encountered situations where language was the barrier. But language may be the smallest of the issues when dealing with other cultures. Even when we pull out our Translation Guides or employ translators we may get pass some of the language difficulties. But from the writer’s experience, language is the least of the issues. Ingrained and systemic patterns of cultural behaviours can be so subtle as to completely deny meaningful communications. I found a really good example of just how easily cultural variances can cause communications problems. In this case the issues was â€Å"psychological filtering† of appearance or gesture. I would think is would also be easy for the reader to extrapolate this example into some experiences that may have encountered even in the West. Timofeev (2002), in an article in National Concepts and Globalization, provided the following example: â€Å"The idea or rather the hypothesis that underlies this paper was stimulated by a trivial chat with a friend of mine. Being a linguist by trade, Russian by origin and living in Finland, she is well aware of cross-cultural discrepancies and provided me with a curious example. It was a TV commercial of an international brand of Persil washing powder. Two young ladies were shown sitting in a crowded place, some restaurant or a cafe. One of the ladies notices quite a peculiar manner her friend has chosen to wear her wristwatch. It was placed above the cuff of her blouse. It turned out in a second that the only reason for placing her watch there was to cover some stain that regular detergents failed to deal with. Oh dear, you should use Persil instead! † So everything was straight and simple. But before that, when the attentive and thoughtful lady was describing her version of her friend’s peculiar manner of wearing her watch in Finnish (and I guess that the German, French and English versions were quite similar to that in Finnish), she said: â€Å"You are such a busy person. You have to wear your watch so that it can always be seen. † While in Russian the same lady made quite a different guess: â€Å"Your watch must be terribly expensive since you wear it so that everyone can notice it. † †¦ The Russian version, when translated into English, seems to be full of irony; it describes the lady’s manner as showing off. It would definitely undermine the main purpose of the ad, which was to provide a friend and those watching the commercial with thoughtful advice about using detergents. (p. 1)† To understand the issues we must start with a framework definition of culture. There are just too many definitions of culture, and even speaking the same language, we might get off tract pretty quickly. So, the writer did some research and decided on the following foundational definition of culture upon which to proceed. This is summarized by Kim (1999): â€Å"As the author himself confesses that there are 160 different definitions of the term ‘culture’ and picks up the definition of scholar Clyde Kluckhohn. According to him, â€Å"Culture consists of patterned ways of thinking, feeling and reacting, acquired and transmitted by symbols, constituting the distinctive achievement of human groups, including their embodiment in artifacts; the essential core of culture consists of traditional (i. e. historically derived and selected) ideas and attached values. † continued  © 2004, 2005 Dennis G. Ballow, Sr. , PMKT, Inc. , All Rights Reserved Globalization and Cross-Cultural Issues in Project Management, page 2 Another scholar, Triandis, presents a psychological perspective to the description. â€Å"Culture is a subjective perception of the human – made part of the environment. And this includes the categorization of social stimuli, associations, beliefs, attitudes, roles, and values individuals share. † Culture thus is a melting pot consisting of many things gathered over a period of time in which religion and language play a great role. (p. 228)† Now, with a definition of culture in hand, and a real life example to back up the idea, we will look at some relatively common cultural issues that impact communication, and thus, also have implications for Western corporations working in the Asia Pacific Rim. Cross-Cultural Issues and Implications I will present the materials in a table format such that it may be easier to digest. A simple summary provided by Bhagat et al (2002 provides a good stepping-stone for analysis of the cross-cultural issues: Cross-border transfer of organizational knowledge is most effective in terms of both velocity and viscosity when the type of knowledge (i. . , human, social, or structured) being transferred is simple, explicit, and independent and when such transfers involve similar cultural contexts. In contrast, transfer is least effective when the type of knowledge being transferred is complex, tacit, and systemic and involves dissimilar cultural contexts. (p. 204) Table 1: Cross-cultural Implications – Asian (China, Hong Kong, Malaysia, Taiwan, Singapore, Japan) and the West Cross-culture Dimension Language Implications Asian Perspective Not that complicated to the Asian. Foreigners should have more respect and learn the language. American Perspective English is the international business language so everyone should use it. Implications It is generally good practice to â€Å"localize† materials when feasible. Local words and expressions sometime just do not properly translate for English and may actually be offensive. A focus on team activities and collaboration vs. individual competitive activities is preferred. Individualism vs. Collectivism Strong Collectivism – The Asians depend more on groups or institutions to determine what they should do and emphasize loyalty to the group. They are more likely to cooperate with others to avoid risks and reduce responsibilities. Their value systems appreciate duty to the group and harmony among its members while pursuing personal goals is viewed rather negatively in Asia. The Asian person does not consider contracts as seriously as the Americans. They think there will always be changes and the contracts can be reasonably modified according to changes. Instead, they tend to pay more attention to relationships than contracts. Strong Individualism – They rely on their own view to determine what they should do. They tend to work alone and are reluctant to cooperate because their individualism and masculine culture view cooperation in general as a sign of weakness and place a high value on independence and control. Americans place greater importance on contractual safeguards than the Asian. They believe that contracts can ensure that their partners’ tendencies to focus on individual goals and aspirations do not interfere with their own individual goals and aspirations. Cooperation Nothing is cast in stone for the Asians. Authority is seldom, if ever, challenged. But when encouraged and trust is gained by the instructor, students will interact better, and challenge each other in a negotiative manner as not to create a †save face† problem. This takes much longer that you will ever plan – so take time to let the process work itself through. Asian employees seldom have the chance to really participate in the decision-making process. So activities requiring decisions may well take longer. continued

The Chronicles of Order Research Paper

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Should People Learn the Basic History and Fundamentals of...

Music is all around us, it is a part of our culture and for some it is a way of life! We all know how music is and how it should sound, but most people don’t realize that if it weren’t for previous musical eras, music wouldn’t sound like how it does today. Music classes after 6th grade aren’t mandatory and if people aren’t going into that field they don’t take music classes, so they don’t have the information anymore. It could only benefit a person’s brain to know some simple things about music. Seems how music has evolved over the decades, it seems obvious to know music’s history to understand our own music. Fundamentals should be tied in as well to help understand what music really is. People should learn the basic history and†¦show more content†¦Next is the 20th Century, which was the beginning of a new age. Variety became important and likable in all sorts of ways. Traditional ways of making music sound were in a sense thrown out the window. From 1945 through now is important and different now because Jazz came into the picture. This was a new type of music and people enjoyed it so much! Now, there are many other important things that happened during these eras, but the main point is that with each era as time moved on they put their own marks on the music industry. With all things considered, each era has evolved music into what it is today and every person should realize this and needs this knowledge to actually understand music and where it has come from and where it could lead Additionally with the basic history of music, there are the fundamentals of music as well that people should learn. With each era that was talked about they had put different fundamentals into music, which shaped it into what it is today. For example, during the Middle Ages, a major fundamental was the basso continuo. This was used throughout the different eras and is still used in songs today. The Renaissanc e Era came up with secular music and the lute. The Baroque Era used ternary forms and Ritenello form. A Concerto Grosso came to light during this era as well. The Classical Era changed and ended up having four movements in pieces. Sonata form was used in pieces. MusicShow MoreRelatedMusic As A Universal Experience1375 Words   |  6 Pages Music used as an Educational Tool in Advanced Higher Learning Tennessee State University Miller, Cordell 4/21/2016 â€Æ' Musical Minds â€Å"Musical is a universal experience. With few exceptions, all humans perceive musical pitch, tone, timbre, and harmony. We listen to music to relax, to help us think, to celebrate, and grieve. Our emotional responses to music have been noted in literature, poetry, and drama. The power of music to evoke an emotional response is used by advertising companiesRead MoreThe Modern Era1014 Words   |  5 Pagesproduce better work without any art experience. 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Normally, teacher provides everything prior toRead MoreThe History Of Music Education Essay1931 Words   |  8 PagesThe History of Music Education in the Americas The history of our schools is told beginning with the founding of our nation, moving through the common school movement, the arguments of the progressive era, and leading up to all of the modern acts made in the 21st century. Music education is a factor in the public schools, and it is rarely discussed as part of the history of our schools. Music education has been a part of our schools since the beginning and continues to better our students to this