We are a us based investment firm that is looking to determine which manufacturers will likely be well positioned following adoption of new nfpa 1981 standard scheduled for june 2018. We aren't certain what positions these folks will be in - could be fire chiefs of large fire departments, senior people within manufacturers (msa, scott safety, draeger, avon) or those recently retired from similar positions.
Please include your experience in this area and your familiarity with the nfpa standards. Thank you.+5 Other Responses
Oil And Gas Standards
Need oil & gas standards exports. We would like to speak with people who have expertise in o&g standards, and problems that companies have in converting data to required formats e.G. Ppdm, pidx, witsml, etc.+3 Other Responses
Standard Of Care
I need a nursing expert regarding whether a nurse who adjusted an icd without taking a history, physical or vital signs, in an elderly patient with a history of two prior ischemic strokes violated the standard of care, failing to evaluate the patient's right sided weakness which was increasing perceptibly during the visit, and the patient died of a massive hemorrhagic stroke a few days later.
november 17, 2009 – first stroke – left brain
male patient age 67 found unresponsive at the rehab facility where he was recovering from an episode of cardiogenic shock. Patient was taken to nearby emergency room and received two administrations of tpa. Pre-treatment images showed several focal areas of dissection with clot resulting in loss of flow to the left pica and proximal pontine perforators, which resolved on treatment with relief of the patient’s “locked in” stroke symptoms.
Images revealed acute lacunar infarct on the left side within the posterior lateral thalamus together with a 2 mm focus within the left posterior centrum semi ovale white matter no mass lesions and no midline shift. Anatomical variations revealed both anterior cerebral arteries take origin from the left a1 segment, and the right a1 segment is atretic.
March 25, 2010 – second stroke – right brain
slurred speech beginning yesterday afternoon with left facial droop and left sided weakness. Images show acute infarct involving the right anterolateral thalamus, posterior limb of the right internal capsule and globus pallidus with subsequent left sided weakness.
History before these strokes includes uncontrolled hypertension, asthma, diabetes, coronary artery disease, chf, valve replacements, sleep apnea and coronary bypass graft. Ekg shows right bundle branch block and left anterior fascicular block.
No stroke specific treatment was provided due to the passage of time before admission.
June 22, 2010 – icd implantation
june 30, 2010 – first follow up visit
follow up of icd, not pacemaker dependent. Nursing note includes chief complaint, risk factors for cad, review of symptoms, past history, past cv history [see above], allergies, medications, vital signs, neurological/psychological work up and plan. No complaints at this time.
July 13, 2010 – urgent visit
this patient was sent to a different office of the midwest heart specialists due to his regular heart doctor’s office not having a nurse trained in icd interrogation in attendance on tuesdays. His wife was with him, and she observed increasing weakness on his right side during the time between arriving at the office and leaving there about half an hour later. Patient complained the device was shocking him, which the nurse recorded in her two line note as “c/o lv stim.” the nurse attempted to adjust the icd settings but ultimately returned them to their pre-visit settings. The interrogation printout shows an episode of pmt occurring same day at 1:44 p.M. And an earlier one at 4:02 p.M. On 7/6, but the nurse denies that this was “real pmt.” she took no history, relying instead on the earlier 6/30 chart entry, which only included a notation of “cva” to indicate the two prior strokes. She performed no physical exam and no neurological signs were checked. No vitals were taken by her. Patient’s right leg was so impaired he could barely walk out of the office, even with his wife’s assistance, when this busy nurse sent him home.
This visit was at a medical office building attached to a hospital. There were physicians in the office where the patient saw the nurse who could have seen him had the nurse requested it. The hospital had all necessary facilities for brain imaging with and without contrast, to find and identify a brain bleed if there was one, but no images were taken, the patient and his wife were sent home by the nurse.
July 17-19, 2010 – death from massive brain bleed
during the evening, the patient collapsed at home in his kitchen, and was rushed to the hospital er by ambulance where imaging studies showed an intraparanchymal hemorrhage centered within the left superior thalamus extending superiorly into the periventricular white matter and then extending into the left ventricle, with a small amount of blood crossing into the right ventricle. The bleed was so large by this time that the point or points of origin could not be identified. Dnr orders were given and comfort care was provided. By 7:28 the morning of july 18, the bleed had enlarged from 2.5x2.9 cm to 3.9x5.9cm. The patient died july 19 at 4:50 a.M.+21 Other Responses