Left Bundle Dranch Blockade and Atrial Fibrillation Essay

Left Bundle Dranch Blockade and Atrial Fibrillation - Essay Example In this paper, a case study of an older patient diagnosed with Left Bundle Branch Block (LBBB) and fast Atrial Fibrillation (AF) after a Total Knee Replacement (TKR) will be discussed, including the assessment, pathophysiology, treatment and management. Atrial fibrillation (AF) may result after a Total Knee Replacement (TKR) especially in older adults as a consequence of hypercoagulability and proinflammatory states associated with anaesthesia and surgical trauma, hyperadrenergic state related to perioperative stress, hypoxia, and hypovolemia leading to increased myocardial oxygen demand. Specifically, tachycardia as the heart’s compensatory mechanism to supply the systemic circulation leads to subsequent arrhythmias. In addition to AF, Left Bundle Branch Block (LBBB) also occurs as an associated condition in older adults above 75 years old due to vascular incompetency and stasis. Usually, people with AF experience palpitations, dyspnea, syncope, fatigue and other cardiovascular and pulmonary manifestations. However, the most important danger posed by LBBB and AF is the hemodynamic stagnation which promotes the thrombus formation and decreased cardiac output. The patient is an 83-year-old gentleman who had undergone a total knee replacement on August 16, 2011. His past medical history was significant for hypertension and arthritis. He reported to have past medical history of atrial fibrillation. ... He reported to have past medical history of atrial fibrillation. On the other hand, he stated independence on performing most of his activities of daily living including household chores without difficulties. He claimed not having episodes of orthopnea or paroxysmal nocturnal dyspnea. He was able to walk half a mile before becoming short of breath. Impaired with worsening arthritis, the involved knee caused immobility problems and extremely debilitating pain that occurred usually after an exertion. In a short walk, the patient’s knee was traumatically injured that prompted surgical intervention. The patient qualified for the operation after the panel of pre operative assessment was carried out. However, the patient manifested shortness of breath and chest pain two days after the operation. He was then transferred to an orthopaedic centre to manage the acuteness of the symptoms. Also, the patient was connected to a cardiac monitor and an electrocardiographic reading was taken. He was initially given Bisoprolol 2.5 mg but the condition showed no improvement. At that same night, the patient was transferred to Critical Care Unit of Royal Sussex County Hospital where blood studies were run through. His final diagnosis is Left Bundle Branch Block (LBBB) and fast Atrial Fibrillation (AF). Assessment Cardiac complications resulting from surgery are the result of an intricate and dynamic relationship among patient- related risk factors including the patient’s functional capacity, procedure-related risk factors, and the circumstances surrounding the operation. Preoperative patient evaluation begins with obtaining a detailed history and physical examination (Fleisher et al. 165). After the total knee

The Definition and Criticism of an Insanity Defense Essay - 1

The Definition and Criticism of an Insanity Defense - Essay Example Very few people plead insanity though and among those who plead it, a very minor part wins the plea. An important point here is people acquitted under insanity defense are seldom allowed to walk free. In almost all cases, the acquitted people are allowed to go to treatment centers and kept there until mental health officials determine they do not pose a danger to anyone. Criticism to insanity defense is a common phenomenon. Critics argue that some defendants misuse insanity defense, effectively faking insanity to win acquittals or less severe convictions. And often the trials involving an insanity defense get the most attention because they involve crimes that are peculiar within themselves. Nevertheless, studies suggest the overwhelming majority of defendants acquitted by reason of insanity suffer from schizophrenia or some other mental illness (Fersch, 2005). There could be several reasons for criticizing the insanity defense, including political, legal as well as humanistic. In USA, for instance, the insanity defense received harsh public criticism when, after the 1981 assassination attempt on Ronald Reagan by John Hinckley Jr., Hinckley was found not guilty by reason of insanity. Lot of people argues argued that his premeditation of the crime was undeniable proof of his sanity. Public criticism of the insanity defense has continued to grow with each high profile case. In conclusion, insanity plea is a poor excuse for serious lawbreaking, and should not ideally influence or ease the punishment. In a majority of criminal cases, especially murder trials, an insanity plea is used as a defense strategy aimed at saving guilty defendants from death penalty or serving time in prison. The accused usually pretend to be mentally ill and their lawyers use this as a way to confuse jury and influence their judgment. And then most of the accused, by reason of insanity,