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Newsletters > NIHE Talks Health January 2013
NIHE Talks Health January 2013

Jan 27, 2013

NIHE TALKS HEALTH—January 2013*
www.nationalhearted.com
*Look for the coupon at the bottom of this newsletter good for $30 off any BLS-add on class registered on our website www.nationalhearted.com . This is a BLS class taken on the same day that you are taking either ACLS, PALS, or NRP at any of our locations. Good for any registration placed before Feb. 10, 2012. We offer NO STRESS classes where you get your AHA card the day of the class, no waiting for it to be mailed to you, when you pre-register for the class.
In this issue:
1.    2013 Schedule of Classes posted on our website: www.nationalhearted.com Register NOW!!
2.   Start the New Year off right with our Heart Healthy Breakfast recipes
3.   2 New Online ACLS Prep Courses: “ECG for Everyone” and “Underlying Causes of Cardiac Arrest”. Get Instant CE when done ONLINE!
4.   FREE CE course: “Hypothermia and other Cold Related Injuries.”
5.   ACLS and PALS Prep courses. Get CE credit and be fully prepared for your ACLS or PALS class! See Dr. Stonebraker lecture live in our video based classes!
6.   January’s Coupon good for $30 off ALL BLS-Add on classes registered online in before Feb. 10, 2013. This is a BLS class taken on the same day that you are also, taking ACLS, PALS, or NRP at any of our locations.
7.   Get a 50% discount for putting together a private class at your location. We bring ACLS, PALS, BLS, or NRP to your location for the same price as our regular classes if you have 8 or more students. The organizer get 50% off the price of their certification just for organizing the class. Contact our program director at nihe@earthlink.net or call 800-773-8895 for details.
Heart healthy Breakfast Recipes for January 2013.
It’s January and many of us start off every New Year with resolutions to make healthy changes in our lives. Eating a diet rich in foods as they are grown is one of the best ways to lower your risk for cancer, heart disease, diabetes, osteoporosis, and many more lifestyle diseases. Here are a couple of recipes that I use regularly. For a recipe to become a favorite in our household it not only has to be nutritious but it also, needs to taste good and be easy to prepare.
Granola
7 cups quick oats 1 Tbs Stevia (I buy this at Trader Joe’s but you can find it in most grocery stores)
1 cup unsweetened coconut 1 cup slivered almonds (or any other raw nuts)
½ cup walnuts ¼ cup sunflower seeds
1 ½ tsp. vanilla 1 tsp salt
½ cup extra virgin coconut oil melted
½ cup water
Mix the dry ingredients. Combine the liquids and add them to the oat mixture. Spread in a thin layer on two large cookie sheets. Bake at 225 degrees F (do NOT bake at a higher temperature) for 1 to 1 ½ hours, stirring every ½ hour. Top with fresh fruit, soy or almond milk to serve for a complete breakfast. Store in an airtight container.
Brown Rice Pudding
2 cups cooked brown rice ¼ tsp cinnamon
½ cup chopped dates ¼ cup dried or fresh chopped pineapple
½ cup raisins    2/3 cup water or enough to blend
½ cup raw cashews 1 Tbs. honey, maple syrup, or agave syrup
Preheat oven to 350 degrees F. Mix rice, dates, raisins, cinnamon, and pineapple in a bowl. Blend cashews water, and sweetener until creamy. Add blended ingredients to rice mixture and combine well. Place in a well-oiled casserole dish and bake for 30 minutes. Serve warm with soymilk or pear cream.
Pear Cream
½ cup raw cashews ¼ tsp salt
1 tsp honey 1 qt canned pears in fruit juice
1 cup fruit juice from canned pears or water
Place nuts in the blender. Add pear juice and blend until smooth. Add remaining ingredients until the milk is smooth and thick. Chill. Great on fruit salad, breakfast cereal, or Brown Rice Pudding (above)
Is Your AHA ACLS, PALS, BLS, or NRP due to expire or do you need the full Provider class? We have lots of NO STRESS classes throughout California everyday as well as, the only AHA online BLS, AHA online ACLS, and AHA online PALS that will get you an AHA card. Upcoming ACLS, PALS, BLS, & NRP classes in: San Francisco, CA; Sacramento, CA; Loma Linda/Colton, CA, Torrance, CA, Fremont, CA; Walnut Creek, CA; Vacaville, CA; Culver City, CA; Pasadena, CA; San Jose, CA; Sherman Oaks, Ca; & Burbank, CA. Check out our website: www.nationalhearted.com for dates and times.

2013 Schedule of Classes is here!!
Go to www.nationalhearted.com and check out the Register Now pages. Click on your area and you will be taken to the registration page with all the new dates. Our calendar pages are still being updated but the Register Now pages are done for 2013!
Upcoming ACLS, PALS, BLS, & NRP classes in: San Francisco, CA; Sacramento, CA; Loma Linda/Colton, CA, Torrance, CA, Fremont, CA; Walnut Creek, CA; Vacaville, CA; Culver City, CA; Pasadena, CA; San Jose, CA; Sherman Oaks, Ca; & Burbank, CA. Check out our website: www.nationalhearted.com for dates and times. Always get your AHA card the day you complete the class.
Is Your AHA ACLS, PALS, BLS, or NRP due to expire or do you need the full Provider class? We have lots of NO STRESS classes throughout California everyday as well as, the only AHA online BLS, AHA online ACLS, and AHA online PALS that will get you an AHA card.
New!! New!! Online ACLS & PALS Prep Courses: We have 2 new video based prep courses for ACLS & PALS. These are the best courses we have ever seen. Get your CE cert as soon as you complete the class online. No waiting. CA BRN Provider #13886.
ACLS & PALS Course Prep Course #1 Underlying Causes of Cardiac Arrest H's &T’s covers the10 most common underlying causes of cardiac arrest and how to treat them. It integrates the Guidelines 2010 algorithms with the most recent science and treatment protocols. If you need a refresher before taking either ACLS or PALS this online video is the best course we have found. This course offers 3 hours CE. CA BRN Provider #13886
Register Now for "Underlying Causes of Cardiac Arrest, H's & T's" Click on Control and click on link to go to class.
ECG for Everyone ACLS & PALS Prep Course #2
This course teaches how an ECG pattern is generated, normal sinus rhythms, and identifying characteristics of the most common arrhythmias taught in ACLS and PALS. It integrates this knowledge with the Guidelines 2010 algorithms. This video based course we have found for teaching how to read ECG's and the basic ACLS algorithms. It works well as a stand alone prep for ACLS & PALS or partners well with "Underlying Causes of Cardiac Arrest" to give a complete prep for ACLS or PALS. This course offers 4 hours CE. CA BRN Provider #13886
Register Now for ECG for Everyone Click on Control and click on link to go to class

NEW ACLS & PALS Prep Courses Featured on our Website
If you need a little help preparing for your upcoming ACLS or PALS class check out our website, www.nationalhearted.com and click on the "Online CE" page for some great NEW ONLINE CE courses. ACLS Prep and PALS Prep cover how to identify the EKGs needed so that you can use the algorithms appropriately. They are great for not only preparing for your ACLS or PALS class but also, for follow-up to reinforce what you learn at the class. There are also, some great online courses about stroke.
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Do you need even more help to prepare for your ACLS or PALS class?
If you want a text that covers not only what to do during a code, check out the ACLS In Depth and PALS In Depth Home study Courses available at www.nationalhearted.com . Get CE credit for being the best prepared student in the class. Also, available, buy just the textbook as a reference text: ACLS Study Guide and PALS Study Guide. These textbooks have all details on why as well as what to do during resuscitation. Go to our product page Buy Books and Products Now to buy the ACLS and PALS Study Guides and go to the Home Study CE to get the ACLS In Depth and PALS In Depth home study courses good for Nursing CE. CA Provider #13886.
Earn Extra Money in Your Spare Time as an AHA Instructor
Nurses, Paramedics, EMTs, & Respiratory Therapists—Become an American Heart Association Instructor and teach for us in your spare time or start your own business teaching AHA classes. It is easy to get started quickly and be qualified to start teaching AHA courses for us. If you decide to start your own business we will be happy to mentor and assist you to be successful. Call us at 909-824-0400 or go online to Become an AHA Instructor to get started making good money in your spare time today.
January’s FREE CE Course   
National Institute for Healthcare Education Presents:
Hypothermia & other cold related injuries
Linnea Stonebraker RN, Ph.D.
Objectives
Upon completion of this course the student will be able to:
1.    Define three stages of hypothermia and their treatments
2.    Identify the patient populations at risk for hypothermia
3.   Identify and treat frostbit and chilblains
4.   Identify the changes in the cardiac, neurologic, respiratory, and metabolic systems as a result of hypothermia.
A state of hypothermia is said to exist when the core body temperature drops below 95 degrees F or 35 degrees C. Causes may include exposure to excessive cold or wind, immersion in water, wearing wet clothing, inability to produce heat, increased heat loss, and impaired thermoregulatory ability. 90-95 degrees For 32.2-35 degrees C is considered mild hypothermia. 82.5-90 degrees F or 28 to 32.2 degrees C is considered moderate hypothermia. Below 82,5 degrees F or 28 degrees C is considered severe hypothermia.
   Those at high risk for hypothermia include the elderly; the very young; homeless people; substance abusers; economically deprived people; alcoholics; outdoor recreation employees or outdoor enthusiasts; and people with chronic cardiovascular, endocrine, or musculoskeletal disorders.
   Many body systems are affected by hypothermia. In the cardiac system there will be initially, increased heart rate and decreased cardiac output. This will be followed by decreased heart rate and cardiac output with prolonged QT interval & J or Osborne waves (which are a positive deflection on the terminal 0.04 seconds of the QRS complex) that develops as the core temperature drops below 92-90 degrees F (or 33.3-32.2 C) and is fully prominent at 84 degrees F or 2.8 degrees C. Ventricular Fibrillation (vfib) can occur with stimulation and a further decline in core temperature to below 82 degrees F or 27.7 degrees C. Asystole presents around 75 degree F or 23.8 degrees C.
   The neurological system will show a subtle decrease in logical thinking, mood swings, and relative amnesia starting at 95 degrees F or 35 degrees C. Dilated pupils and progressive come will present between 88-80 degrees F or 31.1 to 26.6 degrees C. Progressive to severe paralysis will be seen between 87 -85 degrees F or 30.5 -29.4 degrees C. A flat EEG will be seen below 68 degrees F or 20 degrees C.
   The Acid/Base balance will show changes beginning in mild hypothermia. Respiratory alkalosis in initial compensatory hyperventilation stages, progressing to respiratory acidosis with decreasing respiratory rate & shallower efforts, then to metabolic acidosis as a shit to anaerobic metabolism occurs.
   Fluid and Electrolytes will show a shift from intracellular to extracellular spaces and diuresis will occur. Dehydration increases hematocrit and viscosity of the blood. There is a decreased resistance to bacterial and viral pathogens. The basal metabolic rate increases initially and rapidly declines; insulin release decreases; hypoglycemia results from fluid shifts and increased urine output.
   The treatment for hypothermia focuses on returning the core body temperature to normal and providing supportive care. The methods for rewarming depend on the severity of hypothermia. All patients should have wet clothing removed and given warmed inhalations if available. Mild hypothermia can be treated with passive rewarming such as warmed blankets, forced warm-air systems, warm fluids to drink, and a warmed environment. Moderate hypothermia requires active core rewarming with warmed IV fluids, warmed humidified oxygen, and warm peritoneal lavage. Severe hypothermia may require CPR for patients in non-perfusing rhythms while they are warmed using active core rewarming. This active core rewarming may including warmed IV/IO fluids, warmed peritoneal lavage, warmed thoracotomy/mediastinal lavage, or even warm bladder irrigations can be used. For severe hypothermia cardiopulmonary bypass or continuous arteriovenous rewarming (CAVR) with a Level 1 fluid warmer if available may be used. Warmed blankets should be avoided as they can cause burns due to vasoconstriction in patients in severe hypothermia.
   Atrial fibrillation is a common arrhythmia after exposure to cold weather. PVCs and vfib are frequently seen during sever hypothermia throughout the rewarming process. ACLS protocols should be followed.
   Afterdrop is the continued drop of the core body temperature after rewarming has been initiated. This is caused by the return of cold peripheral blood to the body core. The best way to tell if rewarming is effective is to continuously monitor core body temperature during the rewarming process. A return to normal consciousness and normal urine output are better indicators of effective rewarming than pupillary response, heart rate, or blood pressure. Core body temperature may be measured using rectal, esophageal, tympanic, and urinary bladder devices. It is important to remember that the rectal temperature measurements may be affected by the presence of cold stool, and the esophageal temperature measurements may be affected by heated inhalations or warmed gastric lavage.
   In trauma patients with abdominal vascular injury hypothermia is a major cause of morbidity and mortality. To prevent this these patients should receive warmed, humidified oxygen; all fluid infusions should be warmed; the patients head should be covered; and warming blankets and lights should be used when available.
   Frostbite is a local tissue-freezing injury. Ice crystals form during metabolic standstill, initially extracellularly, because of intracellular to interstitial fluid shifts. Ninety percent of frostbit cases involve the hand and feet, followed by ears, nose, cheeks, and penis. Superficial frostbite involves the skin and the subcutaneous fat and presents with numbness and clumsiness of the affected part. A throbbing pain develops with rewarming. The affected area feels soft on palpation and during rewarming flushes and turns red or deep purple. Deep frostbite involves the deeper structures and produces no pain or sensation. The affected area feels quite hard on palpation and may appear white or waxy. The skin appears dehydrated and becomes purple, blue, or blackish on rewarming. Blisters generally form in 24 to 48 hours; blisters and colors changes indicate repurfusions.
   Because most tissue damage from frostbite occurs during the thaw and refreeze cycle, rewarming should not be started until the body part can be warmed and not reexposed to the cold. Rewarming should be done in a warm (100.8 -106 degree F or 38.2 -41.1 degree C) agitated water bath. Elevate the affected area to limit edema. Rewarming activity continues until the body part appears pink or reddened. Debride nonhemorrhagic blisters, because they contain high levels of inflammatory mediators. Rinse with sterile water (90-95 degree F or 32.2 -35 degree C). Pat dry, and apply a nonconstrictive protective bulky barrier dressing. Tetanus prophylaxis should be given as indicated. Ibuprofen has been advocated for systemic and topical thromboxane inhibition.
Chilblains, also known as perniosis, is an inflammatory skin lesion that occurs in non-freezing climates, usually as a result of repeated exposure to cold (30 to 60 degrees F) and typically affects the hands and the feet. The vasoconstriction-vasodilation cycle leads to vasospasms, intense pain, and itching. The affected parts redden and are slightly edematous; nodules and ulcerations may develop. Immersion foot or trench foot is also, a non-freezing injury of prolonged exposure to wet cold (32 to 60 degrees F) either through actual immersion or wearing tight or wet socks and ill-fitting boots. Patients who wear waterproof footwear for an extended period are also at risk because of moisture from sweat. The affected parts appear cold, swollen, and dusky red or cyanotic in color. The complication is liquefaction gangrene rather than frostbite. For rewarming of either chilblain or trench foot it is important to use soft gentle handling of the affected tissue, and rewarm in water of 104 to 108 degrees F. Stop ingestion of caffeine or nicotine and administer drugs with antiplatelet activity and hydrotherapy two to three times daily.
Whether the cold related injury is systemic or localized it is important that rewarming measures been done appropriately in a timely manner. Even after the initial rewarming has been completed it is important to provide appropriate follow up care to limit tissue damage. The patient should be monitored until all effects from the injury have been resolved.
References
1.    Emergency Nursing Core Curriculum, edited by Kathleen Sanders Jordan RN, MS, RNP, CEN, CCRN.
2.   Emergency Nursing Procedures 3rd Edition, by Jean A. Proehl RN, MN, CEN, CCRN
3.   Triage Nursing Secrets, Polly Gerber Zimmermann, RN, MS, MBA, CEN and Robert D. Herr, MD, MBA, FACEP, CPE, CMCE.
4.   Emergency Nursing Secrets, 2nd edition, edited by Kathleen S. Oman RN, Ph.D., CNS and Jane Koziol-McLain, RN, PhD.

Post Test
1.    A state of hypothermia is said to exist when the core body temperature drops below:
a.    97 degrees F
b.    96 degrees F
c.   95 degrees F
d.   94 degrees F
2.    The best way to tell if rewarm is effective is to monitor
a.    Pupillary response
b.   Respiratory rate
c.   Core body temperature
d.   Heart rate
3.    The neurological system will show a decrease in logical thinking, mood swings, and relative amnesia at approximately:
a.    95 degrees F
b.   90 degrees F
c.   85 degrees F
d.   80 degrees F
4.    A flat EEG will be seen at:
a.    90 degrees F
b.   84 degrees F
c.   75 degrees F
d.   68 degrees F
5.    Mild hypothermia should be treated with all of the following except:
a.    CAVR
b.   Warmed environment
c.   Warmed blankets
d.   Warmed fluids to drink
6.    Some common arrhythmias that may be seen in patients with hypothermia are:
a.    Atrial fibrillation
b.   Ventricular fibrillation
c.   PVCs
d.   All of the above
7.    After drop is caused by the return of warmed peripheral blood to the core during rewarming.
a.   True
b.   False
8.    Severe frostbite is characterized by all of the following except
a.    Area is hard upon palpation
b.   Severe pain
c.   Waxy looking
d.   Blue or black color to the skin
9.    Chillblains can only occur after long exposure to below freezing temperatures.
a.    True
b.   False
10.    Trench foot should be treated by:
a.    Drugs with antiplatelet activit
b.   Immersion in warm water
c.   Hydrotherapy 2-3 times daily
d.   All of the above
To get 1 hours CE (CA Provider #13886) for taking this course you must fill in the following and email it to nihe@earthlink.net You must get a score of 80% in order to pass.
Date_________________________________________________
Name________________________________________________
Address______________________________________________
_____________________________________________________
_____________________________________________________
Email________________________________________________
Phone_______________________________________________
RN License #_________________________________________
1.______ 2.______ 3.______ 4.______ 5.______ 6.______
7.______ 8.______ 9.______ 10.______
Course Evaluation
1.    This course took me ____hours to complete.
2.   This course met my expectations:
a.    Completely
b.   Partially
c.   Not at all
3.    This course covered all of the stated objectives
a.    Completely
b.   Partially
c.   Not at all
4.    Possible topics for future courses that I would be interested in:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
January’s Coupon
Get $30 off of any BLS-Add on course registered online before Feb. 10, 2013. Enter the code: Valentine into the discount code field when you register online.
*The American Heart Association strongly promotes knowledge & proficiency in BLS, ACLS, & PALS & has developed instructional materials for this purpose. Use of these materials in an educational course does not represent course sponsorship by the American Heart Association. Any fees charged for such a course, except for a portion of fees needed for AHA course material, do not represent income to the Association.
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This site has a complete ACLS Algorithms knowledge library, hundreds of practice ACLS questions that mirror the actual ACLS exam, flashcards, dozens of video lectures, practice megacodes, complete ACLS pharmacology, megacode video simulator with lots of scenarios and much more!  You even get nursing CE for completing all the activities.  For less than $14 you can do a fast review or complete in-depth study.  This is the best ACLS Prep/Review site available today.

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*The American Heart Association strongly promotes knowledge & proficiency in BLS, ACLS, & PALS & has developed instructional materials for this purpose.  Use of these materials in an educational course does not represent course sponsorship by the American Heart Association.  Any fees charged for such a course, except for a portion of fees needed for AHA course material, do not represent income to the Association.