What Is A Dull Heart?

Professionalità

The professionalism is the content, skills and professional character of a work . Professionalism also identifies the professional, one who as a result of proper preparation and training, uses his knowledge to do their work, disseminating and honor their profession and who has taught it to him.

In the health sector in general and with regard to the operating room in particular, a high level of professionalism riduce di molto il numero e la pericolosità degli errori e delle inadeguatezze e, di conseguenza, aumenta la sicurezza del paziente.
La professionalità racchiude la consapevolezza, da parte del professionista, delle proprie capacità e potenzialità, ma soprattutto della propria responsabilità.

Responsabilità
Nel dizionario Garzanti è testualmente affermato :
- Responsabilità : o l’essere responsabile o l’essere nella possibilità di dover rispondere degli effetti (benefici o dannosi nda) derivanti dalle altrui o proprie azioni
Alla voce responsabile del medesimo dizionario è affermato :
- responsible: it is he who is conscious of its responsibilities

The two terms make clear that those who act consciously and with recognized responsibility, for better or for worse, is in the position of having to answer for what he does and says.
is not responsible for those who are not aware of the responsibility addossategli (a figure that does not care medical acts without their knowledge, can not be held responsible for actions committed), who is compelled by force or blackmail to actions of any kind and outside of its recognized responsibilities.
also delegate responsibilities to others, however, does not negate the responsibility of the delegate himself.

The concepts of Accountability and Responsible recall three other concepts related to the performance of its shares, which can be completed with inexperience with recklessness or negligence .

inexperience

The incompetence involves the commission of actions and functions for which you have not completed the appropriate training through which the professional knows all the possible implications of their actions and possible solutions in the face of known problems.

imprudence imprudence entails the commission of actions and functions without compliance with the approved rules of prudence and common sense to avoid, if properly observed, damage or casualty or hazard generic borne by the person to whom these actions and functions.

Negligence Negligence prefigures commit acts harmful and dangerous being aware of such potential damage and danger. It's about doing things voluntarily that you know can be dangerous and harmful.

The inexperience is a less serious condition, while neglect is the most serious form of behavior. It should not be forgotten, however, it is not always possible to hide behind their own inexperience, to justify any harm done to a patient during the exercise of its welfare functions.
fact that a nurse uses equipment that does not know and knows he does not know well, makes negligent act. Deny, that is, its status as a novice and use something that does not know.

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L’Area Critica

E 'defined Critical Area that sector health professionals in which the patient is in particular danger of life, indeed the vital conditions of the patient are critical and therefore require intensive monitoring and therapy and constant. The Operating Room
is part of the problem areas but, diversity of Intensive Care, 's . and Neonatal Pathology , in which the patient is in critical condition for pathological event random and however difficult to assess in the operating room the plight of the patient are mostly caused deliberately in order to carry out acts of therapeutic or diagnostic purposes and this greatly increases the hazard ratio and the weight of responsibility.

For example, if a patient comes in ICU with a serious disease, it is difficult to know the cause, development, factors worst and best, the most effective therapeutic options, the possible dangers, and more. The critical point is pathological. You try to save his life and this can obiettivamente non essere possibile proprio per via della estrema gravità del quadro patologico e della sua casualità.

In Sala Operatoria il paziente giunge quasi sempre volontariamente, indotto a farlo dal medico che gli prospetta l’intervento chirurgico come soluzione preferenziale per la soluzione del suo quadro patologico.
Le sue condizioni non sono critiche in se, ma lo divengono per fare in modo che l’atto operatorio possa compiersi. La criticità, pertanto, è di tipo iatrogeno, ovvero, le alterate condizioni di salute del paziente sono frutto di azioni intraprese volontariamente da operatori sanitari (medici e non medici).
Mentre per le condizioni critiche del malato di Rianimazione di cui sopra, nessuno può sentirsi responsabile, per quelle del paziente in Sala Operatoria, tutti gli operatori sanitari che hanno operato su di lui, ne sono effettivi responsabili.
Naturalmente ci sono pazienti che giungono proprio da altre aree critiche e le loro condizioni divengono ipercritiche per risolvere i problemi di criticità primari. Altresì, un paziente operato può precipitare in condizioni critiche per via della finalità chirurgica e divenire un ospite di un altra area critica come la Rianimazione.

Stabilita quindi la differenza tra un tipo di criticità ed un altro e rimanendo in argomento di Sala Operatoria, la criticità può essere determinata no solo dal peso chirurgico dell’intervento o dall’anestesia, o dal quadro patologico, ma anche dalla preparazione, dalla professionalità e dal comportamento del personale sanitario.
Se quest’ultimo è ben preparato, educato, efficiente, equilibrato e adeguatamente riposato, il gradiente di criticità iatrogena può confinarsi ad un livello molto basso.
Viceversa il personale impreparato, svogliato, stanco, inefficiente ed inadatto potrebbe determinare un innalzamento di suddetto gradiente, per l’assai probabile commissione di errori, inavvertenze e inadeguatezze.
Ne deriva che la criticità delle condizioni del paziente e della sua sicurezza, durante la sua permanenza in Sala Operatoria ed escludendo i fattori patologici di base, il tipo di intervento e di anestesia, è inversamente proporzionale al grado di preparazione ed appropriatezza del personale sanitario.

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Delusione!

Avevo preparato la mia relazione sicuro di me, convinto delle mie capacità espositive. Contento di essere stato scelto tra tanti.
Mi sentivo abbastanza carico e convinto di vincere l'emozione. Io, che ho sempre creduto di poter mantenere il controllo di me stesso, nel discutere un argomento che trattava proprio di Controllo.
Controllo dell'ambito chirurgico...
Invece ho fatto una figura da pistolone!
Vinto dalla tachicardia, dalla proditoria scomparsa della memoria di una relazione che avevo scritto e ripetuto all'ossessione.
Ho farfugliato quattro cose, sudando come in una sauna.

Che figura!
Mi dispiace per chi mi ha dato questa opportunità, per chi ha ascoltato e non ha capito e per chi ha perso il suo tempo ad ascoltarmi.

Non capiterà mai più.

N.B.= Per chi non l'avesse capito, la relazione è quella relativa a questo articolo

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Sala Operatoria

Con questo primo articolo prende avvio una categoria poco trattata, la Sala Operatoria (SO), la vita al suo interno, i suoi ospiti, il lato oscuro e affascinante, le cose belle e brutte che la contraddistinguono.
Non è facile parlare di cose che la gente normale conosce attraverso le fandonie di ER e il Dr. House. Chi ha avuto la sua esperienza di Sala Operatoria be patient, it can tell the little that he knew or was able to glimpse, but remains silent on its patient lived in a place that you do not know practically nothing.
Yet the Operating Room is the pride of every hospital, the dark corner in the collective, the source of sensational news and terrible on alternate days.

But what is an Operating Room? First place is a
closed and this is the most important aspect of the whole topic. In this place you can not see anything, but nothing comes out mostly by it and even if something manages to leak out, it is always filtered or mutilated some truth or developed to provide an acceptable appearance.
In principle, the operating room environment is an illusion, the chamber of secrets of medicine.
A number of factors contribute to contain the secret, some necessary to the success of the functions and activities taking place within it, are necessary to avoid other people can see the dramatic side of what I would call "Violation of human beings."
violate a human being is an act of dramatic, sometimes creepy, cold, deliberate and carried out with scrupulous determination and, on reflection, there is not much difference in making the act of shooting at a person and surgery. It violates the integrity, if it materializes a purpose and is executed with clear determination, what changes are the effects, but the time that elapses between the first and the next moment, is a phase of extreme violence, where human beings are at the mercy of others humans.

Then the Operating Room is a place to high technology, tools and aids which are used only for cost and sophistication. This not only admirable and charming aspects, but also leading to evil sides to develop technology to enrich the users of such tools.
As with other areas of health, is not separated from the SO mode and the "trends" and, given the 'impressive amount of money that circulates around the hidden activities of the SO, materialize real acts of corruption and waste.

Then the SO, because of its impenetrability, is a place of unlimited power year, an arena where there are humans who fight against the lions, but lions biting to the prevalence and domination, forgetting that humans are often scratched and sometimes succeeds.
Beyond the instincts of the predator and its prey, the exercise of power is very often poisoned by envy, jealousy, revenge and blackmail to which the big fish is not content just to eat the little one wants to humiliate him.

The Operating Room view from a patient, it can show the side of the inscrutable fear of "no wake" , but for those who work inside the OS show the exciting side and put a room of people you bring into play every day to allow others to try to win their game with the disease.

I spent 20 years in a Operating Room, I believed and believe, I love my job, but I can not hide that he was a witness to events that, good or bad that they have been, and I have marked in I want to share with you.
A small attempt to raise awareness of what people often do not want to know.

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GESTIONE DELLO STRUMENTARIO NELLA COLECTOMIA LAPAROSCOPICA

of George Beltramme
Operating Theatre - Ceccarini Hospital - Riccione Rimini
Local Health

Presentation

Hello,
in these next 10 minutes I will show you how, in our reality, good organization shared between different shapes, together with a good management of surgical instruments - electronic and otherwise - has contributed to the optimization of time and actions, consequently, led to the making of:

• right hemicolectomy Left hemicolectomy
• = = =
• resection of rectum
• Amputation of the rectum (In Miles) =

Control all! In the surgery

control is a very important role and the nurse carries out a nearly constant and at different levels. In laparoscopic surgery
control is all .

1. control means Know
   Knowing the procedure, its stages, the maneuvers. Means knowing the material required, the instrument and its use
2. control means Provide
   predict the actions, the phases of the operation. It also means to think about potential problems to avoid them and the variables in order to anticipate
3. Control means not correct
   Where corrections lead to lose control and continuity of surgical
4. control means
   Optimize Optimize timing, functions, actions, use of the material and the instruments and the impact surgical patient. Optimize the learning and interaction between figures of different levels

The control is achieved with the attention and teamwork, with the accurate knowledge of the instruments, with the ongoing implementation and sharing .
In our experience, it came to control of a good standard that allows us to:

1. Packaging containers standard to the implementation of any intervention in laparoscopy
2. Prepare a single serving trolley, then restricting the control to a sterile area of \u200b\u200blimited size
3. Position and use the electronic equipment in a methodical and almost with a high level of nursing autonomy
4. Complete learning nursing figures contained in the very rapid and constant update
5. of procedural protocols

Question of Roles

control also means respecting the roles of nursing figures.

• Instrument - Arm
• Nursing Room (IDS) - The mind

In our reality, the instrumentalist has sold part of its importance for the nurse to leave her room. The latter was involved in the functions and tasks, making it clear the entire project director. If the instrument has the
local control intervention, the IDS has total control of the action, both before it is made, both during its development, and after. While in the traditional interventions
control was limited to the operative field and the involvement of the IDS was very content in Laparoscopic Surgery the operative field extends well beyond the sterile areas of the same and the involvement of the IDS is nearly constant and total, these being responsible for a variety of actions directly related to the intervention (position of the electronic instruments, patient positioning, lighting, recording media, etc.).
For these reasons we aim very accurate figures on the formation of government and a profound ability to control , which of course assumes that the same figure is able to play the role of tools and IDS.

Even before the instrument, which is the IDS must tune in to the surgery and the surgeon, in order to harmonize and streamline all procedures implemented in the field.

It is therefore worth remembering that the equipment:

1. subsidiaries and affiliates, together with the IDS, the preparation of materials necessary for carrying out the intervention
2. Consult the surgeon on the possible need for additional instruments to help completion of the intervention
3. Prepares the serving trolley
4. assists the surgeon in performing surgery and in maintaining the sterility of the operative field and that the

Nursing Room:

1. subsidiaries and affiliates, together with the instrument, the preparation of materials necessary for carrying out the intervention
Look
2. the surgeon on the possible need for additional instruments useful to the completion of surgery and / or the possible need for positional changes of the patient during surgery
3. Place, inspections, preliminary testing of electronic instruments and electro
4. Join correct positioning of the patient undergoing presurgical and check that the positional changes can be made safe for both the patient and the instruments
5. Inspect the instruments electronic / electro during surgery
6. make any multimedia recordings when they are absent fittings integrated
7. Restore the material and the instruments at the end of surgery, and check integrity and proper storage facilities

The

for carrying out an operation of laparoscopic colectomy, these four units are required:

1. Container surgical instruments
   Al order to respect the principle of control, we have observed that the packaging of standard containers (ie, acts on the completion of any variation of laparoscopic colectomy), allows a widely shared procedural standardization and a short training period.
   Our containers include specific tools for stage laparoscopic ed una dotazione minimale di strumenti per le fasi open dell'intervento. Eventuali ulteriori strumenti, vengono prelevati da altri container solo nel momento in cui, grazie al Controllo globale, venga suggerita la loro necessità. Questo fa si che possa essere circoscritto il numero di strumenti presenti sul campo operatorio, a favore di un controllo più lineare e semplice dell'intera dotazione, facilitando le azioni e le funzioni delle due figure infermieristiche coinvolte nell'intervento.
   Lo strumentario viene inserito nei container rigorosamente smontato e riconfezionato al momento della preparazione del carrello servitore. Ciò, oltre ad imporre una preparazione adeguatamente anticipata del suddetto strumentario, allows the instrument and the IDS to maintain control rigorous and clear of all surgical equipment
2. serving trolley
   In our experience, thanks to its accurate control phases of operations and a progressive optimization, has long been able to manage the entire operation without the need to prepare two separate trucks tools and aids.
   The truck is prepared to have two distinct areas: the area
   1. generic tools - where the instruments are set up for the open stage of colectomy
   2. the area of \u200b\u200blaparoscopic instruments - where the instruments are prepared for stage laparoscopic
   This architecture allows the tool to maintain tight control a restricted area of \u200b\u200bthe surgical field and not to lose control of its actions in areas not strictly adjacent to the operating field.
   
   
3. Column Video
   The video column is a complex, consisting of sections and components that increase the need for control exclusively by the IDS. This person shall:
   
   
   • Place the column - in agreed locations, ensuring accessibility to the surgical and anesthetic to the area, mantenendo il controllo sulla sua visibilità da parte del chirurgo operatore e della equipe chirurgica
   • Controllare e testare la colonna prima dell'intervento - procedendo alla verifica:
     1. del livello della CO ² nella bombola, o dell'effettiva erogazione della medesima in caso di impianti centralizzati
     2. dell'effettiva erogazione del gas, avviando l'insufflazione
     3. dei parametri di insufflazione (litri/minuto in avvio, pressione endoaddominale)
     4. delle ore di esercizio effettuate dalla fonte luminosa
     5. dell'effettivo funzionamento dei presidi di acquisizione immagini
   • Azionare le componenti della colonna in corso di intervento - procedendo per fasi:
     1. Accensione delle apparecchiature solo dopo che siano avvenuti i collegamenti delle cavetterie e tubolature, al fine di evitare traumi alle strumentazioni
     2. Azionamento delle strumentazioni di acquisizione multimediale
   • Variare le impostazioni delle componenti in corso di intervento - Incremento graduale delle prestazioni della strumentazione (incremento dei litri/minuto nella erogazione della CO ² )
   • Spegnere e ripristinare la colonna a conclusione dell'intervento - procedendo a spegnere le singole unità prima della disconnessione dei cavi e delle tubolature
4. electrical equipment
   These instruments are entirely the prerogative of the IDS must:
   1. Place to the appropriate electrical distance from the surgical field, while maintaining accessibility to its control panels and the same operating field
   2. Proceed to Checkout effective functioning
   3. Proceed to check the values \u200b\u200bof exercise
   4. Connect all the probes so that the cables are not subjected to traction or inadvertent disconnections
   5. Check and ensure that they are near streams of water (needed for washing endocardial)
   6. off at the end of intervention tools and place them in safe areas and protected

Intervention

The surgery colectomy (in any of the possible variations) involves the execution and control several steps and actions.
In principle, the following rules:

1. Prepare the instruments according to a protocol, avoiding customizations. This promotes the standardization and control by the whole team (including surgeons), as well as learning techniques from all staff. And 'the team doctor / nurse that customizes the intervention on the conditions / needs of the patient, not vice versa!
2. Place the instruments electronic / electro first entry in the patient's room, so that now define the spaces and routes to be used in order to allow staff to have a extended control over the entire operating room and to move freely and safely, without having to find the most suitable path and fast
3. Start intervention only when the conditions are more favorable to those control. It 'a principle that should the entire team and avoid delays and corrections
4. Follow the action closely, both by the instrument by which - above all - the IDS. The first will limit the control only surgical field and the second will maintain an adequate level of control widely over the surgery. It 's more simple and cost effective to maintain a medium value of continuously monitored, rather than recover the lost control
5. Check continuously and at regular intervals, all electronic equipment / electro. It 'a task that relates to both the figures involved in the act surgical nursing. It 's a control especially important in the positional changes of the patient, to prevent the cables and pipes subjected to traction or accidental breakage / disconnections.
6. Check insufflation of CO 2 especially in the early stages of the production of peritoneal chamber. In case of difficulty with anesthesia type, it can be remedied by the rapid withdrawal of inflation
7. Standardize the movements and actions in order to maintain control on the conduct of the operation, save time, effort and reduce the impact of chronological intervention on the patient.
8. Publish now stable at about changes in procedures and conventions regarding the conduct of the operation. Draw up immediately in writing and attenervicisi so repetitive and shared.

Conclusioni

E' risaltato in modo pressochè ossessivo il termine "Controllo" e non è un caso; perchè nulla deve essere lasciato al caso od allo svolgimento spontaneo degli eventi. Per quanto possibile, e per far si che le figure professionali infermieristiche traggano beneficio e interesse dal proprio operato, è necessario che abbiano il controllo su se stesse, ancor prima che su tutto il resto.
Affinchè chi non può controllare (il paziente), possa affidarsi al controllo di noi tutti.

Grazie

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Unlocking Ipod Touch 2G with 3.1 software

A poco meno di 3 settimane dalla Release del Firmware 3.1 i magnifici del DEV-TEAM sono riusciti a portare lo sblocco (jailbreak) dell'iPhone anche sul fratellino minore iPod Touch.

Al momento in cui scrivo la procedura è limitata agli iPod Touch di prima generazione 1G e di seconda generazione 2G. Restano quindi esclusi (per il momento) gli iPod Touch di terza generazione 3G ovvero quello da 8Gb e quelli da 32Gb e 64Gb che sono decisamente più appetibili data la velocità turbo di cui dispongono.

Limitazioni :

• Il sistema di sblocco si effettua con il programma PwnageTool 3.1.3 che è un software nativo per Mac OSx, sono quindi tagliati fuori gli utenti Windows.
• Per lo sblocco è necessario che l'iPod abbia gia un firmware 3.0 o 3.0.1 SBLOCCATO. Quindi gli iPod che si comprano adesso sono tagliati fuori per definizione.

Procedura:

1. Imstallare un Firmware 3.0 sbloccato utilizzando il metodo redsn0w di cui ho gia scritto
2. Scaricare il firmware 3.1 dal sito apple, consultare questa pagina
3. Scaricare Pwnage Tool e dopo averlo lanciato seguire le istruzioni per creare il firmware taroccato
4. Lanciare iTunes ed importantissimo SENZA mettere l'ipod in modalità DFU o RESTORE effettuare un ripristino scegliendo come file del firmware il nuovo 3.1 taroccato. (Premete il tasto Alt mentre cliccate su "ripristina")

Se tutto è andato bene nel giro di 10 minuti avrete un iPod 3.1 sbloccato. Altimenti installate il firmware 3.0 (sempre da iTunes) e iniziate da capo