The committee noted that this variation led to confusion among bedside nurses about how to monitor patients and communicate with physicians immediately after chest tube removal. Although other services did perform such a trial, there was variation in when the radiograph was performed after clamping the tube. For example, the trauma surgery service did not routinely perform a clamping trial before chest tube removal. The RCA committee found that there was considerable variation around chest tube removal practices between services. The hospital conducted a root cause analysis (RCA). The patient required tracheostomy and feeding tube placement, and she was eventually transferred to a long-term care facility with a poor neurologic prognosis. Despite these measures, the patient did not recover spontaneous circulation for more than 30 minutes and sustained severe anoxic brain injury as a result. The code team recognized that the arrest could have been due to a tension pneumothorax, reconnected the chest tube to suction, and eventually performed needle decompression. Unfortunately, the radiograph was not done, and the nurse became busy with another acutely deteriorating patient.Īpproximately 2 hours later (3 hours after the tube was clamped), the nurse found the patient unresponsive, in cardiac arrest with a rhythm of pulseless electrical activity. She noted that the radiograph had not yet been done but assumed that it would be done soon. The nurse gave the patient pain medication. The plan was to obtain a chest radiograph 1 hour after clamping the tube, and if the pneumothorax had not recurred, the tube would be removed.Ībout 45 minutes after the tube was clamped, the patient complained of acute, sharp pain radiating to her left arm. The consulting pulmonary team felt that the chest tube might be able to be removed, so they requested that the tube be disconnected from suction and clamped. Over the next 2 days, the patient improved, and repeat imaging showed reexpansion of her lung. The chest tube was connected to wall suction in order to promote reexpansion of her lung. She required urgent thoracostomy (chest tube) placement in the emergency department. The producers design a system that ensures efficiency and higher-grade materials that are more widely acceptable on the world market (less contamination) and can better deal with investments in technology, innovation in packaging/products and market development.A 30-year-old woman with a history of cystic fibrosis was admitted to the hospital for management of a spontaneous left pneumothorax (collapse of her lung). This way the producers deal with the processing and marketing of the materials, relieving municipalities of this burden. In provinces with EPR, such as British Columbia, the producers manage the recycling system, and it is consistent across the province. As a citizen, you can take action by contacting your MLA and voice your support for implementing an EPR program. The City works closely with Alberta Urban Municipalities Association, Edmonton Region’s Waste Group, Tri-Municipal Region Waste Group and the Recycling Council of Alberta, all of which have been very vocal regarding the need for a provincial approach. This policy approach is called Extended Producer Responsibility (EPR).Īt this time, Alberta is one of the only provinces in Canada that currently does not have a provincial EPR policy. The City of Spruce Grove has been active in advocating the provincial government to enable provincial policy that puts responsibility of the end-of-life of a product to the producer/manufacturer. drink cups, lids and straws – most paper coffee cups can go in the green organics cart)įrequently Asked Questions about Recycling fruit and vegetable bags, cereal box liners, pet food bags, plant pots) Plastic packaging from toys, food and household items (e.g. coat hanger, nails, broken household items) packaging material, meat tray, take-out containers) grocery bag, food wrap, re-sealable bags)
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