The Salton Sea and its Significance to Birds

/in /by

American_white_Pelican-480x372

The Salton Sea is a massive man-made lake in the Imperial Valley, which has also proved to be a massive man-made problem that scientists and activists have yet to resolve. One side of the argument is to leave the Sea alone and let it dry up. The other side of the argument believes that no matter the monetary cost, we must address the problems that have occurred in or around the Sea that have caused a decline in health of the water, which in turn has caused a decline in the health of the many animals that now rely on the Salton Sea as a habitat, and if left to dry up will end up causing a decline in health for some residents of Southern California. In this paper I will address why I believe that no matter the cost, action must be taken to prevent the Sea from failing more than it already has.

“For millennia, the Colorado River filled and emptied lakes that predate the current Salton Sea.” (Zap, 2012). It was a seasonal lake that when floods would occur it would fill, and in the heat of the desert would dry up. In 1853 a Biologist named William Phipps Blake was in California’s Colorado Desert, he did some analysis of the soil in part of the Imperial Valley and determined that the soil was rich in minerals, and made the assertion that if water could be supplied permanently to the Imperial Valley there was a possibility for good agricultural production in the area. Because of his vision, in 1904 an irrigation canal was cut in the nearby Colorado River. Unfortunately, a levee broke in 1905 and for the next 18 months almost the entire contents of the Colorado River spilled into the Salton Sink forming a lake that is 35 miles long and 15 miles wide in the middle of the California desert (Payne, 2006). The lake was born from a disaster, but as time has gone on fish were introduced and salinity levels rose, the Sea has become a hotspot for migrating birds. After the levee was repaired, there were no natural inlets or outlets for the Salton Sea. Agricultural fields which are sustained by the same water that filled the Sea, have sustained the sea with the runoff. Without the runoff from the fields, the sea would have evaporated in the hot desert sun, but with the agricultural runoff, the sea has sustained its size. “The water flowing into the sea carries 5.2 million tons of salt a year, enough to fill a mile-long freight train every day. As a result, the sea is already 25 percent more saline than the Pacific Ocean and getting saltier every year.” (Cohn, 2000). This accidental lake that was not planned for or thought out by professionals is no longer able to provide the stability that a lake with natural inlets and outlets would. It has not been engineered to simulate a natural lake, and now it is posing health threats to aquatic, avian, and human life alike.

The Salton Sea provides a massive wetland for migrating birds. Wetlands play a vital role in the health and fitness of birds. They nest in the wetlands, some birds need a lot of space in order to nest and eat in a way that is beneficial to their species. That is why looking at the loss of wetland along these birds migration route is necessary when discussing the Salton Sea. It is estimated that in the 1600’s, there were 221 million acres of wetlands in the lower 48 United States (Lundmark, 2001). As the early settlers came to America they regarded swamps and wetlands as carriers of disease and a hindrance of development. People started draining swamps and wetlands in order to use the areas for agricultural land. In the 1849 Congress passed the Swamp Land Act which allowed for all swamps and wetlands in Louisiana to be dredged and drained. In 1850 the Act was made applicable to 12 more states (Watts, 2007). As of 2001, only 105 million acres of wetland remained (Lundmark, 2001). Two of the states most affected by wetland loss are California and Florida.  California alone has lost 91% of its wetlands. (ActionBioscience). With this dramatic loss of wetlands for birds to nest, eat, and recover in, the Salton Sea has become a place where millions of birds stop every year on their long migration along the Pacific Flyaway, which is one of four major migration routes that birds travel through as they migrate from North to South America and back again. With the immense loss of suitable habitat for these birds, the Salton Sea has become a very important and even vital place for birds.

The importance of the Salton Sea is clear; it is one of few remaining suitable places for migrating birds on the Pacific Flyway to stop. Another aspect of importance is the state of the Salton Sea itself. Because of its unnatural beginnings, the lake has no inlets or outlets to flush out salts or take in fresh water. This means that the millions of tons of salts a day it receives from agricultural runoff remains in the lake. The Salton Sea has proven to be a disaster when it comes to the health of the fish, and the birds that eat them.  The agricultural runoff that flows into the lake carries large amounts of pesticides and salts, and the lake has limited oxygen due to it being mostly stagnant. The health implications of this situation came to a head in 1996 when 15,000 birds were stricken with type C botulism at the Salton Sea. It was discovered that the tilapia in the lake, which the birds were eating, making the birds sick. Tilapia has never been the culprit of passing the type C Botulism toxins to birds until this time (Meteyer, 2005). Botulism occurred because it is an unnatural place for water to be, and it is lacking the fundamental inlets and outlets of a healthy lake.

The debate over the Salton Sea has been ongoing for some 40 years. Some have suggested diverting the agricultural runoff to San Diego, and letting the lake dry up. In order to get the lake healthy again, pipelines need to be constructed either to Mexico, or to San Diego to bring lower salinity water into the lake. This would start a multi-billion dollar project. Some people believe that because the state of California is in one of the greatest recessions since the great depression, that fixing the problems are too costly and shouldn’t be done.

The other side of the argument is to use whatever means necessary to build pipelines from San Diego to bring in lower level salinity water into the Salton Sea. This would also give the sea a much needed flushing mechanism (Cohn, 2000).  Other ideas of how to reduce salinity are desalination plants, and sprinkler systems. There is another obstacle to these ideas because there are proposals that will go into effect in 2017 which will take the water which is now flowing into the sea, and divert it to San Diego to be treated as waste water there. This threatens the water levels of the sea. If the lake were to dry up, huge amounts of sediment, up to a mile deep, would start blowing across the Coachella valley in huge dust storms, the sediment is full of selenium and salts so this dust storm has the potential to be toxic. (Zap, 2012).

The history of the sea is as complex as the answer to what should be done now.  I care deeply about the ecological problems we have already created for the birds in the Pacific Flyway, as well as all wildlife that has to adapt to what humanity has done to their habitats. I understand the importance of leaving one of the only remaining wetlands large enough to support the millions of birds who use it daily intact. There is no way that allowing the Salton Sea to dry up and create a toxic dustbowl, which could potentially do harm to people and all other living things in Southern California, is a better option. Finances may be scarce, but the financial implications of relocating Palm Springs and dealing with the toxic clean-up are just as unfathomable. Leaving the birds high and dry will have other ecological implications for our earth. It will lend to the loss of vital habitat for hundreds of species of birds, many of which will end up in endangered status. Luckily, during the time I have been writing this paper, the United States Federal Government has approved a plan which, although still vague, lays out a plan for a 15 year restoration process. This is good for everyone. The more the Salton Sea is discussed and brought to the attention of those who can provide help, the less likely it is that real restoration for this vital and productive habitat will be put on the back-burner.

 

 

References

Cohn, J. 2000. “Saving the Salton Sea.” BioScience, 50.4: 295-301.

“Loss of Wetlands: How Are Bird Communities Affected?” Actionbioscience. N.p., n.d. Web. 01 Oct. 2014.

Lundmark, C. 2001. Keeping track of wetland restoration. Bioscience, 51(8): 696.

Meteyer, C. 2005. The impact of disease in the american white pelican in north america. Waterbirds: The International Journal of Waterbird Biology, 28(sp1): 87-94.

Payne, W. 2006. The salton sea: A selective annotated bibliography. Reference Services Review, 34(2), 316-321. Cohn, J. P. (2000). Saving the salton sea. Bioscience, 50(4): 295-301.

Watts, Raymond D. 2007. “Roadless Space of the Conterminous United States.”Science 316.5825: 736-38. Web.

Zap, Claudine. 2012. “Salton Sea: Is It Drying Up?” Yahoo! News. Yahoo!, 25 Apr. 2012. Web. 01 Oct. 2014.

ICU Delirium

/in /by

ICU Delirium: Nursing and Medical Staff Knowledge of Current Practices and Perceived Barriers
Delirium is a common problem in the ICU. It’s divided into three subtypes (hyperactive, hypoactive, and mixed delirium). It’s been known that delirium in the ICU is associated with prolonged hospital and ICU stays. It is also associated with an increased six month mortality rate. The Intensive Care Society recommends screening for delirium on a daily basis using a validated screening tool such as the CAM-ICU. Two thirds of cases could be missed if a validated screening tool isn’t used. This article is suggesting that there is a lack of knowledge on ICU delirium, the screening tools used to assess it and also that it is not screened for on a regular basis, partly due to perceived barriers to screening. A sample of 149 nurses and medical staff from three different hospitals were surveyed.
The results show that 44% of the respondents never received any training or education on ICU delirium and that 37% used a delirium screening tool. 51% said they did not use a screening tool. The rest checked off “did not know”. The majority of respondents said they knew about the CAM-ICU screening tool but did not use it on a regular basis. The second most recognized screening tool was the ICDSC (Intensive Care Delirium Screening Checklist). 52% said they screened for ICU delirium on a daily basis and 14% said they screened for it on a weekly basis and another 14% said they screened on a monthly basis. The ones that did not use a screening tool said they just observed for hallucinations, agitation, and confused patients.
Some of the respondents said they did not screen for delirium due to perceived barriers such as it was time consuming to complete, that it would take up valuable nursing and medical staff time. Some were also unconfident at detecting delirium.
This article also revealed that the nurses and medical staff had some knowledge of ICU delirium but the education they received was during school and not at bedside. They also found that the staff had a medium level of knowledge about the risk factors and complications of ICU delirium.
I agree with the article in that most of the staff at many hospitals lack education on ICU delirium. This article brings to light how serious ICU delirium is and how much training and education needs to be done. The CAM-ICU takes about 2-5 minutes and needs to be done at least on a daily basis, not weekly or monthly. The medical staff who do not use a structured validated tool to assess delirium confirms that many of the ICU delirium cases are missed or are identified as hyperactive (least common) when it should be identified as hypoactive or mixed.

Reference:

Elliott, Sara.  ICU delirium: A survey into nursing and medical staff knowledge of current practices and perceived barriers towards ICU delirium in the intensive care unit, Intensive and Critical Care Nursing (2014) 30, 333-338.

Delirium in Hospitals Overlooked

/in /by

If you’ve ever visited a family member or friend in the hospital it is an overwhelming emotional scene with the amount of machinery, loud constant noises, code calls over the intercom, and staff going in and out of the room. Not to mention the increase concern you have for your loved one, it can make anyone one in their right mind go delirious for that brief moment. Now imagine being one of those patients, critically ill, in bed most of the day where their physical, emotional, and mental abilities that have become altered. It came to my surprise that over 7 million Americans out of about 36 million of hospital admissions have been affected by cases of delirium each year (Boodman, 2015)

Delirium is a “sudden disruption of consciousness and cognition marked by vivid hallucinations, delusions, and an inability to focus”. It occurs suddenly and typically fluctuates throughout the day. One patient mentioned his delirium being like nightmares, although he knew that he was in the hospital and was sick he could not awaken from this terrible reality even after 3 years of being discharged from the hospital (Anthony Rossum, 2014). Some patients with delirium can be agitated and combative while other are lethargic and inattentive (Boodman, S., 2015), which makes me wonder, how many patients I have worked with in the hospital, whom had these horrible experiences and were silent about it. It wasn’t until recently that delirium was recognized or understood said Dr. Wes Ely from Vanderbilt University. Nearly, two thirds of Ely’s patients from the ICU reported signs of delirium, which led to his research and developed successful protocols in improving care and decreasing delirium in over six well known hospitals. The main interventions he utilized were the following ICU measures, in acronym: “ABCDEF,” which includes: Assessing and managing pain, Both Spontaneous Awakening Trials (SAT) and Spontaneous Breathing Trials (SBT), Choice of Sedation/Analgesia, Delirium Monitoring, Early Mobility and Family engagement which after these interventions studied over 50% of the drugs normally given for sedation were decreased or cut cold turkey, showing a 4 day decrease stay in the ICU, and decreasing mortality rate up to 15%.

If you get a chance, please watch the story of Anthony Russo delirium he explains in the video above, I am a loss of words what he experienced in the ICU. I believe it will help in opening the eyes of what can be reality for these patients we care for everyday, as well as identifying how the long term complications can even occur after their discharge home from the ICU.

The astonishing fact is researchers have estimated that about 40% of delirium cases are preventable, which surprises me that so many people are still experiencing this reality this last year 7 million cases, especially for those elderly whom are at higher risk due to their sensitivity receiving large doses of anti-anxiety drugs and narcotics.

Brain injury is preventable by lowering exposure to potent sedative meds and shortening the duration of delirium with assessment and monitoring with the ABCDEF method. Think about it, it costs more than 143 billion annually to care for such delirium patients due to their longer hospital stays and complications, more is needed to be done in these preventable cases to reach out to those whom needs us most. Educate yourself and follow such articles on assessment tools in detecting delirium in patients.

Here are some examples:

Confusion Assessment Method (CAM)

Delirium Assessment and Management

 

References:

Boodman, S. (2015). The Overlooked Danger of delirium in Hospitals. The Atlantic Article. Published by Kaiser Public Health News. Retrieved from: http://www.theatlantic.com/health/archive/2015/06/the-overlooked-danger-of-delirium-in-hospitals/394829/

Landro, L. (2011). Informed patient: changing sedation status quo in the ICU.  Health Blog, Wall Street Journal. Retrieved from http://blogs.wsj.com/health/2011/02/15/changing-the-sedation-status-quo-in-the-icu/

Liver Transplant

/in /by

IMG_20150923_173643191 IMG_20150923_173731729

Technology, Data and trending

/in /by

Smart Blood Pressure (SmartBP) BP Tracker

iPhone Screenshot 1iPhone Screenshot 4

This is a free App and what is does is, it keeps track of your blood pressure and allows for convenient storage and trending. The app is straightforward and easy use .This is very helpful if you have hypertension. Especially if you take your blood pressure a couple of times a day. You can keep a log of diet, exercise and medication. You can then plot on your trend graph when you did what. The great thing about this is you can send all the information to your Physician or Clinician. A couple of days before yours scheduled appointment and they can then go over the data and can make decision based on the recorded actual data. Scientist look for trends over time before making a decision as to the effectiveness of an intervention or deciding a different approach. Data is king when making any decision and this app allows you to store and share this data in a professional organized way.

 

Class board work

/in /by

IMG_0143IMG_0144IMG_0142IMG_0141IMG_0140IMG_0146IMG_0145-1IMG_0138

Pancreatitis

/in /by

What is it? inflammations of the pancreas

Who gets it? all ages, mortality rate increases with age, hx of alcohol abuse , hx gallstones, contraction of bacterial or viral disease

When should seek care? when mid epigastric abdominal pain arrises

Where is the location? pancreas, left upper abdomen, behind the stomach

Why does it happen? gallstones in ampulla of Vater obstruct the flow of pancreatic juice, backup of pancreatic juice or bile, alcohol increases pancreatic secretions leading to calculi which causes further obstructions

Treatments? NPO, pain management, managing exocrine and endocrine insufficiency, antbiotics, IV fluids

 

Liver Cancer

/in /by

Group Members: Rozelle Nebran, Bernadette Entezami, Duan Nguyen, Kara Mead, Jamie Allison

What is it?

  • Liver Cancer

Who gets it?

  • Chronic alcoholics, Hepatitis B and C, exposure to chemical toxins, cigarette smokers, toxic molds

When should you seek care?

  • When you experience continuous dull ache in right upper quadrant, epigastrium, or your back
  • Unexplained weight loss
  • Anorexia
  • Loss of strength
  • Anemia

Where (specific organ)?

  • Liver

Why does it happen?

  • combination of lifestyle, genetic factors, and environmental exposures

Treatment 

  • Surgical resection
  • Radiation therapy
  • Chemotherapy
  • Percutaneous biliary drainage
  • Liver transplant
  • Lobectomy
  • Local Ablation

 

Delirium in the ICU

/in /by

Delirium, a sudden onset and fluctuating cause of mental status often occurs in critical ill patients hospitalized in the ICU.  Memory and language difficulty, disorientation, paranoid ideas are part of delirium with an increase in morbidity and mortality in the elderly   (Svenningsen & Tonnesen, 2011).  ICU delirium can be divided in hyperactive delirium with symptoms such as restlessness, aggression, and psychomotor hyperactivity.  Hypoactive delirium portrays symptoms such as lethargic, and decreased psychomotor responds.  Mixed delirium consist out of hyper-and hypoactive delirium.  A study was performed in three ICU’s in Denmark with the goal to identify the correlation of delirium regarding analgesics, sedatives, opiods and age.  Intubated and non-intubated patients participated in the study.  In this particular study a correlation was detected between delirium and the length of stay in the ICU and an increase in mortality was observed in patients who died in the ICU with delirium.  40% of the patients in the ICU developed delirium. The usage of Fentanyl as an analgesic occurred to show also an increase in delirium.  In order to reduce the incidence of delirium in the elderly it is important to manage cognitive impairment, immobility, and sleep deprivation, visual and hearing impairment.

Delirium is frightening experience for the patient and needs to be addressed immediately. It is interesting to read 40% of patients in ICU develop delirium, a concerning number.  The article does not elaborate too much in the prevention of delirium which is disappointing.  As nurses we are the patient’s advocates and have a unique role in the prevention and detection of delirium.

 

 

References

(Svenningsen H Tonnesen E 2011 Delirium incidents in three Danish intensive care units)Svenningsen, H., & Tonnesen, E. (2011). Delirium incidents in three Danish intensive care units. Nursing in critical care, 16(4), 186-192.

 

 

 

 

 

The ABCDE approach to ICU Delirium

/in /by

Prior to discussion assignment, I was not aware of the condition know as ICU delirium. Watching the videos and researching articles gave me a better understanding of this condition associated with negative outcomes.

In the article, Preventing Delirium in the Intensive Care Unit, delirium in the ICU is characterized as acute organ dysfunction, which then manifest to both consciousness and cognitive disturbances and affects approximately 60-80% of ventilated patients and 20-50% on non-ventilated patients (Brummel & Girard, 2013). Risk factors for delirium in the ICU setting are sedatives, immobility, and sleep disturbances. Since, delirium is a multifactorial, a bundled approach known as the ABCDE approach has been proposed in preventing and reducing the duration of delirium (Brummel & Girard, 2013). This approach utilizes the Awakening and Breathing Coordination, Choice of sedatives, Delirium management, and Early mobility and Exercise components. Implementing these components has with positive improvements of outcomes, which include a decrease in the duration of mechanical ventilation, shorter length of stay in the ICU and hospital, and prevented adverse effects associated with critical illnesses, which can lead to delirium (Brummel & Girard, 2013).

Awakening and Breathing Coordination:
This component utilizes the ABC trial. This includes daily awakening trails that are coordinated with daily spontaneous breathing trials. This strategy has been shown to decrease the duration of brain dysfunction, patients were extubated 3 days sooner, discharged 4 days earlier from the hospital then the patients who received usual care, and a 14 % decrease in mortality rates (Brummel & Girard, 2013).

Choice of sedative:
There were three trials (MENDS, SEDCOM, MIDEX) which showed positive results when utilizing dexmedetomidine as a sedative as oppose to benzodiazepines, versed, and lorazepam. There was a reduction in the development of delirium, and a shorter duration in mechanical ventilation (Brummel & Girard, 2013).

Delirium monitoring and management:
It is important that all clinicians in the ICU setting utilize the CAM-ICU or ICDSC screening tools to monitor their patients. These screening tools assist with alerting the clinicians with identifying reversible and treatable risk factors (e.g. sleep deprivation, dehydration, immobility, visual and hearing impairment) associated with delirium (Brummel & Girard, 2013).

Early Mobility and Exercise:
Early physical rehabilitation resulted in positive outcomes for patients. One study showed that patients who received PT/OT therapy within the 72-hours of being intubated had a reduction in delirium, were discharged from the ICU 2 days earlier and discharged from the hospital 3.5 days earlier than patients receiving usual care (Brummel & Girard, 2013).

Even though, I do not work in the ICU and am not familiar with this common condition, I agree with the strategies this article suggests for the treatment and prevention of Delirium. The ABCDE approach utilizes evidence-based practice strategies that have shown improvement of outcomes associated with critical illness and ICU delirium. I think it is important for researchers to continue to find evidence based strategies that can prevent ICU delirium in patients. Also, it is important for clinicians to identify both modifiable and non modifiable risk factors that can be associated with ICU delirium on admission and include the patient’s family in the care of the patient and listen to their concerns and what they have to say about the patient’s history. Other than the patient, they are the best resource.

Reference:
Brummel, N. E., & Girard, T. D. (2013). Preventing delirium in the intensive care unit. Critical Care Clinics, 29(1), 51–65. Retrieved from: http://www.ncbi.nlm.nih.gov/articles/PMC3508697/pdf/nihms418369.pdf