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Environmental health

The study of environmental health is crucial to one’s understanding of the hazards and potential adverse effects posed by environmental agents and the extent to which environmental factors play a role in human disease. This foundation is essential for being an effective advocate for preventing environmentally caused diseases, identifying strong and weak protection policies, and for more advanced study of environmental health issues.

For this discussion forum,

Research the top environmental health concerns of your city or town, using government (.gov) websites or credible news outlets (such as the Los Angeles Times, New York Times, Atlanta Journal-Constitution), and post your “Top Five” list.
Include links to the sources in which you found your health concerns.
Place these concerns in what you consider descending order of importance (i.e., #1 is most important, #5 is least important).
What employment opportunities might pertain to these environmental health concerns?
Check out the following resources from Career Services to help you identify these opportunities:
Public Health Jobs
Professional Development from the APHA American Public Health Associate website.
You can also visit the career section of your state’s public health department website and search for relevant positions.
To what extent are these concerns relevant to the environmental health objectives presented in Healthy People 2030?

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Sample Answer

Invasive hemodynamic monitoring (IHM) is a valuable tool for assessing the cardiovascular status of critically ill patients. It can provide information about heart rate, blood pressure, cardiac output, and systemic vascular resistance (SVR). This information can be used to guide treatment decisions and improve patient outcomes.

Acute, Chronic, and Complex Care Patients

IHM is most commonly used in acute care settings, such as intensive care units (ICUs). However, it can also be used in chronic care settings, such as cardiac rehabilitation units, and in complex care settings, such as trauma centers and burn units.

Acute care patients are those who have a sudden, life-threatening illness or injury. These patients often have unstable hemodynamics and require close monitoring. IHM can be used to identify and correct hemodynamic abnormalities early, which can improve patient outcomes.

Full Answer Section

Chronic care patients are those who have a long-term illness, such as heart failure or chronic obstructive pulmonary disease (COPD). These patients may be more stable than acute care patients, but they may still benefit from IHM. IHM can be used to assess the effectiveness of treatment and identify early signs of worsening hemodynamics.

Complex care patients are those who have multiple medical problems or conditions. These patients may be difficult to assess using traditional methods, such as physical examination and vital signs. IHM can be used to provide more detailed information about the patient’s hemodynamics, which can help to guide treatment decisions.

Evidence-Based Treatment Plan

The specific treatment plan for a complex care patient with abnormal hemodynamics will depend on the patient’s individual circumstances. However, some general principles of treatment include:

Optimize preload: Preload is the volume of blood in the ventricles before they contract. Optimizing preload can be done by giving fluids, inotropes, or vasopressors.
Optimize afterload: Afterload is the resistance against which the ventricles must pump. Optimizing afterload can be done by giving vasodilators or beta-blockers.
Optimize contractility: Contractility is the force of the heart’s contraction. Optimizing contractility can be done by giving inotropes.
Risk Factors

There are a number of risk factors that should be considered when using IHM. These include:

Bleeding: IHM can increase the risk of bleeding, especially in patients who are anticoagulated or who have thrombocytopenia.
Infection: IHM can increase the risk of infection, especially if the catheters are not properly inserted and cared for.
Arrhythmias: IHM can trigger arrhythmias, especially in patients with underlying heart disease.
Systemic Vascular Resistance

Systemic vascular resistance (SVR) is a measure of the overall resistance to blood flow in the body. It is calculated as the difference between mean arterial pressure (MAP) and central venous pressure (CVP), divided by cardiac output (CO).

Normal values for SVR are 700-1200 dynes/sec/cm^5.

Differential Diagnoses for Altered SVR

An increase in SVR can be caused by a number of factors, including:

Vasoconstriction: Vasoconstriction is the narrowing of blood vessels. This can be caused by a number of factors, such as sympathetic nervous system activation, pain, and certain medications.
Increased blood volume: An increase in blood volume can increase SVR by increasing the pressure in the blood vessels. This can be caused by fluid overload, kidney failure, and certain medications.
A decrease in SVR can be caused by a number of factors, including:

Vasodilation: Vasodilation is the widening of blood vessels. This can be caused by a number of factors, such as parasympathetic nervous system activation, certain medications, and sepsis.
Decreased blood volume: A decrease in blood volume can decrease SVR by decreasing the pressure in the blood vessels. This can be caused by dehydration, hemorrhage, and certain medications.
Scholarly Resources

Marik, P., & Vachon, F. (2016). Invasive hemodynamic monitoring in the intensive care unit. Critical Care Medicine, 44(12), e783.

Rhodes, A., Grounds, M., Cecconi, M., & Vincent, J.-L. (2012). Hemodynamic monitoring and outcome in critical care. Chest, 141(6), 1338-1344.

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