scholarly journals Just the Facts: Postintubation sedation in the emergency department

CJEM ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 764-767
Author(s):  
Hans Rosenberg ◽  
Ariel Hendin ◽  
Erin Rosenberg
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Heart Rate ◽  
Respiratory Distress ◽  
Oxygen Saturation ◽  
Respiratory Rate ◽  
Video Laryngoscopy

A 67-year-old male presents to the emergency department (ED) in respiratory distress secondary to pneumonia. His oxygen saturation is 86% on a nonrebreather, respiratory rate is 32 respirations/minute, blood pressure 147/72 mmHg, heart rate 121 beats/minute, and temperature is 38.7° Celsius. The decision is made to intubate the patient. Fentanyl and propofol are used for analgesia and sedation, and rocuronium is used for paralysis. Using video laryngoscopy, the patient is successfully intubated, and now the ED team is awaiting your orders for the postintubation sedation care of this patient.

Just the Facts: The Five F's of Focused Echocardiography in Shock

CJEM ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. 655-657
Author(s):  
Paul Atkinson ◽  
Mandy Peach ◽  
David Lewis
Keyword(s):  
Lung Cancer ◽  
Blood Pressure ◽  
Emergency Department ◽  
Heart Rate ◽  
Systolic Blood Pressure ◽  
Oxygen Saturation ◽  
Respiratory Rate ◽  
Sinus Tachycardia ◽  
History Of ◽  
Focused Echocardiography

A 60-year-old female presents to the emergency department (ED) with a 3-day history of fatigue and mild breathlessness. She has a history of lung cancer. Her vitals indicate shock with a heart rate of 140 bpm, a systolic blood pressure (SBP) of 65 mmHg, a respiratory rate of 28, with an oxygen saturation of 90% on 100% a nonrebreather mask, and a normal temperature at 36°C. Her electrocardiograph (ECG) shows sinus tachycardia. She appears mottled and pale.

scholarly journals Just the Facts: Airway management during the coronavirus disease 2019 (COVID-19) pandemic

CJEM ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 440-444 ◽  
Author(s):  
George Kovacs ◽  
Nicholas Sowers ◽  
Samuel Campbell ◽  
James French ◽  
Paul Atkinson
Keyword(s):  
Emergency Department ◽  
Heart Rate ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Airway Management ◽  
Respiratory Distress ◽  
Oxygen Saturation ◽  
Respiratory Rate ◽  
Upper Respiratory Tract ◽  
Upper Respiratory

A previously healthy 42-year-old male developed a fever and cough shortly after returning to Canada from overseas. Initially, he had mild upper respiratory tract infection symptoms and a cough. He was aware of the coronavirus disease-2019 (COVID-19) and the advisory to self-isolate and did so; however, he developed increasing respiratory distress over several days and called 911. On arrival at the emergency department (ED), his heart rate was 130 beats/min, respiratory rate 32 per/min, and oxygenation saturation 82% on room air. As per emergency medical services (EMS) protocol, they placed him on nasal prongs under a surgical mask at 5 L/min and his oxygen saturation improved to 86%.

scholarly journals The Effect of Live Spontaneous Harp Music on Patients in the Intensive Care Unit

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Ann Marie Chiasson ◽  
Ann Linda Baldwin ◽  
Carrol Mclaughlin ◽  
Paula Cook ◽  
Gulshan Sethi
Keyword(s):  
Blood Pressure ◽  
Intensive Care Unit ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Intensive Care ◽  
Oxygen Saturation ◽  
Respiratory Rate ◽  
Rest Period ◽  
Underlying Mechanism ◽  
To Receive

This study was performed to investigate the effect of live, spontaneous harp music on individual patients in an intensive care unit (ICU), either pre- or postoperatively. The purpose was to determine whether this intervention would serve as a relaxation or healing modality, as evidenced by the effect on patient’s pain, heart rate, respiratory rate, blood pressure, oxygen saturation, and heart rate variability. Each consenting patient was randomly assigned to receive either a live 10-minute concert of spontaneous music played by an expert harpist or a 10-minute rest period. Spontaneous harp music significantly decreased patient perception of pain by 27% but did not significantly affect heart rate, respiratory rate, oxygen saturation, blood pressure, or heart rate variability. Trends emerged, although being not statistically significant, that systolic blood pressure increased while heart rate variability decreased. These findings may invoke patient engagement, as opposed to relaxation, as the underlying mechanism of the decrease in the patients’ pain and of the healing benefit that arises from the relationship between healer, healing modality, and patient.

scholarly journals Just the Facts: Diagnosis and management of small bowel obstruction

CJEM ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. 648-651
Author(s):  
Brit Long ◽  
Elisha Targonsky ◽  
Alex Koyfman
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Abdominal Pain ◽  
Small Bowel ◽  
Oxygen Saturation ◽  
Respiratory Rate ◽  
Small Bowel Obstruction ◽  
Vital Signs ◽  
Oral Temperature ◽  
Include Blood Pressure

A 63-year-old female patient presents with abdominal pain, vomiting, and abdominal distention. She has previously had a cholecystectomy and hysterectomy. She has had no prior similar episodes, and denies fever, hematemesis, or diarrhea. She takes no medications. Vital signs include blood pressure 123/61 mm Hg, heart rate 97, oral temperature 37.2°C, respiratory rate 18, oxygen saturation 97% on room air. Her abdomen is diffusely tender and distended.

Effects of a closed tracheal suction system on ventilatory and cardiovascular parameters

1992 ◽  
Vol 1 (3) ◽  
pp. 57-61 ◽  
Author(s):  
SA Harshbarger ◽  
LA Hoffman ◽  
TG Zullo ◽  
MR Pinsky
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Oxygen Saturation ◽  
Respiratory Rate ◽  
Arterial Oxygen Saturation ◽  
Control Mode ◽  
Arterial Oxygen ◽  
Acid Base ◽  
Suction System ◽  
Repeated Measures Design

OBJECTIVE: To determine whether patients ventilated in the assist-control mode experienced a change in oxygenation, respiratory rate, inspiratory:expiratory ratio, heart rate, blood pressure or acid-base balance when suctioned with a closed tracheal suction system. DESIGN: A quasi-experimental, within-subject, repeated-measures design was used. SUBJECTS: 18 patients ventilated on a fraction of inspired oxygen of 0.47 +/- 0.17 and 2.3 +/- 5.0 cm H2O positive end-expiratory pressure. INTERVENTIONS: Two suction passes were performed, with measurements at baseline, immediately after the first suction pass, immediately before the second suction pass, immediately after the second suction pass, 2 minutes after the second suction pass and 5 minutes after the second suction pass. No hyperoxygenation was used. RESULTS: Significant differences were seen over time for arterial oxygen saturation, respiratory rate and inspiratory:expiratory ratio. Arterial oxygen saturation decreased to less than 90% in four subjects (range 88% to 89%), with a maximum fall of 9%. No significant differences were seen for heart rate, blood pressure, partial pressure of carbon dioxide, bicarbonate, time to nadir (lowest arterial oxygen saturation) or recovery time. CONCLUSIONS: Subjects ventilated in the assist-control mode and suctioned with a closed tracheal suction system did not experience significant changes in cardiovascular or acid-base parameters when suctioned without hyperoxygenation. Although most subjects did not become desaturated, four subjects experienced desaturation at one or more intervals. To prevent desaturation, hyperoxygenation should be used before and after suctioning with a closed tracheal suction system.

scholarly journals Physiological Responses at Rest and Exercise to High Altitude in Lowland Children and Adolescents

Life ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1009
Author(s):  
Morin Lang ◽  
Guillem Vizcaíno-Muñoz ◽  
Paulina Jopia ◽  
Juan Silva-Urra ◽  
Ginés Viscor
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Oxygen Saturation ◽  
Respiratory Rate ◽  
Children And Adolescents ◽  
Diastolic Blood Pressure ◽  
Arterial Oxygen Saturation ◽  
Submaximal Exercise ◽  
Arterial Oxygen ◽  
Children And Adolescent

During the last decades, the number of lowland children exposed to high altitude (HA) has increased drastically. Several factors may influence the development of illness after acute HA exposure on children and adolescent populations, such as altitude reached, ascent velocity, time spent at altitude and, especially, their age. The main goal of this study was to evaluate the resting cardiorespiratory physiological and submaximal exercise responses under natural HA conditions by means of the six-minute walking test (six MWT). Secondly, we aimed to identify the signs and symptoms associated with acute mountain sickness (AMS) onset after acute HA exposure in children and adolescents. Forty-two children and adolescents, 18 boys and 24 girls aged from 11 to 15 years old, participated in this study, which was performed at sea level (SL) and during the first 42 hours at HA (3330 m). The Lake Louise score (LLS) was recorded in order to evaluate the evolution of AMS symptoms. Submaximal exercise tests (six MWT) were performed at SL and HA. Physiological parameters such as heart rate, systolic and diastolic blood pressure, respiratory rate and arterialized oxygen saturation were measured at rest and after ending exercise testing at the two altitudes. After acute HA exposure, the participants showed lower arterial oxygen saturation levels at rest and after the submaximal test compared to SL (p < 0.001). Resting heart rate, respiratory rate and diastolic blood pressure presented higher values at HA (p < 0.01). Moreover, heart rate, diastolic blood pressure and dyspnea values increased before, during and after exercise at HA (p < 0.01). Moreover, submaximal exercise performance decreased at HA (p < 0.001). The AMS incidence at HA ranged from 9.5% to 19%, with mild to moderate symptoms. In conclusion, acute HA exposure in children and adolescent individuals produces an increase in basal cardiorespiratory parameters and a decrement in arterial oxygen saturation. Moreover, cardiorespiratory parameters increase during submaximal exercise at HA. Mild to moderate symptoms of AMS at 3330 m and adequate cardiovascular responses to submaximal exercise do not contraindicate the ascension of children and adolescents to that altitude, at least for a limited period of time.

“Cardio - respiratory effects in children aged 6-12 years in their first dental visit

2018 ◽  
Vol 14 (1) ◽  
Author(s):  
M González
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Oxygen Saturation ◽  
Respiratory Rate ◽  
Dental Visit ◽  
Systemic Diseases ◽  
Waiting Room ◽  
Cross Sectional ◽  
Respiratory Effects ◽  
Before And After

Objetive: A descriptive, cross-sectional studywas performed to determine the cardiorespiratoryeffects in child’s first dental visit to thePediatric Dental Clinic at Alas Peruanas University,without the presence of any pre-existingcondition, such as pain, previous traumatic dentalvisits, use of medications and systemic diseases. Material and méthodos: To accomplish this, heart rate, oxygen saturation, blood pressure,body temperature and respiratory rate were recordedon 70 children before (waiting room) andafter first dental visit (operating room) using afinger pulse oximeter, digital sphygmomanometer,thermometer and a wristwatch.  Results:showed basal and postoperative body temperatureregistered 36° C and 36.1° C, respectively.Basal systolic blood pressure registered 96 mmHg and postoperative 93 mm Hg, and basaldiastolic blood pressure registered 63 mm Hgand postoperative 63 mm Hg. Basal oxygen saturationregistered 96% and postoperative 93%.Basal heart rate registered 88 bpm and postoperative85 bpm. Basal respiratory rate registered20 bpm and postoperative 20 bpm. The authorconcluded that significant cardiorespiratorychanges exist during first dental visit, existingsignificant differences in oxygen saturation andrespiratory rate recorded before and after dentalcare.

Sole Use of Dexmedetomidine Has Limited Utility for Conscious Sedation during Outpatient Colonoscopy

2005 ◽  
Vol 103 (2) ◽  
pp. 269-273 ◽  
Author(s):  
Przemyslaw Jalowiecki ◽  
Robert Rudner ◽  
Maciej Gonciarz ◽  
Piotr Kawecki ◽  
Michal Petelenz ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Side Effects ◽  
Oxygen Saturation ◽  
Respiratory Rate ◽  
Hemodynamic Instability ◽  
Treatment Regimens ◽  
Administration Regimen ◽  
Prolonged Recovery ◽  
Group D

Background This study evaluated the ability of dexmedetomidine to provide analgesia and sedation for outpatient colonoscopy, examining outcomes including cardiorespiratory variables, side effects, and discharge readiness. Methods Sixty-four patients were randomly assigned to one of three treatment regimens. In group D, patients received 1 microg/kg dexmedetomidine over 15 min followed by an infusion of 0.2 microg x kg x h. Group P received meperidine (1 mg/kg) with midazolam (0.05 mg/kg), and group F received fentanyl (0.1-0.2 mg intravenous) on demand. The assessment included measurements of heart rate, blood pressure, oxygen saturation, respiratory rate, quality of sedation/analgesia, and an evaluation of the recovery time. Results The study was terminated before the planned 90 patients had been recruited because of adverse events in group D. In all groups, negligible hemoglobin oxygen saturation and respiratory rate variations were observed. In group D, there was a significantly larger decrease in heart rate (to approximately 40 beats/min in 2 of 19 cases) and blood pressure (to less than 50% of the initial value in 4 of 19 patients). Supplemental fentanyl was required in 47% of patients receiving dexmedetomidine to achieve a satisfactory level of analgesia (vs. 42.8% of patients in group P and 79.2% of patients in group F). Vertigo (5 patients), nausea/vomiting (5 patients), and ventricular bigeminy (1 patient) were observed only in group D. Time to home readiness was longest in group D (85 +/- 74, 39 +/- 21, and 32 +/- 13 min in groups D, P and F, respectively; P = 0.007). Conclusions The use of dexmedetomidine to provide analgesia/sedation for colonoscopy is limited by distressing side effects, pronounced hemodynamic instability, prolonged recovery, and a complicated administration regimen.

Cardiorespiratory variables of the six-minute walking test of women submitted to bariatric surgery.

2014 ◽  
Vol 12 ◽  
pp. 158
Author(s):  
Fabiana Sobral Peixoto-Souza ◽  
Letícia Baltieri ◽  
Dirceu Costa ◽  
Camila Piconi-Mendes ◽  
Irineu Rasera-Junior ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Heart Rate ◽  
Oxygen Saturation ◽  
Respiratory Rate ◽  
Functional Capacity ◽  
Lower Limbs ◽  
Walking Test ◽  
Post Surgery

Introduction: It's known that bariatric surgery provides an improvement in the functional capacity and cardiorespiratory performance. However, most of these studies are limited to the distance walked during the 6MWT as a function of the functional capacity. Objective: The goal of this study was to evaluate the functional capacity and cardiorespiratory responses of women with morbid obesity, applying the six-minute walk test before and 6 months after bariatric surgery. Method: Prospective and observational study in which 14 women with morbid obesity submitted to Roux-en-Y gastric derivation were studied. The volunteers performed made the six-minute walking test (6MWT) before and six months after surgery gastric bypass. The distance walked and the blood pressure were registered as well as the subjective sensation of dyspnea and exhaustion of the lower limbs. In addition, the heart rate, oxygen saturation and respiratory rate were registered at the beginning, during and the end of the 6MWT. Results: An increase in the distance walked was observed 6 months post-surgery (588.92 ± 34.81m) as compared to the preoperative distance (516.28 ± 50.91m). Regarding to the cardiorespiratory variables, which included the heart rate (HR), blood pressure (BP), peripheral oxygen saturation (SatO2), respiratory rate (RR) and sensation of dyspnea, there was a decrease in the systolic and diastolic blood pressures during the recovery period of the 6MWT. There was no statistical difference in the other variables analyzed. Conclusion: the bariatric surgery and the following weight loss provided improvements in the functional capacity and blood pressure values during recovery from the exercise.

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