scholarly journals Characterization of Long-range Aeromedical Transport and Its Relationship to the Development of Traumatic Extremity Compartment Syndrome: A 7-year, Retrospective Study

2021 ◽  
Vol 187 (1-2) ◽  
pp. e224-e231
Author(s):  
Joseph K Maddry ◽  
Alejandra G Mora ◽  
Crystal A Perez ◽  
Lauren K Reeves ◽  
Joni A Paciocco ◽  
...  
Keyword(s):  
At Risk ◽  
Lower Extremity ◽  
Compartment Syndrome ◽  
Long Range ◽  
Medical Center ◽  
Vital Signs ◽  
Long Distance ◽  
Aeromedical Evacuation ◽  
Temporal Features ◽  
Aeromedical Transport

ABSTRACT Background Military aeromedical transport evacuates critically injured patients are for definitive care, including patients with or at risk for developing traumatic compartment syndrome of the extremities (tCSoE). Compartment pressure changes of the extremities have not been determined to be associated with factors inherent to aeromedical transport in animal models, but the influence of aeromedical evacuation (AE) transport on the timing of tCSoE development has not been studied in humans. Using a registry-based methodology, this study sought to characterize the temporal features of lower extremity compartment syndrome relative to the timing of transcontinental AE. With this approach, this study aims to inform practice in guidelines relating to the timing and possible effects of long-distance AE and the development of lower extremity compartment syndrome. Using patient care records, we sought to characterize the temporal features of tCSoE diagnosis relative to long-range aeromedical transport. In doing so, we aim to inform practice in guidelines relating to the timing and risks of long-range AE and postulate whether there is an ideal time to transport patients who are at risk for or with tCSoE. Methods We performed a retrospective record review of patients with a diagnosis of tCSoE who were evacuated out of theater from January 2007 to May 2014 via aeromedical transport. Data abstractors collected flight information, laboratory values, vital signs, procedures, in-flight assessments, and outcomes. We used the duration of time from injury to arrival at Landstuhl Regional Medical Center (LRMC) to represent time to transport. We compared groups based on time of tCSoE (inclusive of upper and lower extremity) diagnosis relative to injury day and time of transport (preflight versus postflight). We used descriptive statistics and multivariable regression models to determine the associations between time to transport, time to tCSoE diagnosis, and outcomes. Results Within our study window, 238 patients had documentation of tCSoE. We found that 47% of patients with tCSoE were diagnosed preflight and 53% were diagnosed postflight. Over 90% in both groups developed tCSoE within 48 hours of injury; the time to diagnosis was similar for casualties diagnosed pre- and postflight (P = .65). There was no association between time to arrival at LRMC and day of tCSoE diagnosis (risk ratio, 1.06; 95% CI, 0.96-1.16). Conclusion The timing of tCSoE diagnosis is not associated with the timing of transport; therefore, AE likely does not influence the development of tCSoE.

Abstract 17258: The Relationship Between D-Dimer Levels and Deep Venous Thrombosis in COVID-19: An Analysis From a Quaternary Academic Medical Center in New York City

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mahesh V Madhavan ◽  
Aakriti Gupta ◽  
Behnood Bikdeli ◽  
Björn Redfors ◽  
Jessica Hennessey ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Medical Center ◽  
Academic Medical Center ◽  
Vital Signs ◽  
Doppler Imaging ◽  
Baseline Characteristics ◽  
The Relationship ◽  
D Dimer

Background: D-Dimer values may be elevated in hyperinflammatory or prothrombotic states and are frequently measured in patients with coronavirus disease 2019 (COVID-19). Many institutional algorithms and ongoing studies suggest using D-Dimer cutoffs to initiate anticoagulation. The relationship between D-Dimer levels and deep venous thrombosis (DVT) has not been extensively studied specifically in patients with COVID-19. Methods: We retrospectively studied patients hospitalized at our institution between 2/1/20-5/19/20 for COVID-19 who underwent lower extremity venous doppler imaging. After stratifying by presence of DVT, baseline characteristics, vital signs, and laboratory values were assessed. We assessed the association between peak D-Dimer levels and diagnosis of DVT during admission. Upper limit D-Dimer value for the hospital’s laboratory assay was >20 mg/dL. Results: Of the 2677 patients admitted, 514 underwent lower extremity imaging, out of whom 186 (36.2%) were diagnosed with DVT. Other than history of cancer, which was more common in patients with a diagnosis of DVT (14.7% vs. 6.3%, p<0.01), baseline characteristics and presentation vital signs were similar between groups. Median peak D-Dimer levels were similar in patients with and without diagnosis of DVT [18.5 mg/dL, IQR: 6.4-20.0 vs. 12.2 mg/dL, IQR: 3.7-20, p = 0.80]. Density plots of initial D-Dimer values grouped by presence of DVT are presented in Figure 1. Conclusions: In this analysis of patients hospitalized with COVID-19, DVT was frequently diagnosed in patients who underwent imaging. There was considerable overlap of peak D-Dimer values in patients with and without documented DVT. As such, elevation in D-Dimer values alone should not prompt routine initiation of therapeutic anticoagulation in COVID-19 patients. Data from prospective clinical trials and registries regarding optimal antithrombotic practices in this patient population is needed.

scholarly journals Longitudinal remotely mentored self-performed lung ultrasound surveillance of paucisymptomatic Covid-19 patients at risk of disease progression

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Andrew W. Kirkpatrick ◽  
Jessica L. McKee ◽  
John M. Conly
Keyword(s):  
At Risk ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Human Life ◽  
Vital Signs ◽  
Home Monitoring ◽  
Cost Effective ◽  
Care Providers ◽  
Vital Signs Monitoring ◽  
Ultrasound Probes

AbstractCOVID-19 has impacted human life globally and threatens to overwhelm health-care resources. Infection rates are rapidly rising almost everywhere, and new approaches are required to both prevent transmission, but to also monitor and rescue infected and at-risk patients from severe complications. Point-of-care lung ultrasound has received intense attention as a cost-effective technology that can aid early diagnosis, triage, and longitudinal follow-up of lung health. Detecting pleural abnormalities in previously healthy lungs reveal the beginning of lung inflammation eventually requiring mechanical ventilation with sensitivities superior to chest radiographs or oxygen saturation monitoring. Using a paradigm first developed for space-medicine known as Remotely Telementored Self-Performed Ultrasound (RTSPUS), motivated patients with portable smartphone support ultrasound probes can be guided completely remotely by a remote lung imaging expert to longitudinally follow the health of their own lungs. Ultrasound probes can be couriered or even delivered by drone and can be easily sterilized or dedicated to one or a commonly exposed cohort of individuals. Using medical outreach supported by remote vital signs monitoring and lung ultrasound health surveillance would allow clinicians to follow and virtually lay hands upon many at-risk paucisymptomatic patients. Our initial experiences with such patients are presented, and we believe present a paradigm for an evolution in rich home-monitoring of the many patients expected to become infected and who threaten to overwhelm resources if they must all be assessed in person by at-risk care providers.

scholarly journals A Long-Distance Communication Architecture for Medical Devices Based on LoRaWAN Protocol

Electronics ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 940
Author(s):  
Nicoleta Cristina Gaitan
Keyword(s):  
Energy Consumption ◽  
Long Range ◽  
Medical Devices ◽  
Low Energy ◽  
Area Network ◽  
Wide Area Network ◽  
Long Distance ◽  
Communication Architecture ◽  
Low Energy Consumption ◽  
Distance Communication

Recent market studies show that the market for remote monitoring devices of different medical parameters will grow exponentially. Globally, more than 4 million individuals will be monitored remotely from the perspective of different health parameters by 2023. Of particular importance is the way of remote transmission of the information acquired from the medical sensors. At this time, there are several methods such as Bluetooth, WI-FI, or other wireless communication interfaces. Recently, the communication based on LoRa (Long Range) technology has had an explosive development that allows the transmission of information over long distances with low energy consumption. The implementation of the IoT (Internet of Things) applications using LoRa devices based on open Long Range Wide-Area Network (LoRaWAN) protocol for long distances with low energy consumption can also be used in the medical field. Therefore, in this paper, we proposed and developed a long-distance communication architecture for medical devices based on the LoRaWAN protocol that allows data communications over a distance of more than 10 km.

scholarly journals 460. Point-of-Care, In-Home SARS-CoV-2 IgG Antibody Testing to Assess Seroprevalence in At-Risk Health Care Workers

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S297-S297
Author(s):  
Eric G Meissner ◽  
Christine Litwin ◽  
Tricia Crocker ◽  
Elizabeth Mack ◽  
Lauren Card
Keyword(s):  
Health Care ◽  
At Risk ◽  
Health Care Workers ◽  
Medical Center ◽  
Point Of Care ◽  
Academic Medical Center ◽  
Significant Risk ◽  
Documented Infection ◽  
Inconclusive Result ◽  
Care Workers

Abstract Background Health care workers are at significant risk for infection with the novel coronavirus SARS-CoV-2. Methods We utilized a point-of-care, lateral flow SARS-CoV-2 IgG immunoassay (RayBiotech) to conduct a seroprevalence study in a cohort of at-risk health care workers (n=339) and normal-risk controls (n=100) employed at an academic medical center. To minimize exposure risk while conducting the study, consents were performed electronically, tests were mailed and then self-administered at home using finger stick blood, and subjects uploaded a picture of the test result while answering an electronic questionnaire. We also validated the assay using de-identified serum samples from patients with PCR-proven SARS-CoV-2 infection. Results Between April 14th and May 6th 2020, 439 subjects were enrolled. Subjects were 68% female, 93% white, and most were physicians (38%) and nurses (27%). In addition, 37% had at least 1 respiratory symptom in the prior month, 34% had cared for a patient with known SARS-CoV-2 infection, 57% and 23% were worried about exposure at work or in the community, respectively, and 5 reported prior documented SARS-CoV-2 infection. On initial testing, 3 subjects had a positive IgG test, 336 had a negative test, and 87 had an inconclusive result. Of those with an inconclusive result who conducted a repeat test (85%), 96% had a negative result. All 3 positive IgG tests were in subjects reporting prior documented infection. Laboratory validation showed that of those with PCR-proven infection more than 13 days prior, 23/30 were IgG positive (76% sensitivity), whereas 1/26 with a negative prior PCR test were seropositive (95% specificity). Repeat longitudinal serologic testing every 30 days for up to 4 times is currently in progress. Conclusion We conducted a contact-free study in the setting of a pandemic to assess SARS-CoV-2 seroprevalence in an at-risk group of health care workers. The only subjects found to be IgG positive were those with prior documented infection, even though a substantial proportion of subjects reported significant potential occupational or community exposure and symptoms that were potentially compatible with SARS-COV-2 infection. Disclosures All Authors: No reported disclosures

Acute Compartment Syndrome of the Lower Extremity: Update on Proper Evaluation and Management

2016 ◽  
Vol 01 (02) ◽  
Author(s):  
Galyfos G ◽  
Gkovas C ◽  
Kerasidis S ◽  
Stamatatos I ◽  
Stefanidis I ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Compartment Syndrome ◽  
Acute Compartment Syndrome

Field Study of Low-Energy Long-Distance Wireless Communication for IoT Application in Remote Areas

Mekatronika ◽  
2020 ◽  
Vol 2 (1) ◽  
pp. 52-62
Author(s):  
Kwai Yang Sak ◽  
Ahmad Najmuddin Ibrahim
Keyword(s):  
Radio Frequency ◽  
Long Range ◽  
Essential Element ◽  
Low Energy ◽  
Line Of Sight ◽  
Area Network ◽  
Structural Elements ◽  
Wide Area Network ◽  
Residential Areas ◽  
Long Distance

Long Range (LoRa) is a wireless radio frequency technology under the Low Power Wide Area Network (LPWAN). LoRa is able to communicate long range and low energy consumption. The communication range has become an essential element in the wireless radio frequency technology in the Internet of Things (IoT). The presence of LoRa is able IoT application performs in long communication distances with high noise sensitivity ability. People can operate, monitor, and do a variety of tasks from a remote distance. Therefore, this research aims to evaluate the performance of the LoRa connection between radio transceivers in remote locations. The different environment and structural elements affect the LoRa performance. This thesis will be supported by the experiment that LoRa communication in different environments and tests. This experiment tests in line of sight (LOS) and non-line of sight (NLOS). Two sets of LoRa parameters, including Spreading Factor (SF), Bandwidth, and coding rate, are tested in different environments. The experiment tests the LoRa performance in various aspects: received signal strength indicator (RSSI) and packet received ratio (PPR) at different coverage ranges. In addition, the LoRa performance is evaluated in university, residential areas and vegetation areas under similar temperature, weather, and time. The LoRa coverage distance in the vegetation area and university area is reached 900 meters in the LOS test. Still, the vegetation area's signal is more stable and able to receive weaker RSSI signals. The LoRa coverage distance in the NLOS test is shorter compared to the LOS test. NLOS test has only one-third of the LOS LoRa communication distance. It is due to the signal penetration on structural elements such as buildings and woods cause the signal power loss and only transmitting a shorter distance. The LoRa parameter with SF9, 31.25kHz bandwidth and 4/8 coding rate has a better coverage range and stable connection.

scholarly journals Lower extremity compartment syndrome after off-pump aortocoronary bypass

2006 ◽  
Vol 131 (5) ◽  
pp. 1173-1174 ◽  
Author(s):  
Karthik R. Vaidyanathan ◽  
Thiagarajamurthy Sundaramoorthi ◽  
Jagannath Raghavendrarao Byalal ◽  
Ganapathy Subramaniam Krishnan ◽  
Madhu N. Sankar ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Compartment Syndrome ◽  
Aortocoronary Bypass ◽  
Off Pump

scholarly journals Implementation of a QTc-interval monitoring protocol by pharmacists to decrease cardiac risk in at-risk patients in an acute care inpatient psychiatric facility

2019 ◽  
Vol 9 (2) ◽  
pp. 82-87 ◽  
Author(s):  
Nicole M. Daniel ◽  
Kim Walsh ◽  
Henry Leach ◽  
Lauren Stummer
Keyword(s):  
At Risk ◽  
Acute Care ◽  
Medical Center ◽  
Intervention Group ◽  
Psychiatric Hospitals ◽  
Control Group ◽  
Qtc Interval ◽  
Psychiatric Facility ◽  
End Point ◽  
Monitoring Protocol

Abstract Introduction Many medications commonly prescribed in psychiatric hospitals can cause QTc-interval prolongation, increasing a patient's risk for torsades de pointes and sudden cardiac death. There is little guidance in the literature to determine when an electrocardiogram (ECG) and QTc-interval monitoring should be performed. The primary end point was improvement of the appropriateness of ECGs and QTc-interval monitoring of at-risk psychiatric inpatients at Barnabas Health Behavioral Health Center (BHBH) and Monmouth Medical Center (MMC) following implementation of a standardized monitoring protocol. The secondary end point was the number of pharmacist-specific interventions at site BHBH only. Methods Patients who met the inclusion criteria were assessed using a standardized QTc-prolongation assessment algorithm for ECG appropriateness. A retrospective analysis of a control group (no protocol) from January 1, 2016, to July 17, 2017, was compared with a prospective analysis of the intervention group (with protocol) from December 11, 2017, to March 11, 2018. Results At BHBH, appropriate ECG utilization increased 25.5% after implementation of a standardized protocol (P = .0172) and appropriate omission of ECG utilization improved by 26% (P &lt; .00001). At MMC, appropriate ECGs decreased by 5%, and appropriate ECG omissions increased by 28%, neither of which were statistically significant (P = 1.0 and P = .3142, respectively). There was an increase in overall pharmacist monitoring. Discussion The study demonstrated that pharmacist involvement in ECG and QTc-interval monitoring utilizing a uniform protocol may improve the appropriateness of ECG and QTc-interval monitoring in patients in an acute care inpatient psychiatric hospital.

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