scholarly journals The Electrocardiograph: Applications and Limitations—An Analysis of 2000 Incident Reports

1993 ◽  
Vol 21 (5) ◽  
pp. 558-564 ◽  
Author(s):  
G. L. Ludbrook ◽  
W. J. Russell ◽  
R. K. Webb ◽  
I. D. Klepper ◽  
M. Currie
Keyword(s):  
Heart Rate ◽  
Pulse Oximeter ◽  
Significant Risk ◽  
Organ Damage ◽  
Additional Information ◽  
Anaesthetic Agents ◽  
Incident Reports ◽  
Oxygen Analyser ◽  
Do So

The first 2000 incidents reported to the Australian Incident Monitoring Study (AIMS) were analysed with respect to the role of the electrocardiograph (ECG). Of these, 138 (7%) were first detected by the ECG. Of the 1256 incidents which occurred in association with general anaesthesia (GA incidents) 48% were “human detected” and 52% “monitor detected”, the ECG was ranked third and detected 121 (19%) of these monitor detected GA incidents. However over 98% of incidents first detected by the ECG were heart rate changes; they would also have been detected by a pulse meter or pulse oximeter which would have supplied additional information about the adequacy of peripheral perfusion. The ECG is a “first-line” monitor in situations with the potential for myocardial ischaemia, complex dysrhythmias or altered myocardial conduction and should be used in all critically ill patients as well as those at significant risk of these problems. The ECG frequently detects incidents involving minor physiological trespass, such as simple heart rate and rhythm changes associated with anaesthetic agents. These incidents are generally detected relatively early in their evolution. AIMS data has confirmed, however, that the ECG has such poor sensitivity for serious physiological changes such as hypoxia, hypercarbia and hypotension that it cannot even be regarded as a useful “back-up” monitor for these problems. Indeed a “normal” ECG in a dangerous situation may lead to a degree of complacency. Because the anaesthetist cannot differentiate between these minor and serious causes of ECG changes, it was decided, for a theoretical analysis, that although the ECG used on its own would have detected 55% of the 1256 GA incidents, had they been allowed to evolve, it could not be assumed that it would do so without potential for organ damage. The ECG may be regarded as an adjunct to, but does not replace, an oxygen analyser, pulse oximeter, capnograph, or high pressure alarm. An ECG should always be available but need not be used for young fit patients unless specifically indicated.

scholarly journals Which Monitor? An Analysis of 2000 Incident Reports

1993 ◽  
Vol 21 (5) ◽  
pp. 529-542 ◽  
Author(s):  
R. K. Webb ◽  
J. H. Van Der Walt ◽  
W. B. Runciman ◽  
J. A. Williamson ◽  
J. Cockings ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pulse Oximeter ◽  
Blood Pressure Monitoring ◽  
Low Pressure ◽  
Organ Damage ◽  
Mechanically Ventilated ◽  
Blood Pressure Monitors ◽  
International Monitoring ◽  
Oxygen Analyser

The role of monitors in patients undergoing general anaesthesia was studied by analysing the first 2000 incidents reported to the Australian Incident Monitoring Study; 1256 (63%) were considered applicable to this study. In 52% of these a monitor detected the incident first; oximetry (27%) and capnography (24%) detected over half of the monitor detected incidents, the electrocardiograph 19%, blood pressure monitors 12%, a low pressure (circuit) alarm 8%, and the oxygen analyser 4%. Of the other monitors used, 5 first detected 1–2% of incidents, and the remaining 8 less than 0.5% each. The oximeter would have detected over 40% of the monitor detected incidents had its more informative modulated pulse tone always been relied upon instead of the “bleep” of the ECG. A theoretical analysis was then carried out to determine which of an array of 17 monitors would reliably have detected each incident had each monitor been used on its own and had the incident been allowed to evolve. To facilitate “scoring” of monitors, the incidents were categorized empirically into 60 clinical situations; 40% of applicable incidents were accounted for by only 5 clinical situations, 60% by 10 and nearly 80% by 20. 98% were accounted for by the 60 situations. A pulse oximeter, used on its own, would theoretically have detected 82% of applicable incidents (nearly 60% before any potential for organ damage). These figures for capnography are 55% and 43 % and for oximetry and capnography combined are 88% and 65%, respectively. With the addition of blood pressure monitoring these become 93% and 65%, and of an oxygen analyser, 95 and 67%. Other monitors, including the ECG, each increase the yield by by less than 0.5%. The international monitoring recommendations and those of the Australian and New Zealand College of Anaesthetists are thoroughly vindicated by the patterns revealed in this study. The priority sequence of monitor acquisition for those with limited resources should be stethoscope, sphygmomanometer, oxygen analyser if nitrous oxide is to be used, pulse oximeter, capnograph, high pressure alarm, and, if patients are to be mechanically ventilated, a low pressure alarm (or spirometer with alarm); an ECG, a defibrillator, a spirometer and a thermometer should be available.

scholarly journals The Oxygen Analyser: Applications and Limitations – An Analysis of 2000 Incident Reports

1993 ◽  
Vol 21 (5) ◽  
pp. 570-574 ◽  
Author(s):  
L. Barker ◽  
R. K. Webb ◽  
W. B. Runciman ◽  
J. H. Van Der Walt
Keyword(s):  
Anaesthetic Machine ◽  
Organ Damage ◽  
Improper Use ◽  
Total Failure ◽  
The Common ◽  
Incident Reports ◽  
Oxygen Analyser ◽  
Gas Leaks ◽  
Hypoxic Mixtures

The first 2000 incidents reported to the Australian Incident Monitoring Study were analysed with respect to the role of the oxygen analyser; 27 (1%) were first detected by the oxygen analyser. All of these were amongst the 1256 incidents which occurred in association with general anaesthesia, of which 48% were “human detected” and 52% “monitor detected”. The oxygen analyser was ranked 7th and detected 4% of these monitor detected incidents. This figure would have been much higher had the oxygen analyser been correctly used on more occasions. The oxygen analyser detected 10 ventilator-driving-gas leaks into the circuit, 6 hypoxic mixtures due to rotameter settings, 3 inappropriate nitrous oxide concentrations, 2 disconnections and 1 leak at the common gas outlet, and 2 partial and 1 total failure of ventilation. In a theoretical analysis of these 1256 incidents it was considered that the oxygen analyser, used on its own, would have detected 114 (9%), had they been allowed to evolve (3% before any potential for organ damage). In 4 incidents an oxygen analyser gave faulty readings, in 3 caused a leak and in one a total circuit obstruction; 5 incidents were not detected because the alarm had been disabled. Despite the advent of piped gas supplies, failure of gas delivery or delivery of a “wrong” gas mixture still occurs surprisingly frequently in current anaesthetic practice; hypoxic mixtures were supplied on 16 occasions, other “wrong” mixtures on 23 and the oxygen supply failed on 7 occasions. Failure to use and improper use of the oxygen analyser is also surprisingly common; this is mainly due to a rule-based error encouraged by the poor design of the high alarm. It is highly recommended that a suitable, correctly sited, calibrated, tested oxygen analyser be used from before pre-oxygenation until the patient is no longer breathing gas from the anaesthetic machine or circuit.

The Role of Hyperleukocytosis in Predicting the Severity of Pertussis

2020 ◽  
Author(s):  
Xiao-Ying Wu ◽  
chuan gan
Keyword(s):  
Heart Rate ◽  
Respiratory Rate ◽  
Bacterial Infections ◽  
Clinical Manifestations ◽  
Organ Damage ◽  
Clinical Analysis ◽  
Laboratory Findings ◽  
Wbc Count ◽  
The Relationship

Abstract Background: Few reports have described the relationship between WBC count and the severity of pertussis or the timing of ET in patients with hyperleukocytosis.Methods: A retrospective clinical analysis of infants with pertussis and a WBC exceeding 30*10^9/L was performed.Results: A total of 158 patients were enrolled in the study. There were significant differences in the clinical manifestations of cyanosis, fever, highest respiratory rate, and highest heart rate. There were significant differences in all complications except for pulmonary hypertension. In laboratory findings, there were significant differences in organ damage (myocardial markers, ALT), increased inflammation indicators (CRP, PCT), and the incidence of combined bacterial infections. There were significant differences in ICU stay length, mechanical ventilation use, days hospitalized, days until cough relief and days until the WBC fell below 25*10^9/L. A WBC count >55.38 *10^9/L was calculated as the cutoff value with 88.2% sensitivity and 23.4% specificity in predicting ET. A respiratory rate of 59 breaths/min had 94.1% sensitivity and 36.7% specificity in predicting ET. A heart rate of 159 beats/min had 100% sensitivity and 38.1% specificity in predicting ET.Conclusion: WBC count is related to the severity of pertussis. We recommend that ET is considered when the patient’s WBC count exceeds 55*10^9/L, breathing exceeds 60 breaths/min, and/or heart rate exceeds 160 beats/min.

Pulse Oximetry

2011 ◽  
Author(s):  
Patrick Magee ◽  
Mark Tooley
Keyword(s):  
Oxygen Saturation ◽  
Pulse Oximeter ◽  
Anaesthetic Machine ◽  
Additional Information ◽  
Non Invasive ◽  
Point Of Interest ◽  
Arterial Blood ◽  
Body Tissues ◽  
Oxygen Analyser

The pulse oximeter is a device for non-invasive, continuous measurement of oxygen saturation. As such it is arguably one of the most important intraoperative monitors at the disposal of anaesthetists, and efforts are being made to make pulse oximeters available at all operating locations throughout the world [Walker et al. 2009]. Although the device measures oxygen saturation of arterial blood, which is the physiological end point of interest, it is not a replacement for monitoring all the events which may lead to hypoxaemia; in other words it does not replace an oxygen analyser at the common gas outlet of the anaesthetic machine. Depending on the site of the probe, usually ear lobe or finger, there is a variable delay between the onset of a causative hypoxaemic event and detection of hypoxaemia by the pulse oximeter, the delay being longer the more peripherally placed is the probe. Appropriate size and design of the probe for accuracy and safety in children is important [Howell et al. 1993] and finger probes are more accurate but slower to respond than ear probes [Webb et al. 1991]. Forehead reflectance probes have been used with good results [Casati et al. 2007]. It is also true that the human eye is notoriously bad at detecting cyanosis in the range of saturations 81–85%. For additional information on Monitoring Principles see Chapter 11. It is clear, however, that in a hierarchy of monitors for anaesthesia, the pulse oximeter is indispensable. A pulse oximeter uses two separate technologies: one is plethysmography, where reproduction of the pulsatile waveform takes place; the other is spectroscopy, where absorption of light of specific wavelengths by body tissues occurs and is analysed. The spectroscopic aspects depend on the laws of Beer and Lambert, which can be combined to state that the amount of light absorbed by a substance is proportional to the thickness of the substance sample (the path length of the light) and the concentration of the substance.

Target organ damage in patients with rheumatoid arthritis: The role of blood pressure and heart rate

2010 ◽  
Vol 209 (1) ◽  
pp. 255-260 ◽  
Author(s):  
Vasileios F. Panoulas ◽  
Tracey E. Toms ◽  
Giorgos S. Metsios ◽  
Antonios Stavropoulos-Kalinoglou ◽  
Athanasios Kosovitsas ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Blood Pressure ◽  
Heart Rate ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Target Organ

scholarly journals The Stethoscope: Applications and Limitations– An Analysis of 2000 Incident Reports

1993 ◽  
Vol 21 (5) ◽  
pp. 575-578 ◽  
Author(s):  
I. D. Klepper ◽  
R. K. Webb ◽  
J. H. Van Der Walt ◽  
G. L. Ludbrook ◽  
J. Cockings
Keyword(s):  
Continuous Monitoring ◽  
Organ Damage ◽  
Endobronchial Intubation ◽  
Monitoring Study ◽  
Electronic Monitors ◽  
Incident Reports ◽  
Actual Yield ◽  
Continuous Monitor ◽  
Precordial Stethoscope

The first 2000 incidents reported to the Australian Incident Monitoring Study (AIMS) were analysed with respect to the role of the oesophageal or precordial stethoscope as a continuous monitor. There were 1099 of the 1256 incidents during general anaesthesia in which one might have been used in this way, but use was reported in only 65 cases (5%), predominantly during paediatric cases. In only one report, a cardiac arrest, was the stethoscope the first to detect the incident. In a theoretical analysis it was considered that the stethoscope, used on its own for continuous monitoring, could have detected 54% of the 1256 incidents (almost 25% before any potential for organ damage), had they been allowed to evolve. However, AIMS data suggest that the actual yield using a stethoscope as a continuous monitor may be much lower than this, and that even the use of a “mobile” stethoscope can not be relied upon to detect oesophageal or endobronchial intubation. These reports confirm that there is limited use of the stethoscope for continuous monitoring in current anaesthetic practice in Australia; it has been superseded by the sophisticated electronic monitors now available. However, in areas with limited resources continuous auscultation with a stethoscope remains a basic requirement.

scholarly journals Role of Endoscopic Ultrasonography in Differential Diagnosis of Pancreatic Cystic Lesions

2021 ◽  
Vol 6 (2) ◽  
pp. 43-49
Author(s):  
Young Jung Kim ◽  
Joung-Ho Han
Keyword(s):  
Significant Risk ◽  
High Sensitivity ◽  
Accurate Diagnosis ◽  
Malignant Degeneration ◽  
Cystic Lesions ◽  
Resonance Imaging ◽  
Additional Information

Pancreatic cystic lesions (PCLs) are being identified increasingly because of recent advancements in abdominal imaging technologies, presenting a number of challenges in clinical practice. Although most PCLs are benign, some carry a significant risk of malignant degeneration. Accurate diagnosis of PCLs is important for proper management and follow-up. Endoscopic ultrasound (EUS) is useful for the characterization of PCLs with high sensitivity and accuracy. Additional information can be obtained using EUS for indeterminate lesions on computed tomography or magnetic resonance imaging. In this review, we introduce the relevant EUS findings for the diagnosis of relatively common PCLs.

scholarly journals The Pulse Oximeter: Applications and Limitations—An Analysis of 2000 Incident Reports

1993 ◽  
Vol 21 (5) ◽  
pp. 543-550 ◽  
Author(s):  
W. B. Runciman ◽  
R. K. Webb ◽  
L. Barker ◽  
M. Currie
Keyword(s):  
General Anaesthesia ◽  
Pulse Oximeter ◽  
Tension Pneumothorax ◽  
Air Embolism ◽  
Organ Damage ◽  
Time Of Arrival ◽  
Front Line ◽  
New Device ◽  
Severe Hypotension ◽  
Oxygen Analyser

The first 2000 incidents reported to the Australian Incident Monitoring Study were analysed with respect to the role of the pulse oximeter. Of these 184 (9%) were first detected by a pulse oximeter and there were a further 177 (9%) in which desaturation was recorded. Of the 1256 incidents which occurred in association with general anaesthesia 48% were “human detected” and 52% “monitor detected”. The pulse oximeter was ranked first and detected 27% of these monitor detected incidents; this figure would have been over 40% if an oximeter had always been used and its more informative modulated pulse tone relied upon instead of that of the “bleep” of the ECG. The pulse oximeter is the “front-line” monitor for endobronchial intubation, the fourth most common incident in association with general anaesthesia (it detected 87% of the 76 cases in which it was in use). It also played an invaluable role as a “back-up” monitor in 40 life-threatening situations in which “front-line” monitors (e.g. oxygen analyser, low pressure alarm, capnograph) were either not in use, were being used incorrectly or failed. Other situations detected, in order of frequency of detection, were: circuit disconnection, circuit leak, desaturation (severe shunt), oesophageal intubation, aspiration and/or regurgitation, pulmonary oedema, endotracheal tube obstruction, severe hypotension, failure of oxygen delivery, hypoxic gas mixture, hypoventilation, anaphylaxis, air embolism, bronchospasm, malignant hyperthermia, and tension pneumothorax. There were 15 reports of “failure”; four because the model in use had no modulated tone or alarm, four in which performance was in fact adequate, three were probe problems, two involved “over-reading”, one “under-reading” and in one new device the alarm failed. In the theoretical analysis of the 1256 general anaesthesia incidents it was concluded that pulse oximetry, used on its own, would have detected 82% of these incidents, had they been allowed to evolve (nearly 60% before any potential for organ damage). It is highly recommended that a suitable pulse oximeter be used on all patients from the time of arrival in the induction room until return of protective reflexes and demonstration of adequate saturation when breathing room air.

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