Managing the Monitors: An Analysis of Alarm Silencing Activities during an Anesthetic Procedure

2000 ◽  
Vol 44 (26) ◽  
pp. 250-253 ◽  
Author(s):  
Yan Xiao ◽  
Colin F. Mackenzie ◽  
F. Jacob Seagull ◽  
Mahmood Jaberi
Keyword(s):  
Critical Care ◽  
Airway Management ◽  
Patient Monitoring ◽  
Life Support ◽  
Attention Allocation ◽  
Trauma Patients ◽  
Care Providers ◽  
The Real ◽  
Patient Status ◽  
Monitoring Devices

Patient monitoring devices are designed to assist users in obtaining information on the patient and life-support equipment status. Most of the these devices have built-in visual and auditory alarms, which are to help the user to manage attention allocation. In this presentation we describe an analysis of the interaction between care providers and the monitoring devices during an anesthetic procedure (airway management) for trauma patients in the real environment. The videotapes of 47 cases were analyzed by coding the activities in silencing auditory alarms. In majority of the cases (87%) alarms could be heard yet only a small portion of the cases (6%) contained patient status events that signified by the alarm conditions. Care providers were frequently forced to interrupt clinical tasks to silence alarms. The differences in silencing frequency and rapidity among different monitoring devices suggest that alarms could be designed to be less intrusive and more tolerable, thus making the monitors easier to manage in critical care settings

Emergency oxygen administration and airway management [continuing education credit]

1992 ◽  
Vol 12 (4) ◽  
pp. 23-31
Author(s):  
SJ Somerson ◽  
MR Sicilia
Keyword(s):  
Critical Care ◽  
Airway Management ◽  
Continuing Education ◽  
Care Providers ◽  
Airway Intervention ◽  
Airway Control ◽  
Oxygen Administration ◽  
Patient Morbidity ◽  
Advanced Airway ◽  
Education Credit

Airway-directed vigilance is a priority for all critical care providers. Methodical respiratory assessment, proficient skill in basic airway support, and thorough preparation for advanced airway control modalities, uniquely enable the nurse to initiate timely airway intervention. Ultimately, this can contribute significantly to reduction and prevention of patient morbidity and mortality.

scholarly journals Trauma ICU Prevalence Project: the diversity of surgical critical care

2019 ◽  
Vol 4 (1) ◽  
pp. e000288 ◽  
Author(s):  
Christopher P Michetti ◽  
Samir M Fakhry ◽  
Karen Brasel ◽  
Niels D Martin ◽  
Erik J Teicher ◽  
...  
Keyword(s):  
Critical Care ◽  
Significant Proportion ◽  
Multiple Organ ◽  
Trauma Patients ◽  
Care Providers ◽  
Patient Acuity ◽  
Level Of Evidence ◽  
Icu Length Of Stay ◽  
Surgical Critical Care ◽  
The Usa

BackgroundSurgical critical care is crucial to the care of trauma and surgical patients. This study was designed to provide a contemporary assessment of patient types, injuries, and conditions in intensive care units (ICU) caring for trauma patients.MethodsThis was a multicenter prevalence study of the American Association for the Surgery of Trauma; data were collected on all patients present in participating centers’ trauma ICU (TICU) on November 2, 2017 and April 10, 2018.ResultsForty-nine centers submitted data on 1416 patients. Median age was 58 years (IQR 41–70). Patient types included trauma (n=665, 46.9%), non-trauma surgical (n=536, 37.8%), medical (n=204, 14.4% overall), or unspecified (n=11). Surgical intensivists managed 73.1% of patients. Of ICU-specific diagnoses, 57% were pulmonary related. Multiple high-intensity diagnoses were represented (septic shock, 10.2%; multiple organ failure, 5.58%; adult respiratory distress syndrome, 4.38%). Hemorrhagic shock was seen in 11.6% of trauma patients and 6.55% of all patients. The most common traumatic injuries were rib fractures (41.6%), brain (38.8%), hemothorax/pneumothorax (30.8%), and facial fractures (23.7%). Forty-four percent were on mechanical ventilation, and 17.6% had a tracheostomy. One-third (33%) had an infection, and over half (54.3%) were on antibiotics. Operations were performed in 70.2%, with 23.7% having abdominal surgery. At 30 days, 5.4% were still in the ICU. Median ICU length of stay was 9 days (IQR 4–20). 30-day mortality was 11.2%.ConclusionsPatient acuity in TICUs in the USA is very high, as is the breadth of pathology and the interventions provided. Non-trauma patients constitute a significant proportion of TICU care. Further assessment of the global predictors of outcome is needed to inform the education, research, clinical practice, and staffing of surgical critical care providers.Level of evidenceIV, prospective observational study.

scholarly journals COVID 19 and obstetrics: anaesthetic challenges, co-morbid conditions and critical care

2021 ◽  
Vol 8 (4) ◽  
pp. 36-44
Author(s):  
Arvind Kumar Yadav ◽  
Savita Choudhary ◽  
Sunanda Gupta
Keyword(s):  
Critical Care ◽  
Pregnant Women ◽  
Health Care Providers ◽  
Pregnancy Outcomes ◽  
Multidisciplinary Team ◽  
Life Support ◽  
Wide Spectrum ◽  
Clinical Manifestations ◽  
Team Approach ◽  
Care Providers

The WHO has declared severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) as a pandemic; it affected approximately 44.5million people since its first breakout in December 2019. COVID-19 can present with wide spectrum of clinical manifestations which range from mild illness with myalgia only to acute respiratory distress syndrome with or without multi-organ dysfunction syndrome necessitating the advance critical care and life support. Pregnant women presenting to emergency department needs to be triaged based on imminent risk factors for maternal and fetal compromise, present haemodynamic status of mother with consideration of gestational age. Pregnant women with comorbid conditions require multidisciplinary team approach for better pregnancy outcomes, resource management and minimizing the risk infection to health care providers. This review emphasizes on management of labour, pregnancy outcomes, co-morbidities and complex critical situations associated with COVID-19 infected pregnant women. Development of safe medical practices and infection prevention protocols with involvement of multidisciplinary team including anaesthesiologist, obstetrician, neonatologist, critical care specialist, infectious disease experts and nursing staff for the perioperative management; is required to optimize the patient outcome and mitigate the infection risk to health personnel and their families.

Current State of Critical Patient Monitoring and Outstanding Challenges

2010 ◽  
pp. 981-1003
Author(s):  
A. Otero ◽  
P. Félix ◽  
S. Barro
Keyword(s):  
Critical Care ◽  
Computer Science ◽  
Patient Monitoring ◽  
Healthcare Quality ◽  
Clinical Staff ◽  
Clinical Routine ◽  
Critical Care Units ◽  
Current State ◽  
Technological Advances ◽  
Monitoring Devices

Technological advances in the fields of electronics and computer science have given rise to a considerable increase in the number of physiological parameters available to clinical staff for interpreting a patient’s state. However, owing to the limitations and flaws in current commercial monitoring devices, this has not resulted in a corresponding increase in healthcare quality. This chapter analyses the reasons why clinical staff are not making full use of information from the monitoring devices currently in use in critical care units; a review is made of the most salient proposals from the scientific literature in order to address the imbalance existing between the amount of data available and the improvement in healthcare; and those problems for which suitable solutions have yet to be found and which have, up until now, hindered the applications of said proposals to clinical routine are analysed.

The General Surgery Model: A More Appealing and Sustainable Alternative for the Care of Trauma Patients

2005 ◽  
Vol 71 (8) ◽  
pp. 633-639 ◽  
Author(s):  
Richard H. Roettger ◽  
Spence M. Taylor ◽  
Jerry R. Youkey ◽  
Dawn W. Blackhurst
Keyword(s):  
Critical Care ◽  
General Surgery ◽  
Life Support ◽  
Penetrating Trauma ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Care Model ◽  
Trauma Service ◽  
Trauma Mortality ◽  
The Mean

The contemporary model of trauma care where dedicated trauma/critical care surgeons exclusively manage trauma patients has become progressively unsustainable. Little objective data, however, is available documenting that a better model exists. From September 2002 through August 2003, the trauma model at a 735-bed level I trauma teaching hospital was changed from the contemporary model to a new one where selected general surgeons with Advanced Trauma Life Support (ATLS) certification covered in-house trauma and emergency surgery call on a rotational basis. As well, each pursued elective practices, admitting all inpatients (trauma, emergent, elective) to a single teaching service (formerly the trauma service). Critical care was managed by a separate group of intensivists. The purpose of this study was to objectively compare the two models. Quantitative, financial, and qualitative data were derived from August 2001 to January 2002 (trauma/critical care model) and compared to August 2003 to January 2004 (general surgery model). During the two periods (trauma/critical care vs general surgery), the mean Revised Trauma Score (7.1 vs 7.2; P = 0.029), the mean Injury Severity Score (ISS) (10.9 vs 10.8; P = 0.84), and the percentage of penetrating trauma (12.5% vs 13.2%; P = 0.79) were similar. Differences (trauma/critical care vs general surgery, % increase/ P value) included average daily census (24 vs 54, 225%), cases/attending (262 vs 543, 207%), cases/resident (54 vs 262, 485%), charges/attending ($353,811 vs $471,725, 133%), collections/attending ($106,143 vs $165,103, 156%), number of trauma patients (643 vs 748, 116%), trauma mortality (7.3% vs 4.0%; P = 0.007), trauma mortality with ISS >15 (21.7% vs 12.0%; P = 0.035), trauma complications (33.1% vs 17%; P < 0.001), and ICU morbidity (66.8% vs 43.9%; P < .001). The new general surgery model produced superior financial results and better quantitative surgical experience while exceeding trauma and ICU quality outcomes compared to the former trauma/critical care model. These data objectively support a model such as ours–one that is financially sustainable and more professionally attractive.

Framework for Biosignal Interpretation in Intensive Care and Anesthesia

1997 ◽  
Vol 36 (04/05) ◽  
pp. 340-344 ◽  
Author(s):  
I. Korhonen ◽  
M. van Gils ◽  
A. Kari ◽  
N. Saranummi
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Data Management ◽  
Clinical Evaluation ◽  
Patient Monitoring ◽  
Research Community ◽  
Clinical Routine ◽  
The Poor ◽  
Outcomes Of Care

Abstract:Improved monitoring improves outcomes of care. As critical care is “critical”, everything that can be done to detect and prevent complications as early as possible benefits the patients. In spite of major efforts by the research community to develop and apply sophisticated biosignal interpretation methods (BSI), the uptake of the results by industry has been poor. Consequently, the BSI methods used in clinical routine are fairly simple. This paper postulates that the main reason for the poor uptake is the insufficient bridging between the actors (i.e., clinicians, industry and research). This makes it difficult for the BSI developers to understand what can be implemented into commercial systems and what will be accepted by clinicians as routine tools. A framework is suggested that enables improved interaction and cooperation between the actors. This framework is based on the emerging commercial patient monitoring and data management platforms which can be shared and utilized by all concerned, from research to development and finally to clinical evaluation.

Case Report: FAST Ultrasound Interpretation in Trauma Resuscitation

POCUS Journal ◽  
2016 ◽  
Vol 1 (3) ◽  
pp. 13-14
Author(s):  
Stuart Douglas, PGY4 ◽  
Joseph Newbigging, MD ◽  
David Robertson, MD
Keyword(s):  
Case Report ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Life Support ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Ultrasound Probe ◽  
Trauma Resuscitation ◽  
Highly Sensitive ◽  
Pouch Of Douglas

FAST Background: Focused Assessment with Sonography for Trauma (FAST) is an integral adjunct to primary survey in trauma patients (1-4) and is incorporated into Advanced Trauma Life Support (ATLS) algorithms (4). A collection of four discrete ultrasound probe examinations (pericardial sac, hepatorenal fossa (Morison’s pouch), splenorenal fossa, and pelvis/pouch of Douglas), it has been shown to be highly sensitive for detection of as little as 100cm3 of intraabdominal fluid (4,5), with a sensitivity quoted between 60-98%, specificity of 84-98%, and negative predictive value of 97-99% (3).

scholarly journals Chinese expert consensus on diagnosis and treatment of trauma-induced hypercoagulopathy

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Jing-Chun Song ◽  
◽  
Li-Kun Yang ◽  
Wei Zhao ◽  
Feng Zhu ◽  
...  
Keyword(s):  
Critical Care ◽  
Tissue Injury ◽  
Massive Hemorrhage ◽  
Expert Consensus ◽  
Chinese Society ◽  
Trauma Patients ◽  
Pathophysiological Mechanism ◽  
Trauma Induced Coagulopathy ◽  
Education Association ◽  
Post Traumatic

AbstractTrauma-induced coagulopathy (TIC) is caused by post-traumatic tissue injury and manifests as hypercoagulability that leads to thromboembolism or hypocoagulability that leads to uncontrollable massive hemorrhage. Previous studies on TIC have mainly focused on hemorrhagic coagulopathy caused by the hypocoagulable phenotype of TIC, while recent studies have found that trauma-induced hypercoagulopathy can occur in as many as 22.2–85.1% of trauma patients, in whom it can increase the risk of thrombotic events and mortality by 2- to 4-fold. Therefore, the Chinese People’s Liberation Army Professional Committee of Critical Care Medicine and the Chinese Society of Thrombosis, Hemostasis and Critical Care, Chinese Medicine Education Association jointly formulated this Chinese Expert Consensus comprising 15 recommendations for the definition, pathophysiological mechanism, assessment, prevention, and treatment of trauma-induced hypercoagulopathy.

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