scholarly journals Responding to a pandemic with Simulation Based Education (SBE)? Sharing lessons learned from Sussex Partnership Foundation Trust (SPFT)

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S147-S148
Author(s):  
Craig McEwan ◽  
Richard Kerslake ◽  
Michael Hobkirk
Keyword(s):  
Physical Health ◽  
Open Space ◽  
Rapid Development ◽  
Geographical Area ◽  
Blood Gases ◽  
Rapid Identification ◽  
Lessons Learned ◽  
Psychiatric Setting ◽  
Arterial Blood ◽  
Medical Leadership

AimsIn March 2020 SPFT was preparing for the first wave of the COVID-19 pandemic. Senior medical leadership supported the rapid development and delivery of SBE workshop for assessment and management of physically unwell patients in a psychiatric setting in the context of COVID-19. The training was delivered to 102 psychiatrists across 10 sessions over 4 weeks.A learning review was completed to identify lessons learned from the delivery of this SBE workshop.MethodThe intervention was reviewed using open-space feedback from attendees, interviews with facilitators and medical leadership, and SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis.ResultOverall, the simulation project met its pre-determined objectives of increasing confidence and competence in the medical workforce in the context of COVID-19 and physical health. Development and delivery of the workshop was rapid, with request to delivery taking 4 days.A summary of the key lessons include:An existing simulation faculty within the trust was essential, allowing for rapid identification of key stakeholders and those able to deliver the project.A “direct-line” relationship to senior leadership enabled the project to be dynamic and responsive to changing demands as COVID-19 guidelines and objectives evolved.Redeploying higher trainees with SBE experience to develop the project as a focussed team allowed for rapid delivery which was resource-effective.The workforce found reassurance from understanding what was not expected of them, as much as what was. For example, making clear that Arterial Blood Gases would not be introduced to the psychiatric setting.There is an ongoing learning need for physical health training through SBE in non-covid scenarios.SBE can be an effective intervention for a range of medical grades and covering a large geographical area.There are opportunities for developing multi-disciplinary training on physical health in psychiatry.ConclusionWe have outlined some of the key learning outcomes from a successfully implemented SBE project during the first COVID-19 wave in spring 2020. The project has cemented the role of the relatively new simulation faculty within the trust and highlighted the effectiveness of close collaboration between leadership and a small, dedicated group of facilitators. The project has continued to be used for training new staff members and the resources have been widely shared, used by other NHS trusts and also internationally.

scholarly journals Elimination of nasal obstruction improves pulmonary functions and oxygenation

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Eman Sobh ◽  
Fatma Elhussieny ◽  
Taghreed Ismail
Keyword(s):  
Nasal Obstruction ◽  
Blood Gases ◽  
Medical Problem ◽  
Forced Expiratory Volume ◽  
Nasal Packing ◽  
Nasal Pack ◽  
Arterial Blood ◽  
Study Population ◽  
The Mean ◽  
The Impact

Abstract Background Nasal obstruction is a significant medical problem. This study aimed to examine the effect of nasal obstruction and nasal packing on arterial blood gases and pulmonary function indices, and the impact of the elimination of nasal obstruction on preoperative values. Results The mean age of the study population was 26.6 ± 10.1 years, males represented 50.8%. Spirometric indices showed statistically significant improvement (preoperative forced expiratory volume in 1st second 66.9 ± 13.9 vs 79.6 ± 14.9 postoperative and preoperative forced vital capacity 65.5 ± 12.7 vs 80.4 ± 13.8 postoperative). Oxygen saturation was significantly lower during nasal packing (95.6 ± 1.6 preoperative vs 94.7 ± 2.8 with nasal pack), and significant improvement (97.2 ± 1.4) was observed after removal of the nasal pack. Nasal obstruction scores significantly improved. Conclusion The results of this study indicate that either simple nasal obstruction or nasal packing may cause hypoxemia and abnormalities in lung function tests. Hypoxemia was more evident with nasal packing.

scholarly journals Pathophysiology and clinical consequences of arterial blood gases and pH after cardiac arrest

2020 ◽  
Vol 8 (S1) ◽  
Author(s):  
Chiara Robba ◽  
Dorota Siwicka-Gieroba ◽  
Andras Sikter ◽  
Denise Battaglini ◽  
Wojciech Dąbrowski ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Mechanical Ventilation ◽  
Cardiac Arrest ◽  
Oxygen Demand ◽  
Blood Gases ◽  
Metabolic Energy ◽  
High Morbidity ◽  
Arterial Blood Gases ◽  
Arterial Blood ◽  
Clinical Consequences

AbstractPost cardiac arrest syndrome is associated with high morbidity and mortality, which is related not only to a poor neurological outcome but also to respiratory and cardiovascular dysfunctions. The control of gas exchange, and in particular oxygenation and carbon dioxide levels, is fundamental in mechanically ventilated patients after resuscitation, as arterial blood gases derangement might have important effects on the cerebral blood flow and systemic physiology.In particular, the pathophysiological role of carbon dioxide (CO2) levels is strongly underestimated, as its alterations quickly affect also the changes of intracellular pH, and consequently influence metabolic energy and oxygen demand. Hypo/hypercapnia, as well as mechanical ventilation during and after resuscitation, can affect CO2 levels and trigger a dangerous pathophysiological vicious circle related to the relationship between pH, cellular demand, and catecholamine levels. The developing hypocapnia can nullify the beneficial effects of the hypothermia. The aim of this review was to describe the pathophysiology and clinical consequences of arterial blood gases and pH after cardiac arrest.According to our findings, the optimal ventilator strategies in post cardiac arrest patients are not fully understood, and oxygen and carbon dioxide targets should take in consideration a complex pattern of pathophysiological factors. Further studies are warranted to define the optimal settings of mechanical ventilation in patients after cardiac arrest.

scholarly journals Prehospital Diagnosis of Shortness of Breath Caused by Profound Metformin-Associated Metabolic Acidosis

Healthcare ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 74
Author(s):  
Pietro Elias Fubini ◽  
Laurent Suppan
Keyword(s):  
Metabolic Acidosis ◽  
Hospital Setting ◽  
Blood Gases ◽  
Shortness Of Breath ◽  
Potential Harm ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Common Causes ◽  
Prehospital Diagnosis ◽  
Gas Measurement

Shortness of breath is a common complaint among patients in emergency medicine. While most common causes are usually promptly identified, less frequent aetiologies might be challenging to diagnose, especially in the pre-hospital setting. We report a case of prehospital dyspnoea initially ascribed to pulmonary oedema which turned out to be the result of profound metformin-associated metabolic acidosis. This diagnosis was already made during the prehospital phase by virtue of arterial blood gas measurement. Pre-hospital measurement of arterial blood gases is therefore feasible and can improve diagnostic accuracy in the field, thus avoiding unnecessary delay and potential harm to the patient before initiating the appropriate therapeutic actions.

Arterial Blood Gases in Pranayama Practice

1978 ◽  
Vol 46 (1) ◽  
pp. 171-174 ◽  
Author(s):  
V. Pratap ◽  
W. H. Berrettini ◽  
C. Smith
Keyword(s):  
Blood Gases ◽  
Neural Mechanism ◽  
Arterial Blood Gases ◽  
Arterial Blood ◽  
Yogic Breathing ◽  
The Mind ◽  
Calming Effect

Pranayama is a Yogic breathing practice which is known experientially to produce a profound calming effect on the mind. In an experiment designed to determine whether the mental effects of this practice were accompanied by changes in the arterial blood gases, arterial blood was drawn from 10 trained individuals prior to and immediately after Pranayama practice. No significant changes in arterial blood gases were noted after Pranayama. A neural mechanism for the mental effects of this practice is proposed.

Dexmedetomidine Attenuates the Microcirculatory Derangements Evoked by Experimental Sepsis

2015 ◽  
Vol 122 (3) ◽  
pp. 619-630 ◽  
Author(s):  
Marcos L. Miranda ◽  
Michelle M. Balarini ◽  
Eliete Bouskela
Keyword(s):  
Blood Gases ◽  
Capillary Density ◽  
Sepsis Syndrome ◽  
In Vivo Studies ◽  
Experimental Sepsis ◽  
Leukocyte Rolling ◽  
Capillary Perfusion ◽  
Arterial Blood ◽  
Baseline Values

Abstract Background: Dexmedetomidine, an α-2 adrenergic receptor agonist, has already been used in septic patients although few studies have examined its effects on microcirculatory dysfunction, which may play an important role in perpetuating sepsis syndrome. Therefore, the authors have designed a controlled experimental study to characterize the microcirculatory effects of dexmedetomidine in an endotoxemia rodent model that allows in vivo studies of microcirculation. Methods: After skinfold chamber implantation, 49 golden Syrian hamsters were randomly allocated in five groups: (1) control animals; (2) nonendotoxemic animals treated with saline; (3) nonendotoxemic animals treated with dexmedetomidine (5.0 μg kg−1 h−1); (4) endotoxemic (lipopolysaccharide 1.0 mg/kg) animals treated with saline; and (5) endotoxemic animals treated with dexmedetomidine. Intravital microscopy of skinfold chamber preparations allowed quantitative analysis of microvascular variables and venular leukocyte rolling and adhesion. Mean arterial blood pressure, heart rate, arterial blood gases, and lactate concentrations were also documented. Results: Lipopolysaccharide administration increased leukocyte rolling and adhesion and decreased capillary perfusion. Dexmedetomidine significantly attenuated these responses: compared with endotoxemic animals treated with saline, those treated with dexmedetomidine had less leukocyte rolling (11.8 ± 7.2% vs. 24.3 ± 15.0%; P < 0.05) and adhesion (237 ± 185 vs. 510 ± 363; P < 0.05) and greater functional capillary density (57.4 ± 11.2% of baseline values vs. 45.9 ± 11.2%; P < 0.05) and erythrocyte velocity (68.7 ± 17.6% of baseline values vs. 54.4 ± 14.8%; P < 0.05) at the end of the experiment. Conclusions: Dexmedetomidine decreased lipopolysaccharide-induced leukocyte–endothelial interactions in the hamster skinfold chamber microcirculation. This was accompanied by a significant attenuation of capillary perfusion deficits, suggesting that dexmedetomidine yields beneficial effects on endotoxemic animals’ microcirculation.

Machine Learning Arrives in Archaeology

2021 ◽  
Vol 9 (2) ◽  
pp. 186-191
Author(s):  
Simon H. Bickler
Keyword(s):  
Machine Learning ◽  
Rapid Development ◽  
Rapid Identification ◽  
First Century ◽  
Traditional Methods ◽  
Archaeological Practice ◽  
The World ◽  
Archaeological Work ◽  
Archaeological Analysis

OverviewMachine learning (ML) is rapidly being adopted by archaeologists interested in analyzing a range of geospatial, material cultural, textual, natural, and artistic data. The algorithms are particularly suited toward rapid identification and classification of archaeological features and objects. The results of these new studies include identification of many new sites around the world and improved classification of large archaeological datasets. ML fits well with more traditional methods used in archaeological analysis, and it remains subject to both the benefits and difficulties of those approaches. Small datasets associated with archaeological work make ML vulnerable to hidden complexity, systemic bias, and high validation costs if not managed appropriately. ML's scalability, flexibility, and rapid development, however, make it an essential part of twenty-first-century archaeological practice. This review briefly describes what ML is, how it is being used in archaeology today, and where it might be used in the future for archaeological purposes.

Newborns With Acute Respiratory Distress: Diagnosis and Management

1988 ◽  
Vol 9 (9) ◽  
pp. 279-285
Author(s):  
Richard L. Schreiner ◽  
Niceta C. Bradburn
Keyword(s):  
Pulmonary Hypertension ◽  
Respiratory Distress ◽  
Newborn Infant ◽  
Blood Gases ◽  
Indirect Measurement ◽  
Chest Roentgenogram ◽  
Inborn Errors ◽  
Severe Respiratory Distress ◽  
Glucose Determination ◽  
Arterial Blood

If respiratory distress develops in the newborn after he or she has been normal for more than a few hours, bacterial sepsis, inborn errors of metabolism, cardiac disorders, and intracranial hemorrhage should be suspected. It is virtually impossible to determine whether an infant with mild respiratory distress in the first few hours of life will have rapid resolution of disease or progress to severe respiratory distress. That is, it is difficult to differentiate among transient tachypnea of the newborn, sepsis, and pulmonary hypertension in the infant with mild respiratory distress in the first few hours of life. Transient tachypnea is a diagnosis that can only be made with certainty after the infant's respiratory distress has resolved. The newborn infant with mild respiratory distress of more than a few hours' duration requires a minimum number of laboratory tests including chest roentgenogram, hematocrit or hemoglobin, blood glucose determination, direct or indirect measurement of arterial blood gases, and blood cultures. The liberal use of oxygen in the near-term, term, or post-term vigorous but cyanotic infant in the delivery room may decrease the incidence and/or severity of respiratory distress due to pulmonary hypertension. A newborn infant with respiratory distress for more than a few hours should be considered a candidate for infection.

DIGITALIS TOLERANCE IN YOUNG PUPPIES

PEDIATRICS ◽  
1970 ◽  
Vol 46 (5) ◽  
pp. 730-736
Author(s):  
Katherine H. Halloran ◽  
Steven C. Schimpff ◽  
Jean G. Nicolas ◽  
Norman S. Talner
Keyword(s):  
Blood Gases ◽  
Acid Base Balance ◽  
Acid Base ◽  
Littermate Control ◽  
Premature Ventricular Contractions ◽  
Toxic Dose ◽  
Arterial Blood ◽  
Wide Range ◽  
Base Balance ◽  
The Mean

Tolerance to acetyl strophanthidin, a rapid-acting cardiac aglycone, was determined in 28 anesthetized mongrel puppies, ages 16 to 56 days, and compared to tolerance in 16 littermate puppies in whom acute hypercapnic acidemia was produced. The tolerance was also compared to that of four adult mongrel dogs. The toxic dose was defined as the intravenous amount required to produce four consecutive premature ventricular contractions. A marked variation in the toxic dose was found in the 28 control puppies (range 83 to 353 µg/kg, mean 169 µg/kg) which could not be correlated with age, arterial blood gases or pH, serum potassium or sodium, arterial pressure, or heart rate. The toxic dose was significantly greater in the puppies than in the adult dogs, in whom the mean toxic dose was 64 µg/kg (range 50 to 89 µg/kg). A significant increase in tolerance was also observed in the puppies with hypercapnic acidemia (mean toxic dose 220 µg/kg, range 93 to 375 µg/kg) in comparison to tolerance in the control puppies and despite the wide range of tolerance, each of the puppies with hypercapnic acidemia showed greater tolerance than its littermate control puppy. Assessment of the clinical implications of these findings will require study of the effects of alterations in acid-base balance on the inotropic effect of acetyl strophanthidin in addition to the toxic electrophysiologic effects.

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