How to detect the subtle changes of early deterioration

2020 ◽  
Vol 11 (7) ◽  
pp. 325-330
Author(s):  
Kathryn Latimer-Jones
Keyword(s):  
Systematic Approach ◽  
Vital Signs ◽  
Nursing Role ◽  
Patient Deterioration ◽  
Life Threatening

A crucial nursing role is the identification of patient deterioration. Identifying deterioration usually begins with the observation of vital signs. Nevertheless, this depends on how users interpret the results they find, as well as their ability to consult with their senior colleagues when needed. The aim of this article is to help nurses improve their knowledge of the skills required to promptly identify potentially life-threatening problems by employing a systematic approach, which can ultimately result in better care and better outcomes.

Necrotizing Fasciitis Occurred in the Lymphedematous leg

2021 ◽  
pp. 153473462110230
Author(s):  
Hisako Hara ◽  
Makoto Mihara ◽  
Takeshi Todokoro
Keyword(s):  
Case Report ◽  
Necrotizing Fasciitis ◽  
Lower Limb ◽  
Gynecologic Cancer ◽  
Vital Signs ◽  
Ethics Committee ◽  
Secondary Lymphedema ◽  
Delayed Treatment ◽  
Institutional Ethics ◽  
Life Threatening

Lymphedema is a chronic edema that sometimes occurs after treatment of gynecologic cancer, and cellulitis often occurs concomitantly with lymphedema. On the other hand, necrotizing fasciitis (NF) is a relatively rare, but life-threatening disease. The symptoms in cellulitis and NF are very similar. In this case report, we describe a case in which the diagnosis of NF in a lymphedematous limb was difficult. A 70-year-old woman had secondary lymphedema in bilateral legs and consulted our department. On the first day of lymphedema therapy, the patient complained of vomiting, diarrhea, and fever (37.7 °C) without local fever in the legs. She was diagnosed with acute gastroenteritis. On the next day, swelling and pain in her left leg occurred and her blood pressure was 59/44 mmHg. She was diagnosed with cellulitis accompanied by lower limb lymphedema and septic shock. On the second day, blisters appeared on the left leg, and computed tomography showed NF. We performed debridement under general anesthesia and her vital signs improved postoperatively. Streptococcus agalactiae (B) was detected in blood culture, and we administered bixillin and clindamycin. Postoperatively, necrosis in the skin and fat around the left ankle gradually spread, and it took 5 months to complete epithelialization. The diagnosis was more difficult than usual NF because patients with lymphedema often experience cellulitis. Clinicians should always think of NF to avoid mortality due to delayed treatment. This case report was approved by the institutional ethics committee.

Determinants of pyelonephritis onset in patients with obstructive urolithiasis

2021 ◽  
pp. 039156032110352
Author(s):  
Georges Abi Tayeh ◽  
Ali Safa ◽  
Julien Sarkis ◽  
Marwan Alkassis ◽  
Nour Khalil ◽  
...  
Keyword(s):  
Emergency Department ◽  
Renal Colic ◽  
Demographic Data ◽  
Vital Signs ◽  
Kidney Injury ◽  
Stone Size ◽  
Positive Urine ◽  
Life Threatening ◽  
Fat Stranding ◽  
Obstructive Pyelonephritis

Background: Acute obstructive pyelonephritis due to urolithiasis represents a medico-surgical emergency that can lead to life-threatening complications. There are still no established factors that reliably predict progression toward acute pyelonephritis in patients presenting with a simple renal colic. Objective: To investigate clinical and paraclinical factors that are associated with the onset of acute obstructive pyelonephritis. Methods: Patients presenting to the emergency department for renal colic with obstructive urolithiasis on imaging were enrolled in the study. Demographic data, vital signs, medical comorbidities, blood test results, urinalysis, and radiological findings were recorded. Obstructive pyelonephritis was defined by the presence of two or more of the following criteria: fever, flank pain or costovertebral angle tenderness, and a positive urine culture. Results: Seventeen patients out of 120 presenting with renal colic, were diagnosed with acute obstructive pyelonephritis (14%). Parameters that were associated with the onset of obstructive pyelonephritis were: diabetes ( p = 0.03), elevated CRP ( p = 0.01), stone size (>5 mm) ( p = 0.03), dilatation of renal pelvis ( p = 0.01), peri-renal fat stranding ( p = 0.02), and positive nitrites on urinalysis ( p < 0.01). Hyperleukocytosis, acute kidney injury, multiple stones, pyuria (>10/mm3), hypertension, and were not associated with the onset of obstructive pyelonephritis. Conclusion: This study showed that known diabetic status, elevated CRP, positive urine nitrites, stone size (>5 mm), pyelic dilatation, and peri-renal fat stranding were associated with the onset of pyelonephritis in patients presenting to the emergency department with obstructive urolithiasis.

scholarly journals Non-contact monitoring of agitation and use of a sheltering device in patients with dementia in emergency departments: a feasibility study (Preprint)

2019 ◽  
Author(s):  
Lisa Kroll ◽  
Nikolaus Böhning ◽  
Heidi Müßigbrodt ◽  
Maria Stahl ◽  
Pavel Halkin ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Real Life ◽  
Vital Signs ◽  
Safety Issues ◽  
Positive Effects ◽  
Real Life Setting ◽  
Life Threatening ◽  
Monitoring Devices ◽  
Study Setting ◽  
Technical Reliability

BACKGROUND Agitation is common in geriatric patients with dementia (PWD) admitted to an emergency department (ED) and is associated with a higher risk of an unfavourable clinical course. Hence, monitoring of vital signs and enhanced movement is essential in these patients during their stay in the ED. Since PWD rarely tolerate fixed monitoring devices, non-contact monitoring systems might represent appropriate alternatives. OBJECTIVE To study the reliability of a non-contact monitoring system (NCMSys) and of a tent-like device (“Charité Dome”, ChD), aimed to shelter PWD from the busy ED-environment. Further, effects of the ChD on wellbeing and agitation of PWD will be measured. METHODS Both devices were attached to patient’s bed. Tests on technical reliability and other safety issues of the NCMSys and the ChD were performed at the iDoc-institute. A feasibility study evaluating the reliability of the NCMSys with and without the ChD was performed in the real-life setting of an ED and on a geriatric-gerontopsychiatric ward. Technical reliability and other safety issues were tested with six healthy volunteers. For the feasibility study 19 patients were included (ten males and nine females; mean age: 77.4 (55-93) years of which 14 were PWD. PWD inclusion criteria were age ≥55 years, a dementia diagnosis as well as a written consent (by patients themselves or by a custodian). Exclusion criteria were acute life-threatening situations and a missing consent. RESULTS Heart rate, changes in movement and sound emissions were measured reliably by the NCMSys, whereas patient movements affected respiratory rate measurements. The ChD did not impact patients’ vital signs or movements in our study setting. However, 53% of the PWD (7/13) and most of the patients without dementia (4/5) benefited from its use regarding their agitation and overall wellbeing. CONCLUSIONS NCMSys and ChD work reliably in the clinical setting and have positive effects on agitation and wellbeing. The results of this feasibility study encourages prospective studies with longer durations to further evaluate this concept for monitoring and prevention of agitation in PWD in the ED. CLINICALTRIAL ICTRP: “Charité-Dome-Study - DRKS00014737”

scholarly journals Physiological Observations and Nursing Interventions in the Pre-Arrest Patient: A Descriptive Study

2021 ◽  
Author(s):  
◽  
Tara Marie Ryton-Malden
Keyword(s):  
Cardiac Arrest ◽  
Medical Staff ◽  
Early Recognition ◽  
Vital Signs ◽  
Nursing Interventions ◽  
Nursing Documentation ◽  
Patient Deterioration ◽  
Tertiary Teaching ◽  
Improve Compliance ◽  
Tertiary Teaching Hospital

<p>Aim: To identify how nurses respond to abnormal physiological observations in the 12 hours prior to a patient having a cardiac arrest. Methods: A descriptive observational design was used to retrospectively review the observation charts and nursing notes of 28 patients who had an in-hospital cardiac arrest, during a 20 month period. This study was performed in a large, tertiary teaching hospital in New Zealand. Key Findings Only one patient met the hospitals minimum standard of four hourly observations and a full set of vital signs were performed on only three patients. The nursing responses were limited to increasing the frequency of observations or informing the doctor. There were few other interventions to treat the abnormality. Eight (32%) patients who had either no response or a partial response to their abnormal physiology did not survive. The nursing documentation demonstrated that abnormal neurological observations were tolerated for significant periods of time and were not acted upon in 62% of these patients. The nursing documentation revealed that the delivery of oxygen was often insufficient to meet the patient's requirements and the medical staff were aware of less than half the patients with abnormal physiology. Discussion removed statement re pt survival: This research identified major deficiencies with recording patient vital signs. If these are not recorded regularly, patient deterioration will be missed and treatment cannot be initiated. Nurses need to respond to abnormal physiology beyond repeating vital signs and informing the medical staff. They are accountable for initiating interventions to prevent further deterioration. Conclusion: The early recognition of patient deterioration and treatment are essential to prevent cardiac arrest. Education strategies are required to improve compliance with recording patient vital signs, communication between nursing and medical staff and how to respond to patient deterioration. The barriers to these must be addressed and solutions sought if patient mortality is to be improved.</p>

Modular Technical Concepts for Ambulatory Monitoring of Risk Patients Based on Multiple Parameters and an Automatic Alarm Function

2016 ◽  
Vol 4 (1) ◽  
pp. 1-9
Author(s):  
Jörg Piper ◽  
Birgit Müller
Keyword(s):  
Data Acquisition ◽  
Ambulatory Monitoring ◽  
Vital Signs ◽  
Data Acquisition System ◽  
Acquisition System ◽  
False Alarms ◽  
Multiple Parameters ◽  
Risk Patients ◽  
Life Threatening ◽  
Long Term Prognosis

Technical concepts of a multi-parameter-based system are described which can be used for continuous ambulatory monitoring of several vital signs. When critical or fatal events are detected, an automatic alarm is generated including information about the patient´s position (global positioning system, GPS) and additional messages. A lot of vital parameters are continuously monitored by “bio detectors” which are connected with a mobile data acquisition system carried by the patient. This data acquisition system interacts with a mobile phone so that an alarm can immediately be sounded in cases of critical or fatal events. Other episodes relevant for the patient´s long-term prognosis without leading to life-threatening outcomes can be stored for elective analyses without generating an alarm. Moreover, patients can manually give an alarm on demand. Potential false alarms can be manually canceled. In further stages of development these technical components could interact with electronic control systems of cars so that cars could be immediately stopped if the driver becomes unconscious.

scholarly journals Cueing Attention to a Matrix of Values on a Head-Worn Display: Four Studies with a Multiple Patient Monitoring Task

2019 ◽  
Vol 63 (1) ◽  
pp. 1771-1771
Author(s):  
Isaac S. Salisbury ◽  
Tsz-Lok Tang ◽  
Caitlin Browning ◽  
Paul D. Schlosser ◽  
Ismail Mohamed ◽  
...  
Keyword(s):  
Patient Monitoring ◽  
Vital Signs ◽  
High Contrast ◽  
Design Features ◽  
Visual Cue ◽  
Monitoring Task ◽  
Patient Deterioration ◽  
Auditory Alerts ◽  
Multiple Patients

Head-worn displays (HWDs) can help clinicians monitor multiple patients by displaying multiple patients’ vital signs. We conducted four experiments exploring design features that affect how a HWD can quickly and reliably cue attention to patient deterioration. In a series of lab-based experiments, we found that a HWD could quickly and reliably cue participants’ attention with high-contrast visual highlights with two distinct levels, or with a short white flash. However, visual alerts on a HWD did not cue attention as quickly as similar alerts on a conventional screen or auditory alerts. We conclude that HWDs can quickly notify clinicians of patient deterioration when paired with a strong visual cue, but there are perceptual challenges unique to HWDs.

scholarly journals Polyserositis: An Extremely Rare Life-Threatening Manifestation of Pheochromocytoma

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Maryam Heidarpour ◽  
Mohammad Ali Haghighatpanah ◽  
Hassan Rezvanian ◽  
Motahare Yadegarfar ◽  
Amir Mohammad Mozafari ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Cardiac Tamponade ◽  
Adrenal Mass ◽  
Vital Signs ◽  
Abdominal Computed Tomography ◽  
Life Threatening

The pericardium is an uncommon site for manifestation of pheochromocytoma. Herein, the case of a 57-year-old man with cardiac tamponade is presented. Pericardiocentesis was performed, and the vital signs were stabilized afterwards. An abdominal computed tomography (CT) scan illustrated a nonhomogeneous right adrenal mass suspicious of pheochromocytoma, planned for right adrenalectomy. He recovered well after surgery, and his subsequent follow-ups did not reveal any complications.

scholarly journals An Uncommon Cause of Gastrointestinal Bleeding in an 84-Year-Old Female

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Suartcha Prueksaritanond ◽  
Aram Barbaryan ◽  
Alaa M. Ali ◽  
Aibek E. Mirrakhimov
Keyword(s):  
Vital Signs ◽  
Intravenous Methylprednisolone ◽  
Drug Induced ◽  
Spontaneous Bleeding ◽  
Laboratory Results ◽  
Bowel Movements ◽  
Life Threatening ◽  
Multiple Units ◽  
Multiple Episodes ◽  
Caucasian Female

The estimated annual incidence for drug-induced thrombocytopenia is 10 per million. Although fatal consequences are uncommon, life-threatening hemorrhage can occur due to spontaneous bleeding. We report a case of 84-year-old Caucasian female who presented to the emergency department with multiple episodes of bloody bowel movements. One week prior to this admission, she was started on trimethoprim-sulfamethoxazole for the treatment of skin abscess. On admission laboratory results showed platelet count of 4 × 103/mm3and hemoglobin of 10.2 g/dL. Because of unstable vital signs, the patient was transferred to the intensive care unit where she received multiple units of platelet and blood transfusion. Drug-induced thrombocytopenia due to TMP/SMX was suspected. Intravenous methylprednisolone was started as well as immune globulin with good clinical response.

Cyclic Antidepressant Poisoning: A Review and Case Report

1993 ◽  
Vol 6 (2) ◽  
pp. 89-102 ◽  
Author(s):  
Henry Cohen ◽  
Robert S. Hoffman ◽  
Mary Ann Howland
Keyword(s):  
Supportive Care ◽  
Tricyclic Antidepressants ◽  
Vital Signs ◽  
The United States ◽  
Qrs Complex ◽  
The Past ◽  
Life Threatening ◽  
Gastrointestinal Decontamination ◽  
Cns Depression ◽  
Intravenous Sodium

Although newer cyclic antidepressants have been introduced over the past several years, the tricyclic antidepressants (TCAs) continue to be the leading cause of morbidity from drug overdose in the United States. Overdose features depend on the particular cyclic antidepressant ingested and its pharmacological properties, and can include CNS depression, cardiac arrhythmias, hypotension, seizures, and anticholinergic symptomatology. Life-threatening symptomatology almost always begins within 2 hours, and certainly within 6 hours, after arrival to the emergency department. Plasma TCA levels are unreliable predictors of TCA toxicity and are not recommended. An ECG with a prolonged QRS complex more than 100 msec seems to be the best indicator of serious sequelae with TCAs. Management consists of stabilization of vital signs, gastrointestinal decontamination, intravenous sodium bicarbonate, and supportive care. Agents once thought to be useful for the treatment of cardiac dysrhythmias and seizures such as phenytoin and physostigmine should be avoided. The future of TCA antibody fragments in the treatment of TCA overdose seems promising. Newer and, to some degree, safer antidepressants in overdose have recently been introduced, and they include fluoxetine, trazodone, and sertraline. Amoxapine, bupropion, and maprotiline seem to be as toxic as the TCAs. A significant interaction between cyclic antidepressants and monoamine-oxidase inhibitors exists. Management includes supportive care and basic poison management. Prevention of poisoning seems to be the most logical and effective method of maintaining patient safety. TCAs should be avoided in children younger than 6 years old. All adults with suicidal ideations should receive no more than a 1-week supply (about 1 g) of drug. Finally consideration should be given to using one of the newer, safer antidepressants in all patients with suicidal ideations.

Antidepressant Poisoning and Treatment: A Review and Case Illustration

1997 ◽  
Vol 10 (4) ◽  
pp. 249-270 ◽  
Author(s):  
Henry Cohen ◽  
Robert S. Hoffman ◽  
Mary Ann Howland
Keyword(s):  
Supportive Care ◽  
Tricyclic Antidepressants ◽  
Vital Signs ◽  
The United States ◽  
The Past ◽  
Cardiac Dysrhythmias ◽  
Life Threatening ◽  
Gastrointestinal Decontamination ◽  
Cns Depression ◽  
Intravenous Sodium

Although newer antidepressants have been introduced over the past several years, the tricyclic antidepressants (TCAs) continue to be a leading cause of morbidity from drug overdose in the United States. Overdose features depend on the particular cyclic antidepressant ingested and its pharmacological properties, and can include CNS depression, cardiac dysrhythmias, hypotension, seizures, and anticholinergic symptoms. Life-threatening events almost always begin within two hours, and certainly within six hours, after arrival to the emergency department. Plasma TCA levels are unreliable predictors of TCA toxicity and are therefore not recommended. An ECG with a prolonged QRS complex more than 100 msec seems to be the best indicator of serious sequelae with TCA overdose. Management consists of stabilization of vital signs, gastrointestinal decontamination, intravenous sodium bicarbonate, and supportive care. Agents once thought to be useful for the treatment of cardiac dysrhythmias and seizures such as phenytoin and physostigmine should be avoided. The future of TCA antibody fragments in the treatment of TCA overdose seems promising. Amoxapine, bupropion, and maprotiline seems to be as toxic as the TCAs. Overdose data is limited for venlafaxine, and mirtazapine, and preclude firm conclusions. A significant interaction between cyclic antidepressants and monoamine-oxidase inhibitors exists. Management includes supportive care and basic poison management. Prevention of poisoning seems to be the most logical and effective method of maintaining patient safety. TCAs should be avoided in children younger than 6 years old. All adults with suicidal ideations should receive no more than a one-week supply (less than 1 g) of drug. Newer and, to some degree, safer antidepressants in overdose have recently been introduced, and they include fluoxetine, sertraline, paroxetine, trazodone, and nefazodone. Finally, consideration should be given to using one of these newer, safer antidepressants in all patients with suicidal ideations.

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