scholarly journals Vital signs effectively predict non-hypoglycaemia in patients with altered mental status in pre-hospital settings: A retrospective analysis

2020 ◽  
Author(s):  
Daisuke Mizu ◽  
Yoshinori Matsuoka ◽  
Ji Young Huh ◽  
Koichi Ariyoshi
Keyword(s):  
Body Temperature ◽  
Mental Status ◽  
Vital Sign ◽  
Measurement Errors ◽  
Vital Signs ◽  
Area Under The Curve ◽  
Altered Mental Status ◽  
Final Diagnosis ◽  
Significant Difference ◽  
Kobe City

Abstract BackgroundBlood glucose (BG) measurement by paramedics for patients with altered mental status is recommended as pre-hospital care in Japan. Therefore, paramedics prioritise BG measurement over transport to hospital even in emergency conditions such as hypotension or hypoxaemia. The purpose of this study was to examine the relationship between BG levels and vital signs, and to evaluate whether vital signs are effective in determining the necessity of BG measurement in pre-hospital settings. MethodsWe extracted data of patients who had BG measurements performed by paramedics in Kobe City from April 2015 to March 2019. We retrospectively investigated patient age, sex, presence of hypoglycaemia (BG level < 50 mg/dL) and vital signs. If a patient did not have hypoglycaemia and was transported to the Kobe City Medical Centre General Hospital, a final diagnosis was obtained. Patients aged below 15 years, and those with BG measurement errors, missing vital sign data, or a Japan Coma Scale 0 and I-digit codes were excluded. The χ2 test and Mann-Whitney U test were used for statistical analysis, and P<0.05 was considered statistically significant. ResultsOf the 1,791 patients, 1,242 were eligible for analysis (mean age, 71.9 years; 805 [58%] male). Hypoglycaemia was observed in 324 patients (26.1%). Of the 918 non-hypoglycaemic patients, 253 (27.6%) were transported to our hospital and stroke was the most common final diagnosis (61 patients [24.1%]). The non-hypoglycaemic group had more elderly patients than the hypoglycaemic group (median 73 vs. 76 years; P < 0.01). A significant difference in each vital sign were noted between hypoglycaemic and non-hypoglycaemic groups, with body temperature showing the highest difference between groups (area under the curve, 0.71; 95% confidence interval [CI], 0.68-0.74). Furthermore, in cases with systolic blood pressure being over 100 mmHg and body temperature being 38°C or less, it was highly unlikely that hypoglycaemia caused impaired consciousness (likelihood ratio 0.12 and 0.16; 95% CI 0.05-0.25 and 0.06-0.35, respectively). ConclusionWhen considering pre-hospital hypoglycaemia assessment, vital signs are an effective index. If patients have significant hypotension or high fever, paramedics should consider immediate transport rather than BG measurement.

scholarly journals Vital-SCOPE: Design and Evaluation of a Smart Vital Sign Monitor for Simultaneous Measurement of Pulse Rate, Respiratory Rate, and Body Temperature for Patient Monitoring

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Guanghao Sun ◽  
Takemi Matsui ◽  
Yasuyuki Watai ◽  
Seokjin Kim ◽  
Tetsuo Kirimoto ◽  
...  
Keyword(s):  
Body Temperature ◽  
Respiratory Rate ◽  
Correlation Coefficient ◽  
Pulse Rate ◽  
Simultaneous Measurement ◽  
Vital Sign ◽  
Vital Signs ◽  
Pearson’S Correlation ◽  
Pearson's Correlation ◽  
The Mean

Consistent vital sign monitoring is critically important for early detection of clinical deterioration of patients in hospital settings. Mostly, nurses routinely measure and document the primary vital signs of all patients 2‐3 times daily to assess their condition. To reduce nurse workload and thereby improve quality of patient care, a smart vital sign monitor named “Vital‐SCOPE” for simultaneous measurement of vital signs was developed. Vital-SCOPE consists of multiple sensors, including a reflective photo sensor, thermopile, and medical radar, to be used in simultaneous pulse rate, respiratory rate, and body temperature monitoring within 10 s. It was tested in laboratory and hospital settings. Bland-Altman and Pearson’s correlation analyses were used to compare the Vital-SCOPE results to those of reference measurements. The mean difference of the respiratory rate between respiratory effort belt and Vital-SCOPE was 0.47 breaths per minute with the 95% limit of agreement ranging from −7.4 to 6.5 breaths per minute. The Pearson’s correlation coefficient was 0.63 (P<0.05). Moreover, the mean difference of the pulse rate between electrocardiogram and Vital-SCOPE was 3.4 beats per minute with the 95% limit of agreement ranging from −13 to 5.8 beats per minute; the Pearson’s correlation coefficient was 0.91 (P<0.01), indicating strong linear relationship.

scholarly journals Incidence, Etiology, and Outcomes of Altered Mental Status in the Perioperative Setting of Liver Transplantation

2017 ◽  
Vol 8 (3) ◽  
pp. 124-128 ◽  
Author(s):  
Christopher Lening ◽  
Vatche G. Agopian ◽  
Ronald W. Busuttil ◽  
David S. Liebeskind
Keyword(s):  
Liver Transplantation ◽  
Mental Status ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Altered Mental Status ◽  
Sudden Onset ◽  
Transplant Patients ◽  
Significant Difference ◽  
Presentation Group

Background: We examined neurologic consultations for altered mental status in perioperative liver transplant patients to determine the overall incidence, to assess the presumed etiology and the data reviewed to determine that etiology, and to assess outcomes. Methods: Retrospective chart review conducted for all 728 adult patients receiving orthotopic liver transplantation (OLT) between January 01, 2010, to June 30, 2014, with identification of 218 receiving neurology consults between 30 days pre-OLT and 90 days post-OLT, with review of all records necessary to determine initial findings and follow-up examination. Results: Seventy-three consults for 69 patients were identified, with 27 felt to be altered since a procedure, 20 with sudden-onset altered mentation, and 26 with gradual or waxing–waning course. A single underlying etiology was identified in only 19 cases, with multiple factors involved in all others, with metabolic, toxic, infectious, and structural etiologies most often implicated. There was no statistically significant difference in outcome for those with altered mental status consults versus the total OLT population, though the sudden-onset presentation group did show significantly increased mortality rates. Conclusions: This systematic study illustrates the variety of potential causes of altered mentation within the perioperative setting of liver transplantation. Workup including neuroimaging (preferably magnetic resonance imaging), infectious cultures, and expanded metabolic laboratory tests should be undertaken.

scholarly journals Design and Improving Vital Sign with Parameter Body Temperature (axilla) and Oxymetry for Patient Monitoring

2020 ◽  
Vol 2 (2) ◽  
pp. 58-64
Author(s):  
Mohamad Adam Firdaus ◽  
Andjar Pudji ◽  
Muhammad Ridha Mak'ruf
Keyword(s):  
Body Temperature ◽  
Oxygen Saturation ◽  
Vital Sign ◽  
Medical Service ◽  
Vital Signs ◽  
Measuring Instruments ◽  
Dressing Tool ◽  
Number Of Patients ◽  
Quality Of Patient Care

In most hospitals, nurses routinely calculate and document primary vital signs for all patients 2-3 times per day to get information on the patient's condition. Vital Sign Monitor is made for medical devices that can diagnose patients who need intensive care to determine patient needs. Some parameters used in patient renewal: Oxygen saturation (SPO2), and body temperature. This makes additional tasks very important to be evaluated for medical staff and equipment manufacturers. This evaluation is needed to get the real condition of the patient. With the large number of patients who need evaluation, it is not possible to see the condition of some medical workers who work. This medical service is expected to reduce the workload of nurses with doctors and improve the quality of patient care. The large demand for these devices, mostly in hospital intensive rooms, is the basis for researching the output of data from multiple vital sensor monitor monitors to obtain accurate and precise outputs. The output of the two sensors is processed by Arduino Mega2560 and requested on a 5 inch TFT LCD in the form of body temperature and oxygen saturation. Comparison of module results with standard measuring instruments calibrated to reference this module is used for accurate and precise results. According to the assessment and reversing tool data with the dressing tool, the highest error value is 1%. With a maximum permitted permission of 5%.

scholarly journals Contactless Vital Signs Measurement System Using RGB-Thermal Image Sensors and Its Clinical Screening Test on Patients with Seasonal Influenza

Sensors ◽  
2020 ◽  
Vol 20 (8) ◽  
pp. 2171 ◽  
Author(s):  
Toshiaki Negishi ◽  
Shigeto Abe ◽  
Takemi Matsui ◽  
He Liu ◽  
Masaki Kurosawa ◽  
...  
Keyword(s):  
Heart Rate ◽  
Body Temperature ◽  
Respiration Rate ◽  
Vital Sign ◽  
Seasonal Influenza ◽  
Estimation Method ◽  
Vital Signs ◽  
Thermal Image ◽  
Image Sensors ◽  
Music Algorithm

Background: In the last two decades, infrared thermography (IRT) has been applied in quarantine stations for the screening of patients with suspected infectious disease. However, the fever-based screening procedure employing IRT suffers from low sensitivity, because monitoring body temperature alone is insufficient for detecting infected patients. To overcome the drawbacks of fever-based screening, this study aims to develop and evaluate a multiple vital sign (i.e., body temperature, heart rate and respiration rate) measurement system using RGB-thermal image sensors. Methods: The RGB camera measures blood volume pulse (BVP) through variations in the light absorption from human facial areas. IRT is used to estimate the respiration rate by measuring the change in temperature near the nostrils or mouth accompanying respiration. To enable a stable and reliable system, the following image and signal processing methods were proposed and implemented: (1) an RGB-thermal image fusion approach to achieve highly reliable facial region-of-interest tracking, (2) a heart rate estimation method including a tapered window for reducing noise caused by the face tracker, reconstruction of a BVP signal with three RGB channels to optimize a linear function, thereby improving the signal-to-noise ratio and multiple signal classification (MUSIC) algorithm for estimating the pseudo-spectrum from limited time-domain BVP signals within 15 s and (3) a respiration rate estimation method implementing nasal or oral breathing signal selection based on signal quality index for stable measurement and MUSIC algorithm for rapid measurement. We tested the system on 22 healthy subjects and 28 patients with seasonal influenza, using the support vector machine (SVM) classification method. Results: The body temperature, heart rate and respiration rate measured in a non-contact manner were highly similarity to those measured via contact-type reference devices (i.e., thermometer, ECG and respiration belt), with Pearson correlation coefficients of 0.71, 0.87 and 0.87, respectively. Moreover, the optimized SVM model with three vital signs yielded sensitivity and specificity values of 85.7% and 90.1%, respectively. Conclusion: For contactless vital sign measurement, the system achieved a performance similar to that of the reference devices. The multiple vital sign-based screening achieved higher sensitivity than fever-based screening. Thus, this system represents a promising alternative for further quarantine procedures to prevent the spread of infectious diseases.

scholarly journals Evaluación de un transductor integral para determinar la magnitud del error de medición.

2019 ◽  
Vol 37 (4) ◽  
pp. 329
Author(s):  
Ronaldo Galindo-Castillo ◽  
Santos Gabriel Campos-Magaña ◽  
Martín Cadena-Zapata ◽  
Alejandro Zermeño-González ◽  
Juan Antonio López-López ◽  
...  
Keyword(s):  
Measurement Errors ◽  
Reaction Force ◽  
Area Under The Curve ◽  
Force Sensor ◽  
Soil Reaction ◽  
Present Measurement ◽  
Significant Difference ◽  
Reaction Forces ◽  
Different Depths ◽  
Para Determinar

The use of soil reaction force transducers coupled between the tractor and integral tillage implements are in their experimental phase in different parts of the world; however, these developments present measurement errors. The objective of this research was to corroborate the magnitude of error between an Integral Force Sensor (SIF) connected to the tractor three-point hitch and two individual sensors coupled to the work tools to monitor soil reaction forces at the integral implements. SIF was tested under laboratory conditions with calibrated equipment to register force measurements at different lever distances and at different weights, using a data acquisition system DaqBook 2000 (Measurement Computing) and a signal conditioner DBK43A (Iotech Inc.). Obtained results indicated that SIF is sensitive to the load position, equivalent to the tillage depth, in a 2 to 10% range of error. Field evaluations were performed with a chisel plow at different depths for validation, finding errors between 13.07 and 41.72%, where chisel arrangement of 0.30 m depth for front chisels and 0.30 m for the rear chisel, showed the smallest error. Applying the 10% calibration correction obtained in the laboratory for a chisel length of 0.70 to 0.90 m, the obtained error was 3.1%. Comparison of the methods spectral analysis and area under the curve, equivalent to the energy used to obtain the error, showed that there is no significant difference between the two methods.

scholarly journals Myxedema Coma: Improving Outcomes With Prompt Recognition and Therapy

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A943-A943
Author(s):  
Aisha Parihar
Keyword(s):  
Mental Status ◽  
Vital Signs ◽  
Altered Mental Status ◽  
Morbidity And Mortality ◽  
Free T4 ◽  
Early Improvement ◽  
Delay In Diagnosis ◽  
Myxedema Coma ◽  
Artery Disease ◽  
Work Up

Abstract Background: Myxedema coma, a misnomer for severe hypothyroidism, is a rare endocrine emergency with an incidence of 1.08 cases per million people per year and a high mortality rate ranging from 30-50%. A delay in diagnosis and treatment worsens the prognosis and increases morbidity and mortality. Delayed management often leads to decompensation, presenting as uncontrolled persistent hypothermia, severe electrolyte derangements, and a potential for ventilator requirement needing ICU care. We present a patient in hypothyroid crisis who was promptly managed in a non-ICU setting who demonstrated a relatively early improvement in vital signs, thyroid lab values, and return to baseline mental status. Clinical Case: A 75 year old female with past medical history of hypothyroidism, atrial fibrillation, hypertension, coronary artery disease, depression, tardive dyskinesia, and dementia presented to the hospital in the month of December due to confusion after a mechanical fall that resulted in a head laceration requiring multiple stitches. Trauma work up included a CT scan of the head that was negative. On presentation, patient was also hypothermic, bradycardic, hypotensive, and lethargic with an altered mental status. Sepsis work up was negative. TSH was checked on day of admission and found to be significantly elevated to &gt; 100 mcIU/mL, consistent with severe hypothyroidism. Free T4 and total T3 levels were low. Patient was immediately given intravenous levothyroxine 300 mcg followed by oral levothyroxine 125 mcg daily. In addition, intravenous hydrocortisone 100 mg every 8 hours was started until adrenal insufficiency was ruled out with a normal cortisol level. Upon discussion with family, it was learned that patient had not been taking her home medications indicating non-compliance to thyroid replacement therapy as the etiology for her hypothyroid crisis. Within a day of initiating therapy, TSH levels drastically improved with a reduction by 50%. Bradycardia, hypotension, and hypothermia resolved as well. In three days, patient’s mentation improved back to baseline and TSH, free T4, and total T3 continued to normalize. Conclusion: This case demonstrates how prompt recognition of hypothyroid crisis and immediate therapy can lead to early improvement in outcomes such as reversibility of mental status, normalization of vital signs and lab values, prevention of escalation of care to an ICU setting, and overall morbidity and mortality.

Abstract TP295: Predictability of Stroke Symptoms in Acute Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Maria J Bruzzone ◽  
Luka Vlahovic ◽  
Ramon Durazo ◽  
Sean Ruland
Keyword(s):  
Acute Stroke ◽  
Mental Status ◽  
Healthcare Providers ◽  
Signs And Symptoms ◽  
Altered Mental Status ◽  
Final Diagnosis ◽  
Facial Weakness ◽  
Stroke Patients ◽  
Accurate Identification ◽  
Limb Weakness

Background: Prompt signs and symptoms recognition and intervention are essential to achieve the best outcome after stroke. Stroke codes were developed to expedite assessment and treatment. Their optimal use requires accurate identification of stroke patients. In order to improve diagnostic accuracy in our institution, we analyzed the predictive value of individual stroke signs and symptoms in patients in whom stroke codes were activated from the emergency department (ED) by physicians and nurses and from inpatient wards by nurses, residents and hospitalists. Methods: We retrospectively analyzed 501 consecutive stroke codes in our stroke log from May 2013 to May 2015. Age, gender, presenting signs and symptoms, medical history and final diagnosis were assessed. Patients were classified as stroke (ischemic and hemorrhagic) or non-stroke based on the final impression after the completed work-up. X2 statistic was utilized to assess associations. Results: Overall, 202 (40.3%) patients were classified as stroke and 299 (59.7%) non-stroke. 78% of stroke codes were activated from ED and 22% from the inpatient wards. Unilateral limb weakness, aphasia and facial weakness were associated with stroke (p<0.05) with PPVs of 0.57 (95%CI 50-64%), 0.56 (43-68%), 0.51 (43-60%), respectively. Altered mental status (AMS) and sensory symptoms were associated with non-stroke (p<0.05). The PPV and NPV for stroke were 0.21 (95%CI 13-31%) and 0.55 (50-60%) for AMS respectively and 0.25 (14-39%) and 0.58 (43-63%) for sensory symptoms. Location of the stroke code (ED or inpatient ward) did not impact the results. Conclusion: Previous studies, based on evaluation of acute stroke by paramedics and ED physicians, demonstrated that some signs or symptoms are more likely to be present in patients experiencing acute stroke. In our experience, unilateral limb weakness, aphasia, and facial weakness as identified by diverse provider disciplines and experience levels are associated with a final diagnosis of acute stroke. However, isolated altered mental status or sensory symptoms seldom result in a final diagnosis of stroke. These data can assist healthcare providers, to more accurately identify stroke patients, thus improving outcomes as well as resources utilization.

scholarly journals Vital Signs Changes of Brick Industry Workers Exposed to Heat Pressure in Sukarami Palembang

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Syokumawena Syokumawena ◽  
Marta Pastari ◽  
Rahmad A. Juliansyah ◽  
Hanna S.W. Kusuma ◽  
Dwi D. Rihibiha
Keyword(s):  
Blood Pressure ◽  
Health Status ◽  
Body Temperature ◽  
Environmental Factors ◽  
Cardiovascular System ◽  
Vital Sign ◽  
Vital Signs ◽  
Chemical Substances ◽  
Pulse Heat

Brick workers are exposed to dust contained of mixtures of chemical substances andhigh temperature. Those environmental factors can affect the health status of the workers;mainly the cardiovascular system. The aim of this research was to observe the effect of heatpressure on vital sign of brick factory manufacturing workers in Sukarami Palembang. Theresearch was conducted in RT 07/13 Sungai Durian, Kecamatan Sukarami, Palembang. Thesubjects were 40 people brick workers; 20 workers were exposed to heat pressure and 20workers did not. We found that in the workers with heat pressure exposure,the average vitalsigns before working are blood pressure of 117/76 mmHg, pulse of 77 x/minutes, and bodytemperature of 36,5°C and after working are blood pressure of 130/84 mmHg, pulse of 92x/minutes, and body temperature of 38°C. In the workers without heat pressure exposure, theaverage vital signs before working are blood pressure of 107/80 mmHg, pulse of 75 x/minutes,and body temperature of 36°C and the average vital signs after working are blood pressure of112/81 mmHg, pulse of 79 x/minutes, and body temperature of 37°C. Conclusion, heat pressurehas effects on vital sign of brick factory manufacturing workers in Sukarami Palembang.Keywords: blood pressure, body temperature, brick factory pulse, heat pressure

scholarly journals An effect of physical exercise-induced fatigue on the vital sign parameters: A preliminary study

2019 ◽  
Vol 15 (2) ◽  
pp. 173-177
Author(s):  
Zulkifli Ahmad ◽  
Mohd Najeb Jamaludin ◽  
Kamaruzaman Soeed
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Body Temperature ◽  
Physical Exercise ◽  
Vital Sign ◽  
Vital Signs ◽  
Health Condition ◽  
The Body ◽  
Physical Movement ◽  
Exercise Induced

Vital sign monitoring is an important body measurement to identify health condition and diagnose any disease and illness. In sports, physical exercise will contribute to the changes of the physiological systems, specifically for the vital signs. Therefore, the objective of this study was to determine the effect of physical fatigue exercise on the vital sign parameters. This is significant for the fitness identification and prediction of each individual when performing an exercise. Five male subjects with no history of injuries and random BMI were selected from students of biomedical engineering, Universiti Teknologi Malaysia. Based on the relationship between physical movement and physiology, the parameters considered were heart rate, blood pressure, and body temperature. Subjects were required to run on the treadmill at an initial speed of 4 km/h with an increase of 1 km/h at every 2 minutes interval. The effect of exercise was marked according to the fatigue protocol where the subject was induced to the maximum condition of performance. All parameters were measured twice, for pre and post exercise-induced protocol. The analysis of relationship of each parameter between pre and post fatigue was p<0.05. The results revealed that the heart rate and gap between blood pressure’s systolic and diastolic were greater for all categories except underweight, where the systolic blood pressure dropped to below 100mmHg at the end of exercise. Also, the body temperature was slightly declined to balance the thermoregulatory system with sweating. Hence, the vigorous physical movement could contribute to the active physiological system based on body metabolism. Heart rate and blood pressure presented significant effects from the fatiguing exercise whereas the body temperature did not indicate any distinguishable impact. The results presented might act as the basis of reference for physical exercise by monitoring the vital sign parameters.

scholarly journals Evaluating the Accuracy of the VitalWellness Device

Iproceedings ◽  
10.2196/16250 ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. e16250
Author(s):  
Nicole Polanco ◽  
Sharon Odametey ◽  
Neda Derakhshani ◽  
Mark Khachaturian ◽  
Connor Devoe ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Standard Deviation ◽  
Body Temperature ◽  
Respiratory Rate ◽  
Linear Relationship ◽  
Vital Sign ◽  
Skin Color ◽  
Vital Signs ◽  
Mean Difference

Background Wellness devices for health tracking have gained popularity in recent years. Additionally, portable and readily accessible wellness devices have several advantages when compared to traditional medical devices found in clinical environments The VitalWellness device is a portable wellness device that can potentially aide vital sign measuring for those interested in tracking their health. Objective In this diagnostic accuracy study, we evaluated the performance of the VitalWellness device, a wireless, compact, non-invasive device that measures four vital signs (blood pressure (BP), heart rate (HR), respiratory rate (RR), and body temperature using the index finger and forehead. Methods Volunteers age ≥18 years were enrolled to provide blood pressure (BP), heart rate (HR), respiratory rate (RR), and body temperature. We recruited participants with vital signs that fell within and outside of the normal physiological range. A sub-group of eligible participants were asked to undergo an exercise test, aerobic step test and/or a paced breathing test to analyze the VitalWellness device’s performance on vital signs outside of the normal physiological ranges for HR and RR. Vital signs measurements were collected with the VitalWellness device and FDA-approved reference devices. Mean, standard deviation, mean difference, standard deviation of difference, standard error of mean difference, and correlation coefficients were calculated for measurements collected; these measurements were plotted on a scatter plot and a Bland-Altman plot. Sensitivity analyses were performed to evaluate the performance of the VitalWellness device by gender, skin color, finger size, and in the presence of artifacts. Results 265 volunteers enrolled in the study and 2 withdrew before study completion. Majority of the volunteers were female (62%), predominately white (63%), graduated from college or post college (67%), and employed (59%). There was a moderately strong linear relationship between VitalWellness BP and reference BP (r=0.7, P<.05) and VitalWellness RR and reference RR measurements (r=0.7, P<.05). The VitalWellness HR readings were significantly in line with the reference HR readings (r=0.9, P<.05). There was a weaker linear relationship between VitalWellness temperature and reference temperature (r=0.3, P<.05). There were no differences in performance of the VitalWellness device by gender, skin color or in the presence of artifacts. Finger size was associated with differential performance for RR. Conclusions Overall, the VitalWellness device performed well in taking BP, HR, and RR when compared to FDA-approved reference devices and has potential serve as a wellness device. To test adaptability and acceptability, future research may evaluate user’s interactions and experiences with the VitalWellness device at home. In addition, the next phase of the study will evaluate transmitting vital sign information from the VitalWellness device to an online secured database where information can be shared with HCPs within seconds of measurement.

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