Could We Use Vital Signs and Lactate Levels Together to Predict the Prognosis in Abdominal Pain?

Objectives: Abdominal pain occupies most of the emergency department admissions. This entity leads to research various markers for the early detection of causes in patients presenting with abdominal pain. There is limited data about collaborations between lactate levels and vital signs at admission in abdominal pain. Materials and Methods: Patients aged 18 years and older, who had presented with abdominal pain to the Emergency Department, in total 102 patients, were included to the study. The patients’ demographics, vital signs, abdominal physical examination findings, diagnosis and outcomes of patients were recorded. The 1 ml venous blood samples were collected by blood gase injectors from the patients and lactate levels were analyzed. Results: Female patients’ percentile was 68,6% and mean age was 39 years old. The systolic blood pressure levels were normal in 45 patients, low in 26% patients and high in 29% patients. The seventy-six of the patients had normal pulse rate and 26 of them were tachycardic. Most common diagnosis was non-specific abdominal pain (37,25%) and the least common was ovarian torsion/intracystic hemorrhage (0,98%) and obstruction due to hernia (0,98%). There was no statistically significant relation between lactate level and pulse rate (p=0,637), systolic blood pressure (p=0,052), diastolic blood pressure (p=0,095), respiratory rate (p=0,527), body temperature (p=0,040) and oxygen saturation (p=0,905). Similarly, no significant association occurred between lactate levels and diagnosis and outcomes. Conclusion: Further studies including more patients groups have to be done in order to attain more reliable data about this topic.

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FRI0618-HPR EFFECTS OF MUSIC THERAPY ON PAIN, ANXIETY, AND VITAL SIGNS IN CHRONIC INFLAMMATORY RHEUMATIC DISEASES PATIENTS DURING BIOLOGICAL DRUGS INFUSION

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.6027 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 914.2-914

Author(s):

S. Boussaid ◽

M. Ben Majdouba ◽

S. Jriri ◽

M. Abbes ◽

S. Jammali ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Music Therapy ◽

Systolic Blood Pressure ◽

Respiratory Rate ◽

Vital Signs ◽

Biological Therapies ◽

Biological Drugs ◽

Pain Anxiety ◽

The Mean

Background:Music therapy is based on ancient cross-cultural beliefs that music can have a “healing” effect on mind and body. Research determined that listening to music can increase comfort and relaxation, relieve pain, lower distress, reduce anxiety, improve positive emotions and mood, and decrease psychological symptoms. Music therapy has been used greatly in various medical procedures to reduce associated anxiety and pain. Patients have a high level of anxiety when they are in the hospital, this is the case of patients with rheumatic diseases who consult regularly to have intravenous infusion of biological therapies.Objectives:The purpose of this study was to examine the effectiveness of music therapy on pain, anxiety, and vital signs among patients with chronic inflammatory rheumatic diseases during intravenous infusion of biological drugs.Methods:Fifty patients were divided into two groups: The experimental group G1 (n=25) received drug infusion while lestening to soft music (30 minutes); and the control group G2 (n=25) received only drug infusion. Measures include pain, anxiety, vital signs (blood pressure, heart rate and respiratory rate). The pain was measured using visual analogic scale (VAS). The state-trait anxiety inventory (STAI) was used for measuring anxiety, low anxiety ranges from 20 to 39, the moderate anxiety ranges from 40 to 59, and high anxiety ranges from 60 to 80. Vital signs (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR], and respiratory rate [RR]) were measured before, during and immediately after the infusion.Statistical package for social sciences (SPSS) was used for analysis.Results:The mean age in G1 was 44.45 years (26-72) with a sex ratio (M/F) of 0.8. Including the 25 patients, 12 had rheumatoid arthritis, 10 had ankylosing spondylitis and 3 had psoriatic arthritis. The mean disease duration was 8 years. In G2, the mean age was 46 years (25-70) with a sex ratio (M/F) of 0.75, 12 had rheumatoid arthritis, 11 had ankylosing spondylitis and 2 had psoriatic arthritis. The mean disease duration was 7.5 years. The biological drugs used were: Infliximab in 30 cases, Tocilizumab in 12 cases and Rituximab in 8 cases.Before the infusion, the patients of experimental group had a mean VAS of 5/10±3, a mean STAI of 50.62±6.01, a mean SBP of 13.6 cmHg±1.4, a mean DBP of 8.6 cmHg±1, a mean HR of 85±10 and a mean RR of 18±3. While in control group the mean VAS was 5.5±2, the mean STAI was 50.89±5.5, the mean SBP was 13.4±1.2, the mean DBP was 8.8±1.1, the mean HR was 82±8 and the mean RR was 19±2.During the infusion and after music intervention in G1, the mean STAI became 38.35±5 in G1 versus 46.7±5.2 in G2 (p value=0.022), the mean SBP became 12.1±0.5 in G1 versus 13±1 in G2 (p=0.035), the mean DBP became 8.1±0.8 in G1 versus 8.4±0.9 in G2 (p=0.4), the mean HR became 76±9 in G1 versus 78±7 in G2 (p=0.04) and the mean RR became 17.3±2.1 in G1 versus 18.2±1.7 in G2 (p=0.39).This study found a statistically significant decrease in anxiety, systolic blood pressure and heart rate in patients receiving music interventions during biological therapies infusion, but no significant difference were identified in diastolic blood pressure and respiratory rate.Conclusion:The findings provide further evidence to support the use of music therapy to reduce anxiety, and lower systolic blood pressure and heart rate in patients with rheumatic disease during biological therapies infusion.References:[1] Lin, C., Hwang, S., Jiang, P., & Hsiung, N. (2019).Effect of Music Therapy on Pain After Orthopedic Surgery -A Systematic review and Meta-Analysis. Pain Practice.Disclosure of Interests:None declared

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Abstract 12689: Cardiovascular Responses to Energy Drinks in a Healthy Population: The C-energy Study

Circulation ◽

10.1161/circ.132.suppl_3.12689 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Teri M Kozik ◽

Mouchumi Bhattacharyya ◽

Teresa T Nguyen ◽

Therese F Connolly ◽

Walther Chien ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Vital Signs ◽

Cardiovascular Responses ◽

Energy Drinks ◽

Energy Drink ◽

Emergency Department Visits ◽

Qtc Interval ◽

Cardiac Responses ◽

Energy Drink Consumption

Introduction: Energy drinks are presumed to enhance energy, physical endurance, mood, and boost metabolism. Serious health risks have been reported with energy drink consumption such as myocardial infarction, cardiac arrest, stroke, seizures, and arrhythmias. More than 20,000 emergency department visits related to energy drink consumption were reported in 2011. Little is known about the possible pathophysiological mechanisms and adverse events associated with energy drinks. Unlike the tobacco and alcohol industry, there are limited restrictions regulating the purchasing and marketing of these drinks. Purpose: To determine if consumption of energy drinks alter; vital signs (blood pressure, temperature), electrolytes (magnesium, potassium, calcium), activated bleeding time (ACT), or cardiac responses measured with a 12-lead electrocardiographic (ECG) Holter. Method: Subjects consumed two-16 ounce cans of an energy drink within one hour and remained in the lab where data was collected at base line (BL) and then during four hours post consumption (PC). Vital signs were taken every 30 minutes; blood samples were collected at BL, one, two and four hours PC and ECG data was collected throughout the entire study period. Paired students t-test and a corresponding non-parametric test (Wilcoxon signed rank) were used for analysis of the data. Results: Fourteen healthy young subjects were recruited (mean age 28.6 years). Systolic blood pressure (BL=132, ±7.83; PC= 151, ±11.21; p=.001); QTc interval (BL=423, ±22.74; PC=503, ±24.56; p<.001); magnesium level (BL 2.04, ± 0.09; PC=2.13, ±0.15; p=.05); and calcium level (BL=9.31, ±.28; PC=9.52, ±.22; p=.018) significantly increased from BL. While potassium and ACT fluctuated (increase and decrease) no significant changes were observed. Eight of the fourteen subjects (57%) developed a QTc >500 milliseconds PC. Conclusions: In our sample, consumption of energy drinks increased systolic blood pressure, serum magnesium and calcium, and resulted in repolarization abnormalities. Because these physiological responses can lead to arrhythmias and other abnormal cardiac responses, further study in a larger sample is needed to determine the effects and possible consequences of energy drink consumption.

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Initial Emergency Department Systolic Blood Pressure Predicts Left Ventricular Systolic Function in Acute Decompensated Heart Failure

Congestive Heart Failure ◽

10.1111/j.1751-7133.2008.00047.x ◽

2009 ◽

Vol 15 (1) ◽

pp. 9-13 ◽

Cited By ~ 4

Author(s):

Joseph F. Styron ◽

Preeti Jois-Bilowich ◽

Randall Starling ◽

Robert E. Hobbs ◽

Michael C. Kontos ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Emergency Department ◽

Systolic Blood Pressure ◽

Acute Decompensated Heart Failure ◽

Systolic Function ◽

Left Ventricular Systolic Function ◽

Decompensated Heart Failure ◽

Left Ventricular ◽

Ventricular Systolic Function

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LO48: Pediatric cannabinoid hyperemesis syndrome in the emergency department: a 5-year retrospective review

CJEM ◽

10.1017/cem.2020.103 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S24-S24

Author(s):

D. Foster ◽

K. Van Aarsen ◽

J. Yan ◽

J. Teefy ◽

T. Lynch

Keyword(s):

Emergency Department ◽

Weight Loss ◽

Abdominal Pain ◽

Pediatric Patients ◽

Venous Blood ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Cannabis Use ◽

Discharge Diagnosis ◽

Cannabinoid Hyperemesis Syndrome

Introduction: Cannabinoid Hyperemesis Syndrome (CHS) in pediatric patients is poorly characterized. Literature is scarce, making identification and treatment challenging. This study's objective was to describe demographics and visit data of pediatric patients presenting to the emergency department (ED) with suspected CHS, in order to improve understanding of the disorder. Methods: A retrospective chart review was conducted of pediatric patients (12-17 years) with suspected CHS presenting to one of two tertiary-care EDs; one pediatric and one pediatric/adult (combined annual pediatric census 40,550) between April 2014-March 2019. Charts were selected based on discharge diagnosis of abdominal pain or nausea/vomiting with positive cannabis urine screen, or discharge diagnosis of cannabis use, using ICD-10 codes. Patients with confirmed or likely diagnosis of CHS were identified and data including demographics, clinical history, and ED investigations/treatments were recorded by a trained research assistant. Results: 242 patients met criteria for review. 39 were identified as having a confirmed or likely diagnosis of CHS (mean age 16.2, SD 0.85 years with 64% female). 87% were triaged as either CTAS-2 or CTAS-3. 80% of patients had cannabis use frequency/duration documented. Of these, 89% reported at least daily use, the mean consumption was 1.30g/day (SD 1.13g/day), and all reported ≥6 months of heavy use. 69% of patients had at least one psychiatric comorbidity. When presenting to the ED, all had vomiting, 81% had nausea, 81% had abdominal pain, and 30% reported weight loss. Investigations done included venous blood gas (30%), pregnancy test in females (84%), liver enzymes (57%), pelvic or abdominal ultrasound (19%), abdominal X-ray (19%), and CT head (5%). 89% of patients received treatment in the ED with 81% receiving anti-emetics, 68% receiving intravenous (IV) fluids, and 22% receiving analgesics. Normal saline was the most used IV fluid (80%) and ondansetron was the most used anti-emetic (90%). Cannabis was suspected to account for symptoms in 74%, with 31% of these given the formal diagnosis of CHS. 62% of patients had another visit to the ED within 30 days (prior to or post sentinel visit), 59% of these for similar symptoms. Conclusion: This study of pediatric CHS reveals unique findings including a preponderance of female patients, a majority that consume cannabis daily, and weight loss reported in nearly one third. Many received extensive workups and most had multiple clustered visits to the ED.

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Impedance threshold device (ResQGARD) increases systolic blood pressure in hypotensive patients in the emergency department

European Journal of Anaesthesiology ◽

10.1097/00003643-201106001-00615 ◽

2011 ◽

Vol 28 ◽

pp. 191

Author(s):

C. Pantazopoulos ◽

E. Karacosta ◽

L. Vallianatou ◽

G. Agaliotis ◽

A. Terzidis ◽

...

Keyword(s):

Blood Pressure ◽

Emergency Department ◽

Systolic Blood Pressure ◽

Threshold Device ◽

Impedance Threshold Device

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Epinephrine syringe exchange events in a paediatric cardiovascular ICU: analysing the storm

Cardiology in the Young ◽

10.1017/s1047951117002232 ◽

2017 ◽

Vol 28 (3) ◽

pp. 409-415 ◽

Cited By ~ 5

Author(s):

Barbara-Jo Achuff ◽

Jameson C. Achuff ◽

Hwan H. Park ◽

Brady Moffett ◽

Sebastian Acosta ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Systolic Blood Pressure ◽

Vital Signs ◽

Syringe Exchange ◽

Control Data ◽

Flow Change ◽

Exchange Event ◽

The Hours ◽

Pressure Perturbations

AbstractIntroductionHaemodynamically unstable patients can experience potentially hazardous changes in vital signs related to the exchange of depleted syringes of epinephrine to full syringes. The purpose was to determine the measured effects of epinephrine syringe exchanges on the magnitude, duration, and frequency of haemodynamic disturbances in the hour after an exchange event (study) relative to the hours before (control).Materials and methodsBeat-to-beat vital signs recorded every 2 seconds from bedside monitors for patients admitted to the paediatric cardiovascular ICU of Texas Children’s Hospital were collected between 1 January, 2013 and 30 June, 2015. Epinephrine syringe exchanges without dose/flow change were obtained from electronic records. Time, magnitude, and duration of changes in systolic blood pressure and heart rate were characterised using Matlab. Significant haemodynamic events were identified and compared with control data.ResultsIn all, 1042 syringe exchange events were found and 850 (81.6%) had uncorrupted data for analysis. A total of 744 (87.5%) exchanges had at least 1 associated haemodynamic perturbation including 2958 systolic blood pressure and 1747 heart-rate changes. Heart-rate perturbations occurred 37% before exchange and 63% after exchange, and 37% of systolic blood pressure perturbations happened before syringe exchange, whereas 63% occurred after syringe exchange with significant differences found in systolic blood pressure frequency (p<0.001), duration (p<0.001), and amplitude (p<0.001) compared with control data.ConclusionsThis novel data collection and signal processing analysis showed a significant increase in frequency, duration, and magnitude of systolic blood pressure perturbations surrounding epinephrine syringe exchange events.

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Characterization of Dexmedetomidine Dosing and Safety in Neonates and Infants

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-20.2.112 ◽

2015 ◽

Vol 20 (2) ◽

pp. 112-118 ◽

Cited By ~ 1

Author(s):

Lauren M. Estkowski ◽

Jennifer L. Morris ◽

Elizabeth A. Sinclair

Keyword(s):

Blood Pressure ◽

Intensive Care Unit ◽

Heart Rate ◽

Intensive Care ◽

Systolic Blood Pressure ◽

Vital Signs ◽

Pediatric Intensive Care ◽

Neonates And Infants ◽

To Receive

OBJECTIVES: To describe and compare off-label use and cardiovascular (CV) adverse effects of dexmedetomidine in neonates and infants in the pediatric intensive care unit (PICU). METHODS: Patients younger than 12 months with corrected gestational ages of at least 37 weeks who were receiving continuous infusion of dexmedetomidine at a tertiary pediatric referral center between October 2007 and August 2012 were assessed retrospectively. Patients were excluded if dexmedetomidine was used for procedural sedation, postoperative CV surgery, or if postanesthesia infusion weaning orders existed at the time of PICU admission. RESULTS: The median minimum dexmedetomidine dose was similar between infants and neonates at 0.2 mcg/kg/hr (IQR, 0.17–0.3) versus 0.29 mcg/kg/hr (IQR, 0.2–0.31), p = 0.35. The median maximum dose was higher for infants than neonates (0.6 mcg/kg/hr [IQR, 0.4–0.8] vs. 0.4 mcg/kg/hr [IQR, 0.26–0.6], p < 0.01). Additional sedative use was more common in infants than neonates (75/99 [76%] vs. 15/28 [54%], p = 0.02). At least 1 episode of hypotension was noted in 34/127 (27%) patients and was similar between groups. An episode of bradycardia was identified more frequently in infants than neonates (55/99 [56%] vs. 2/28 [7%], p < 0.01). Significant reduction in heart rate and systolic blood pressure was noted when comparing baseline vital signs to lowest heart rate and systolic blood pressure during infusion (p < 0.01). CONCLUSIONS: Dexmedetomidine dose ranges were similar to US Food and Drug Administration–labeled dosages for intensive care unit sedation in adults. More infants than neonates experienced a bradycardia episode, but infants were also more likely to receive higher dosages of dexmedetomidine and additional sedatives.

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Modification of Glasgow-Blatchford scoring with lactate in predicting the mortality of patients with upper gastrointestinal bleeding in emergency department

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907918783159 ◽

2018 ◽

Vol 26 (1) ◽

pp. 31-38

Author(s):

Zeynep Konyar ◽

Ozlem Guneysel ◽

Fatma Sari Dogan ◽

Eren Gokdag

Keyword(s):

Emergency Department ◽

Blood Transfusion ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Venous Blood ◽

Erythrocyte Suspension ◽

Laboratory Findings ◽

Significant Difference ◽

Lactate Levels ◽

Upper Gastrointestinal

Background: Gastrointestinal bleeding is a commonly seen multidisciplinary clinical condition in emergency departments which has high treatment cost and mortality in company with hospital admission. Risk evaluation before endoscopy is based on clinical and laboratory findings at patient’s emergency visit. Objective: The purpose of this study is to investigate the efficacy of “Glasgow-Blatchford scale + lactate levels” to predict the mortality of patients detected with gastrointestinal bleeding in the emergency department. Methods: A total of 107 patients with preliminary diagnosis of upper gastrointestinal bleeding included in the study after approval of the ethics committee were prospectively evaluated. Glasgow-Blatchford scale scores were calculated and venous blood lactate levels were assessed. Need for blood transfusion in the follow-up, the amount of transfusion, and mortality in the next 6 months were evaluated. Results: A statistically significant difference was found in mortality rates between the lactate and Glasgow-Blatchford scale cohorts in our study (p = 0.001 and p < 0.01, respectively). The mortality rate was significantly higher in the lactate(+) GBS(+) cases compared to the lactate(–) GBS(+), lactate(+) GBS(–), and lactate(–) GBS(–) cases compared to the bilateral comparisons (p = 0.004, p = 0.001, p = 0.001, and p < 0.01, respectively). There was a statistically significant relationship between the rate of erythrocyte suspension replacement in the cases according to Glasgow-Blatchford scale levels (p = 0.001 and p < 0.01, respectively). The incidence of erythrocyte suspension replacement was 7.393 times greater in patients with Glasgow-Blatchford scale score of 12 and above. Conclusion: Glasgow-Blatchford scale is highly sensitive to the determination of mortality risk and the need for blood transfusion in upper gastrointestinal bleeding. Glasgow-Blatchford scale with lactate evaluation is more sensitive and more significant than Glasgow-Blatchford scale alone. This significance provides us to establish “modified Glasgow-Blatchford scale.” In the future, studies which will use Glasgow-Blatchford scale supported by lactate could be increased and the results should be supported more.

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