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Nonatmospheric Hazardous Conditions: The Role of Confined Energy
Published in Neil McManus, Safety and Health in Confined Spaces, 2018
Asystole is cardiac standstill; the heart does not beat. Current flow above 1 A through the chest cavity can cause asystole. Such high currents are associated with high voltage. Hence, asystole rather than ventricular fibrillation often is the cause of death in accidents at voltages greater than 1,000 V (Bernstein 1991b). Unlike ventricular fibrillation, asystole may revert to a normal heart rhythm once the triggering voltage is removed. As a result, individuals have survived asystole following exposure to high voltage, high current shock, while others have died from ventricular fibrillation following a low current, 120-V shock. This is the basis for concern expressed in NIOSH Alert documents about 110- to 120-V electrical contacts (NIOSH 1986a, b).
Subcutaneous cardiac rhythm monitors: state of the art review
Published in Expert Review of Medical Devices, 2021
Anish Nadkarni, Jasneet Devgun, Shakeel M. Jamal, Delores Bardales, Julie Mease, Faisal Matto, Toshimasa Okabe, Emile G. Daoud, Muhammad R. Afzal
After implantation of the device, two parameters need to be set for initial programming, R wave sensing and arrhythmia episode detection criteria. R wave sensing can be set up manually by the operator. If the patient has a small R wave, one could consider re-programming to a more sensitive value. Arrhythmia episode detection criteria will be set based on ‘patient age’ and ‘Reason for Monitoring’ information entered into the device programmer. The operator can change these parameters if desired. The automatic detection and ECG storage of tachycardia (ventricular tachycardia, supraventricular tachycardia), pause (asystole), bradycardia, and AF episodes are turned on when the device is activated after implantation. An automatically detected episode starts when it meets the detection criteria for that episode type. Table 3 describes the specific detection criteria for each individual arrhythmia, both manufacturers recommended ‘out-of-the-box’ nominal programming, as well as our own institution recommended custom programming. Table 4 shows the nominal arrhythmia detections settings for a given ‘Reason for Monitoring.’ The reason for monitoring and individual parameters can also be changed during follow-up sessions or remotely for some newer SCRMs.
Using timbre to improve performance of larger auditory alarm sets
Published in Ergonomics, 2019
Michael F. Rayo, Emily S. Patterson, Mahmoud Abdel-Rasoul, Susan D. Moffatt-Bruce
We created seven alarm sounds that mapped to eleven signified events, which required that some sounds were associated with multiple events. These events were chosen by the institution’s clinical leadership to be the most important events for nurses to attend to across all inpatient units. To lessen the negative effect that these event mappings would have on informativeness, multiple events were assigned to a single alarm only if they were similar in type, detectability and expected response. For example, one alarm (Cardiac Crisis) was used to signify cardiac arrest (asystole) and two life-threatening heart arrhythmias (ventricular fibrillation and ventricular tachycardia). With current sensor technology, the false alarm rate for the three alarms is similar. The expected response for all of these events is also similar: for a registered nurse to go immediately to the patient and perform life-saving measures. Details of these event-to-sound groupings can be found in Table 1.
Management of out-of hospital cardiac arrest patients with extracorporeal cardiopulmonary resuscitation in 2021
Published in Expert Review of Medical Devices, 2021
Christopher Gaisendrees, Matias Vollmer, Sebastian G Walter, Ilija Djordjevic, Kaveh Eghbalzadeh, Süreyya Kaya, Ahmed Elderia, Borko Ivanov, Stephen Gerfer, Elmar Kuhn, Anton Sabashnikov, Heike a Kahlert, Antje C Deppe, Axel Kröner, Navid Mader, Thorsten Wahlers
Accurate cardiac prognostication remains a significant challenge after successful cannulation. Kalra and colleagues analyzed the echocardiographic utilization of LVEF, LVEDD, and LVESD during VA-ECMO therapy after refractory VF/VT cardiac arrest and did not find any significant differences between survivors and non-survivors regarding these parameters. Noteworthy was a better LVEF during VA-ECMO weaning in surviving patients [70]. A sub-analysis of the CULPRIT-SHOCK trial found VA-ECMO therapy to be associated with higher 30-day mortality and renal replacement therapy rate. However, the control group was poorly comparable and unmatched [71]. A retrospective study on prognostic factors for heart recovery in eCPR patients found high CK-MB levels and VT/asystole during VA-ECMO setup associated with poorer outcomes. If myocarditis causes cardiac arrest, early intravenous immunoglobulin was associated with better survival [72]. There is some evidence that levosimendan application during VA-ECMO therapy promotes higher rates of successful weaning and decannulation [73]. Further and randomized studies are necessary to enlarge evidence on Ca2+ sensitizers during eCPR. Arterial lactate levels are a clinically relevant indicator for cardiac recovery during VA-ECMO weaning, and higher lactate levels are associated with an increased mortality rate [74].To this point, cardiac prognostication cannot be made by a single parameter. It instead relies on a spectrum of parameters and the degree of clinical experience of the physician. Novel diagnostic algorithms may focus on future studies to reliably prognosticate future cardiac function and adjust therapy regimes accordingly.