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PET-CT Systems
Published in Michael Ljungberg, Handbook of Nuclear Medicine and Molecular Imaging for Physicists, 2022
An alternative approach is based on data-driven respiratory gating, where the respiratory signal is derived from either raw sinograms or reconstructed dynamic image series with acquisition frequency of <0.5s. Studies have shown that both approaches lead to the recovery of a data-driven respiratory motion signal equivalent to that of external respiratory monitoring devices [17–20]. The great advantage of using raw datasets to recover the required respiratory signal is that gating-based data binning can take place after the end of the acquisition, and it is totally transparent to the patient and radiographers, therefore making it much easier to accept and does not interfere with the overall acquisition procedure and associated protocol.
Platform-Driven Pandemic Management
Published in Ram Shringar Raw, Vishal Jain, Sanjoy Das, Meenakshi Sharma, Pandemic Detection and Analysis Through Smart Computing Technologies, 2022
Jayachandran Kizhakoot Ramachandran, Puneet Sachdeva
During the CoVs pandemic, wearables have gathered universal acceptance especially in the space of health monitoring. One of the revolutionary application of wearables can be seen in Smart clothing, where built-in sensors enable remote monitoring of patients, thereby eliminating the need to visit the hospital. Respiratory monitoring is another application where sensors track breathing parameters of the subjects and relay them to health-care providers for round the clock monitoring of affected patients. There is another class of versatile wearables that capture various metrics such as heartbeat, blood pressure, blood sugar and oxygen levels and provides them to the health care providers for required intervention. Wearables are also getting prevalent in the manufacturing industry, where employees are provided with bracelets. The bracelets have the sensors that record the movement of individuals, proximity to another employee and overlap of the intersection. Some versions even vibrate to raise alarm if guidelines are breached. Certain group of population believes they are intrusive however, they are remarkably effective when it comes to gathering or actionizing in real-time.
Pain management
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Small intermittent doses (25 µg–50 µg) of short-acting IV opioids, such as fentanyl, are preferable as the first line of analgesics in patients deemed safe to receive opioids. Continuous opioid infusions should be avoided in patients with neurotrauma who are not mechanically ventilated, especially upon initial presentation to the trauma team. Patients without intracranial injury, but isolated spinal injuries, may safely tolerate longer-acting opioids (Table 32.3).4 Caution should be exercised when using morphine as patients may experience histamine release, which may result in hypotension during a time when perfusion pressure is of critical importance. In patients requiring mechanical ventilation, infusions of short acting opioids, such as fentanyl or remifentanil, can be titrated to achieve comfort and ventilator synchrony. End-tidal capnography allows for careful attention to carbon dioxide levels in patients undergoing spontaneous modes of mechanical ventilation. The necessity for continuous respiratory monitoring in nonmechanically ventilated patients will be subsequently discussed at greater length in this chapter.
How to recognize patients at risk of self-inflicted lung injury
Published in Expert Review of Respiratory Medicine, 2022
Tommaso Pettenuzzo, Nicolò Sella, Francesco Zarantonello, Alessandro De Cassai, Federico Geraldini, Paolo Persona, Elisa Pistollato, Annalisa Boscolo, Paolo Navalesi
The clinical assessment of patients’ respiratory drive and effort is key to suspect the occurrence of P-SILI, which is particularly harmful for patients with severely injured lungs. Although the careful monitoring of patient’s breathing pattern and ventilator waveforms during tidal breathing may help, when respiratory system mechanisms are impaired and overt signs of respiratory distress are not clinically evident, more sophisticated methods to estimate respiratory drive and effort are necessary. Measurements performed at the ventilator during end-inspiratory or end-expiratory pauses, diaphragm electromyography, esophageal manometry, and imaging techniques may facilitate the identification of P-SILI. Some of these strategies are still not widely employed. Not only may they require dedicated equipment, but which patients may benefit from more sophisticated levels of respiratory monitoring is still unclear. We believe that focusing on the monitoring of patient inspiratory effort during the core curriculum of modern critical care physicians and nurses would be crucial.
Olanzapine/samidorphan precipitated opioid withdrawal in a patient taking transdermal fentanyl
Published in Clinical Toxicology, 2022
Nicholus M. Warstadt, Zachary P. Schmitz, Samara E. Soghoian
Precipitated opioid withdrawal (POW) is a life-threatening form of opioid withdrawal characterized by the sudden onset of extreme, difficult to control symptoms, with increased potential for pulmonary edema, hemodynamic instability, and death [5]. We inferred a diagnosis of samidorphan POW based on the temporality of the patient’s symptoms following exposure, clinical opiate withdrawal syndrome, lack of likely alternate explanation, and rapid return to baseline [6]. Sympathomimetic toxicity and sedative/hypnotic withdrawal were also considered. There was no evidence of thyrotoxicosis, cardiogenic pulmonary edema, primary neurologic event, or infection on concomitant medical workup. Management of POW is primarily supportive, including fluid replacement, antiemetics, benzodiazepines, and clonidine. Hemodynamic and respiratory monitoring is essential. Intubation and deep sedation are rarely necessary. Naltrexone has been most frequently implicated in POW following administration in acute opioid overdose, rapid opioid detoxification, or after unintentional use [5,7]. Buprenorphine may be helpful in these cases [7]. High potency opioid agonists such as fentanyl may also be helpful to overcome µ-opioid receptor blockade. However, these may be less useful after samidorphan, which has greater receptor affinity [7]. To our knowledge, this is the first case report describing samidorphan POW. With its recent FDA approval as a combination tablet with olanzapine, prescribers should avoid samidorphan in patients taking prescribed or illicit opioids.
The importance of maintaining the same order of performance of lung function and SNIP tests in patients with amyotrophic lateral sclerosis
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2020
Paola Pierucci, Nicolino Ambrosino, Michela Dimitri, Vito Liotino, Stefano Battaglia, Annalisa Carlucci, Giovanna Elisiana Carpagnano, Pierluigi Carratu, Silvano Dragonieri, Giancarlo Logroscino, Isabella Laura Simone, Onofrio Resta
Amyotrophic lateral sclerosis (ALS) is a rare, progressive, and fatal motoneuron disease with 2–4 years average timeframe between symptom onset and death, although 5–10% of patients may survive longer (1). Respiratory muscles become weaker and patients progressively develop nocturnal hypoventilation and hypercapnic respiratory failure (2,3). Death is usually related to complications such as acute respiratory failure and lower respiratory tract infections (4–6). Close clinical and functional follow-up is crucial: guidelines suggest a four-monthly multidisciplinary check with particular care for the respiratory system (1). The recommended respiratory monitoring consists in the assessment of lung and respiratory muscle function, as well as of cough efficiency (7,8).