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Hospital Systems
Published in Salvatore Volpe, Health Informatics, 2022
The EHR itself can have many appendages. There are numerous small devices and technologies that interact with the EHR in a patient’s care. Vital signs equipment measures pulse, oxygen level, and blood pressure. Other equipment includes spirometers, fetal monitors, ventilators, and infusion pumps. There are point-of-care (POC) testing devices such as glucometers, portable x-rays, and portable EKG machines. Identification technology such as RTLS (real-time locating system) and RFID (radio frequency ID), barcodes, and biometrics as well as signature pads can be used to identify patients, clinicians, and equipment. Data input technology such as smart phones, tablets, kiosks, and dictation systems are also used. Workstations on wheels (WOW), high-resolution viewing stations, and mobile devices like wireless tablets allow clinicians to interact more efficiently with the EHR in the workplace. Telemedicine technology has also become commonplace in the hospital setting. A primary use case for telemedicine is to provide the ability for specialists to consult remotely – this is useful for in demand specialists such as radiologists and psychiatrists. It is also especially useful for the rural hospital where specialists are scarcer. Technology in a hospital room could include floors that detect a patient falling, beds that can monitor a patient’s vital signs, and technologies that listen and respond to patient and clinician commands.
Measuring and monitoring vital signs
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
The purpose of vital signs measurement is part of the overall primary assessment of the person. It establishes a baseline for their physical health and offers future comparison to help identify abnormalities of well-being. The Royal College of Physicians, [RCP] (2017) identify that physiological observations should be recorded and interpreted accurately for all adults admitted to acute hospitals so that deterioration is recognised and responded to early. They report how vital signs are primary indicators of physiological status and demonstrate signs of deterioration. However, there is a potential that vital signs can be misinterpreted, mismanaged and often omitted (Bucknall et al. 2017). The move towards handheld devices used in the prehospital situation and at the bedside has attempted to address this issue in many clinical areas. When recorded accurately and responded to quickly, vital signs can provide person-centred healthcare assessments. Their recording and reporting enable the best interests of the person to be considered, promoting health and preventing ill health. They can provide information in accessible ways to help people understand and make decisions about their health requirements. For example, a person who has a high BP can be monitored to see if they require medication to reduce their risk factors of stroke or coronary heart disease. A person with a high temperature and of a non-healing wound can be reviewed to consider for potential signs of infection.
Febrile Seizures
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
Although the great majority of FSs already have ceased by the time the child is seen by a physician, on occasion seizure activity is still ongoing; in such circumstances, it must be treated aggressively. As in other cases of continuing seizures, supportive measures must be provided in order to minimize neurologic morbidity (19). The child should be placed in a semiprone position and an adequate airway ensured. A plastic or rubber airway should be inserted in the oropharynx, and the airway cleared of secretions by gentle suction. Oxygen should be given. If there is any question about the adequacy of respiratory function, endotracheal intubation and assisted ventilation are indicated. An intravenous line should be inserted to obtain blood specimens, maintain hydration, and facilitate administration of medications. A solution containing 5% dextrose in 0.25% normal saline is usually used, with an infusion rate of 1000 ml per M2 per day. A nasogastric tube is inserted to empty the gastric contents. The child must be protected against injury from hard objects and from compromising his respirations by pillows and blankets. Clothing should be loosened and excess clothing removed. The fever is treated with sponging with tepid water, cooling blankets, and antipyretics such as acetaminophen. Vital signs should be monitored frequently. The most useful antiepileptic drugs (AEDs) to give to a febrile child who is still seizing are DZP, lorazepam (LZP), or PB.
A Statewide EMS Viral Syndrome Pandemic Triage Protocol: 24 Hour Outcomes
Published in Prehospital Emergency Care, 2022
Matthew J. Levy, Timothy P. Chizmar, Teferra Alemayehu, Mustafa M. Sidik, Eric Garfinkel, Roger Stone, Jonathan Wendell, Roumen Vesselinov, Asa M. Margolis, Theodore R. Delbridge
From the 2,937 EMS PUI patients who were not transported and did not have the protocol decision tool documented, a random sample of 150 cases were identified. Concerning vital signs parameters, 22 (15%) patients had a heart rate >110 beats per minute; eight (5%) patients were outside of blood pressure limits (Systolic BP <110mmgHg of >180mmHg); nine (6%) patients had a pulse oximetry reading of <94%; 12 (8%) patients had a respiratory rate <12 or >22 breaths per minute. In terms of comorbidities, 20 (13%) patients had an exclusionary diagnosis of COPD/asthma/lung disease; three (2%) patients were immunosuppressed; 11 (7%) patients had heart disease; and 11(7%) patients were documented as having had diabetes. Age appeared to be the single greatest exclusionary parameter, as 63 (42%) of the patients were over the age of 55, and two patients were under the age of two. Of these 150 cases, 29 (19%) of these patients could have met criteria to stay at home, of which 4 (2.6%) patients subsequently presented to an emergency department and 1 (0.67%) person was admitted. Overall, 35 (23.3%) of those patients for whom the triage protocol’s use was not documented had an ED visit within 24 hours vs 41 (14.5%) for the group with documented protocol use (p = 0.025). Of those patients who presented to an ED within 24 hours of initial EMS encounter, 15 (10%) of those without documentation of protocol use were admitted to the hospital, in comparison to 14 (5%) for those with documented protocol use (p = 0.067). Table 3 provides comparison of vital signs, ED presentation, and hospitalization between the two groups.
A novel prognostic model for predicting the mortality risk of patients with sepsis-related acute respiratory failure: a cohort study using the MIMIC-IV database
Published in Current Medical Research and Opinion, 2022
Lina Zhao, Jing Yang, Cong Zhou, Yunying Wang, Tao Liu
The laboratory parameters and mean values of the vital signs were collected within the first 24 h after ICU admission. The laboratory parameters included alanine aminotransferase, aspartate aminotransferase, creatinine, blood urea nitrogen, haemoglobin, platelet count, partial thromboplastin time, international normalized ratio, prothrombin time, white blood cell count, neutrophil and lymphocyte percentage, blood lactate, creatine kinase isoenzyme MB, arterial blood gas analysis (PaO2), PaO2/FiO2, and arterial oxygen saturation (SpO2). The vital signs included heart rate, systolic and diastolic blood pressure, respiratory rate, and temperature. Further, the demographic data included age, gender, length of hospital stay, and hospital mortality, while advanced cardiac life support included mechanical ventilation and renal replacement therapy. System scores for critical illness were evaluated, including the SAPS II, SOFA, and Glasgow Coma Scale (GCS). The comorbidity index on discharge was according to the ICD-9 and ICD-10 codes (Supplementary materials 1–6). The site of infection (Supplementary material 7) and the type of microbial infection were also under the main research focus. The percentage of missing values for creatinine, blood urea nitrogen, and GCS were 0.15%, and missing data were managed by a matrix diagram illustrated in the Data Profiling Report (Supplementary material 8). Further, the mass package of R software was used for multiple interpolations of missing value data.
Kwashiorkor on the south shore
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Samuel T. Arcieri, Szeya Cheung, Alexander Belkin, Ajish Pillai, Ravi Gupta
Vital signs revealed an oral temperature of 98.0°F, BP 142/105 mmHg, heart rate 139 bpm, respiratory rate 30/min, saturating at 89% on room air, and a BMI of 20.1 kg/m2. Physical exam revealed altered mental status; cachexia with sunken orbits, poor oral hygiene, extensive abdominal distention, hypoactive bowel sounds, diffuse tenderness to palpation, and a positive fluid wave. There was no evidence of gastrointestinal bleeding. 3+ pitting edema of the bilateral lower extremities was noted. Initial laboratory studies were significant for hemoglobin 10.0 g/dL, creatinine 1.5 mg/dL, lactic acid 4.4 mmol/L, HCO3 15 mEq/L, ammonia 65 µmol/L and albumin 1.8 g/dL; liver function tests were within normal limits, INR was 1.2. Subsequent iron studies revealed iron of 25 ug/dL, with a total iron binding capacity of 133 ug/dL, a ferritin of 75 ng/mL, and a percent saturation of 18.8%. The vitamin B12 level was 1447 pg/mL, and folate was 4.44 ng/mL. A CT of the chest, abdomen, and pelvis without contrast showed extensive abdominal and pelvic ascites along with bilateral infiltrates and consolidation of the right lower lung lobe. An abdominal ultrasound revealed a large amount of ascites and a lower extremity venous ultrasound demonstrated deep vein thromboses (DVT) Figure 1 in the common femoral veins bilaterally. A computer tomography angiogram (CTA) was negative for acute pulmonary embolism.