Critical Care of the Trauma Patient
Kenneth D Boffard in Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Patients who have one or more primary components are thought to have SIRS. The primary components associated with SIRS include: Temperature <36°C or >38°C.Heart rate >90 beats per minute.Respiratory rate >20 breaths per minute.Deranged arterial gases: partial pressure of carbon dioxide (PaCO2) <32 mm Hg (4.2 kPa).White blood count >12.0 × 109/L or <4.0 × 109/L or 0.10% immature neutrophils
Thoracic Trauma
Ian Greaves, Keith Porter, Jeff Garner in Trauma Care Manual, 2021
The thorax contains the heart, lungs, great vessels (aorta, inferior and superior vena cava, pulmonary arteries and veins), lower trachea, oesophagus and thoracic duct. The lower ribs overlie the ‘intrathoracic abdomen’, including the liver, spleen and biliary apparatus. The bulk of the thoracic volume is taken up by the two lungs, with the mediastinum—principally the heart and great vessels—between them. Each lung is cloaked in visceral pleura, which is continuous with the parietal pleura that lines the thoracic cage. A tiny amount of fluid between the two layers lubricates the movements of the lungs. The pressure gradient required to generate inspiratory flow is achieved largely by flattening the diaphragm to increase the volume of the thorax, creating a sub-atmospheric pressure in the lungs. During expiration the intra-alveolar pressure becomes slightly higher than atmospheric pressure and gas flow to the mouth results. The normal adult respiratory rate is 12–16 breaths per minute with a tidal volume (the normal amount of air inhaled and exhaled per breath at rest) of around 500 mL.
The Efficacy and Safety of MMECT – Technique Parameters
Barry M. Maletzky, C. Conrad Carter, James L. Fling in Multiple-Monitored Electroconvulsive Therapy, 2019
This procedure must be modified in MMECT, as the patient is continuously under the influence of succinylcholine during the procedure, a period often lasting up to 45 min. Continuous bagged breathing of 100% O2 was utilized by the original researchers when investigating MMECT217 and continues to be used today. Most of the ECT literature does not specify O2 flow. In our work we have insisted upon very high flows, up to 13 ℓ/min. Moreover, respiratory rate is similarly not specified in most studies, yet this factor may also play a role in the level of oxygenation in the blood. Our respiratory rates have been very rapid, between 25 and 40 per min in the interseizure interval and between 40 and 60 per min during the seizure itself. These high flows and rapid rates produce hyperoxygenation and hypocapnea, in order to provide the utmost protection against hypoxemia and maximize seizure duration.
Wearable sensors to improve detection of patient deterioration
Published in Expert Review of Medical Devices, 2019
Meera Joshi, Hutan Ashrafian, Lisa Aufegger, Sadia Khan, Sonal Arora, Graham Cooke, Ara Darzi
The blood pressures are measured by using an appropriately sized blood pressure cuff which is attached to the patient during the monitoring process, this often takes a few minutes to calculate and gives both a systolic and diastolic reading. A finger-based probe measures the oxygen saturations and heart rate. The temperature is often recorded using a portable tympanic probe. There are other routes of recording temperature that are less common such as; axillary, oral and rectal. In most hospitals, the observation machines have a local display and this is copied onto the paper-based observation chart by the health-care staff member that is taking the observation. The way that vital signs are obtained in healthcare has not changed for several decades with often a single ward nurse managing many patients. Currently, in most hospitals, the monitoring of respiratory rate is not automated and cannot be calculated by the observation machine itself. Instead, the respiratory rate is measured by the health-care professional counting the breaths over a time period either for a full minute or for 30 s and multiplying it by two. The current way of measuring respiratory rate has been shown to highly inaccurate and poorly reported [14]. Level of cognition is assessed by health-care staff at the bedside and is currently not automated. It is normally measured through simple scales such as AVPU whereby the patient is Alert or responds to Voice or responds to Pain, or is Unresponsive.
The enduring legacy of Marie Curie: impacts of radium in 21st century radiological and medical sciences
Published in International Journal of Radiation Biology, 2022
Rebecca Abergel, John Aris, Wesley E. Bolch, Shaheen A. Dewji, Ashley Golden, David A. Hooper, Dmitri Margot, Carly G. Menker, Tatjana Paunesku, Dörthe Schaue, Gayle E. Woloschak
Radon, thoron and actinon gases decay into solid progeny comprised of radionuclides that emit alpha particles. These progenies deliver >95% of the dose received by the lung airway epithelia. As progeny decay, they form 1 nm clusters, termed the ‘unattached fraction’ alongside larger particles (10 nm to >1 nm), termed the ‘attached fraction’. The difference in concentration between radon gas and solid progeny is given by the ‘equilibrium factor’, its value depends on the radon progeny rather than the radon gas. Radon gas is chemically inert but can be absorbed into the pulmonary, arterial and venous blood. Measurement of the radium radionuclide, typically from gamma spectroscopy of the progeny of the 238U and 232Th series (Figure 1), can be used to calculate the activity concentration and dose coefficient models to determine internalized dose. Effective dose from the inhalation of radon is attributed mostly to lung equivalent doses from the deposition in the respiratory airway of solid aerosol particles (Figure 2), which is dependent on the particle size distribution. Physiologically, breathing rate is additionally a core factor in determining the intake and subsequent lung dose.
Patient vital signs in relation to ICU admission in treatment of acute leukemia: a retrospective chart review
Published in Hematology, 2021
Katharine McLaughlin, Amanda Stojcevski, Abdulkadir Hussein, Devinder Moudgil, Indryas Woldie, Caroline Hamm
Interestingly, RR was the most frequent isolated missed vital sign over the 24 hours prior to ICU admission in the ICU group compared to heart rate, blood pressure and oxygen saturation. Respiratory rate is a difficult vital sign to measure, as it requires a healthcare provider to watch for chest expansion and manually count the number of breaths over 10-15 seconds. Respiratory rate measurement is time consuming and labor-intensive compared to other vitals monitored electronically such as BP, HR and O2Sat. These differences in measuring RR may account for why it is missed more frequently. The fact that RR is manually measured as opposed to electronically also introduces increased risk for human error. However, the data presented in this study suggest that RR is an essential vital sign to monitor in the acute leukemia, specifically AML, patient population.
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