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"The eyes are the windows of the soul": Portable automated pupillometry to monitor autonomic nervous activity in CO2 narcosis: A case report.

RATIONALE: Altered autonomic responses can be observed in patients in the intensive care unit (ICU), and these changes in abnormal autonomic … scharged on Day 3. INTERVENTIONS: The patient was admitted to the ICU after being intubated, where vital signs and blood gas analysis were monitored every 2 hours, and consciousness was assessed using the Glasgow coma scale. Using a portable automated pupillometer (NeurOptics NPi™-200, Neuroptics Inc., Irvine, CA), pupillary responses, including pupil size o …

Novel wearable and contactless monitoring devices to identify deteriorating patients in the clinical setting: a systematic review protocol.

BACKGROUND: With technological advances, there has been increasing interest in developing contactless and/or non-invasive wearable technologies that continuously monitor vital signs in the clinical setting, and in particular in the deteriorating patient. These devices as of yet have not been well validated in the clinical setting in the clinical ranges observed in a critically unwell patient. We will perform a systematic review of all novel wearable and contactless devices in the clinical setting with focus on degree of novelty and the range of vital signs captured. METHODS: Ovid MEDLINE incl…

Prehospital Critical Care Blood Product Administration: Quantifying Clinical Benefit.

BACKGROUND: Prehospital blood transfusion has been widely practiced in the military and is drawing renewed scrutiny after many years of civi … l were compared with patients after initiation of the blood transfusion protocol. Demographic data, vital signs, laboratory analytics, and other outcome measures were analyzed. RESULTS: Nine scene transport patients who met the transfusion criteria before a blood transfusion protocol were compared with 11 patients transported after initiation of the protocol …

A Setup for Camera-Based Detection of Simulated Pathological States Using a Neonatal Phantom.

Premature infants are among the most vulnerable patients in a hospital. Due to numerous complications associated with immaturity, a continuous monitoring of vital signs with a high sensitivity and accuracy is required. Today, wired sensors are attached to the patient's skin. However, adhesive electrodes can be potentially harmful as they can damage the very thin immature skin. Although unobtrusive monitoring systems using cameras show the potential to replace cable-based techniques, advanced image processing algorithms are data-driven and, therefore, need much data to be trained. Due to the lo…

ED-triage-agent: a multi-agent framework for human-in-the-loop emergency triage.

BACKGROUND: Emergency Department (ED) triage requires rapid assessment of acuity under time pressure with incomplete information. Existing AI triage systems require complete clinical data, including vital signs, before generating a prediction, and so cannot support the sequential, information-gathering reality of triage in which patients accumulate in queues before vital signs are collected. Pre-vital queue prioritisation, deciding which patients are seen next before vital signs exist, remains unaddressed. OBJECTIVE: To design and evaluate ED-Triage-Agent (ETA), a multi-agent large language m…

Advances in Patient Monitoring Systems for Prehospital and Resource-Limited Settings.

INTRODUCTION: Vital sign monitoring is essential to the management of critically ill and injured patients. Recent advances in patient monitoring systems have the potential to improve outcomes by providing real-time data and predictive insights, which are particularly valuable in prehospital and resource-limited settings. We conducted a systematic review of the literature to assess the capabilities, performance, and clinical impact of patient monitoring technologies designed for these environments. METHODS: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses g

A Case Study of Infant Physiologic Response to Skin-to-Skin Contact After Surgery for Complex Congenital Heart Disease.

BACKGROUND: Infants with complex congenital heart disease requiring surgical intervention within the first days or weeks of life may be the most seriously ill infants needing intensive nursing and medical care. Skin-to-skin contact (SSC) is well accepted and practiced as a positive therapeutic intervention in premature infants but is not routinely offered to infants in cardiac intensive care units. The physiologic effects of SSC in the congenital heart disease population must be examined before recommending incorporation of SSC into standard care routines. OBJECTIVE: The purpose of this case

The treatment of haematemesis and upper gastrointestinal bleeding in United Kingdom Armed Forces and other deployed units.

INTRODUCTION: Upper Gastro-intestinal (UGI) bleeding is a significant cause of morbidity worldwide. United Kingdom Armed Forces (UKAFs) are not immune to this condition. There is a substantial body of conflicting evidence regarding initial management and risk stratification. AIM: To provide the background knowledge and treatment pathways required to assess and manage a patient adequately during the first 24 hours of an episode of UGI bleeding. ASSESSMENT: Clinical grading of hypovolaemic shock is inaccurate, but is a broad indicator of severity; the Rockall Score must not be used to assess r

Recognizing and responding to clinical deterioration in adult patients in isolation precautions for infection control: a retrospective cohort study.

BACKGROUND: Patient isolation is widely used as a strategy for prevention and control of infection but may have unintended consequences for … ding each episode of clinical deterioration (n = 180), 81.6% (n = 147) of episodes were preceded by vital signs fulfilling pre-Medical Emergency Team criteria. Patients who deteriorated during isolation for infection control were older (median age 74.0 vs 71.0 years, P = 0.042); more likely to live in a residential care facility (21.0% vs 7.2%, P = 0.006); ha …

Accuracy of Signs and Symptoms for the Diagnosis of Community-acquired Pneumonia: A Meta-analysis.

BACKGROUND: Community-acquired pneumonia (CAP) is an important source of morbidity and mortality. However, overtreatment of acute cough illn … perature (LR+ = 2.52, 95% CI = 2.02 to 3.20), while it is decreased most by the absence of abnormal vital signs (LR- = 0.25, 95% CI = 0.11 to 0.48). The overall clinical impression also had the highest AUROCC at 0.741. CONCLUSIONS: While most individual signs and symptoms were unhelpful, selected signs and symptoms are of value for diagnosing CAP. Teaching a …

Evaluation of the threshold value for the Early Warning Score on general wards.

INTRODUCTION: The Early Warning Score (EWS) is used for early detection of deteriorating vital parameters and has been correlated with adverse outcomes. Unfortunately, neither its value on general wards nor the optimal cut-off value have been investigated. We aimed to find the optimal cut-off value for EWS on general wards, and investigated the possibility to raise this value from EWS ≥ 3 without compromising sensitivity too much. METHODS: From May 2010 until May 2011, EWS was calculated from vital parameters in all patients in medical and surgical wards in the Medical Centre Alkmaar. Cut-off

Does This Child With High Blood Pressure Have Secondary Hypertension?: The Rational Clinical Examination Systematic Review.

IMPORTANCE: Guidelines recommend that all children and adolescents with hypertension undergo evaluation for secondary causes. Identifying clinical factors associated with secondary hypertension may decrease unnecessary testing for those with primary hypertension. OBJECTIVE: To determine the utility of the clinical history, physical examination, and 24-hour ambulatory blood pressure monitoring for differentiating primary hypertension from secondary hypertension in children and adolescents (aged ≤21 years). DATA SOURCES AND STUDY SELECTION: The databases of MEDLINE, PubMed Central, Embase, Web

Характеристики и методы работы с подростками, посещающими лечебницу с лихорадкой: перспективное многоцентральное исследование.

ЦЕЛЬ: В большинстве исследований, посвященных фебриальным детям, основное внимание уделялось младенцам и детям младшего возраста, страдающим серьезной бактериальной инфекцией. Хотя демографические исследования свидетельствуют о повышении риска сепсиса среди подростков, мало что известно о фебрильных подростках, посещающих отделение неотложной помощи (ЭД). Мы поставили перед собой цель описать характерные особенности пациентов и методы работы с девушками-подростками, посещающими отделение скорой помощи. DESIGN И SETRING: Исследование MOFICHE/PERFORM (Управленческое управление и результаты работ

Совпадение в аннотации оригинала
OBJECTIVE: Most studies on febrile children have focused on infants and young children with serious bacterial infection (SBI). Although popu … 2-18 years) with younger children in terms of patient characteristics, markers of disease severity (vital signs, clinical alarming signs), management (diagnostic tests, therapy, admission) and diagnosis (focus, viral/bacterial infection). RESULTS: 37 420 encounters were included, of which 2577 (6.9%) were adolescents. Adolescents were more often triaged as h …

Pediatric status epilepticus management.

PURPOSE OF REVIEW: This review discusses the management of status epilepticus in children, including both anticonvulsant medications and overall management approaches. RECENT FINDINGS: Rapid management of status epilepticus is associated with a greater likelihood of seizure termination and better outcomes, yet data indicate that there are often management delays. This review discusses an overall management approach aiming to simultaneously identify and manage underlying precipitant causes, administer anticonvulsants in rapid succession until seizures have terminated, and identify and manage s

Development and validation of a prediction model for evaluating extubation readiness in preterm infants.

Successful early extubation has advantages not only in terms of short-term respiratory morbidities and survival but also in terms of long-te … external validation. From a machine learning model using predictors such as demographics, periodic vital signs, ventilator settings, and respiratory indices, the area under the receiver operating characteristic curve and average precision of our model were 0.805 (95% confidence interval [CI], 0.802-0.809) and 0.917, respectively in the internal validation an …

Advanced wireless monitoring for children in the cardiac perioperative setting.

INTRODUCTION: More than 40,000 children undergo surgical interventions annually for the treatment of congenital heart defects. Intraoperative and postoperative vital sign monitoring is a cornerstone of pediatric care. METHODS: A single-arm prospective observational study was performed. Pediatric patients undergoing a procedure with a planned admission to the Cardiac Intensive Care Unit at Lurie Children's Hospital (Chicago, IL) were eligible for enrollment. Participant vital signs were monitored using standard equipment and an FDA-cleared experimental device (ANNE® ) consisting of a wireless …

Computational frameworks for automated detection and quantification of paroxysmal sympathetic hyperactivity among traumatic brain injury patients.

Paroxysmal sympathetic hyperactivity (PSH) is a syndrome that occurs in a large subset of critically ill traumatic brain injury (TBI) patients and is associated with complications and poor recovery. PSH is defined by recurrent episodic vital sign elevations in the appropriate clinical context. However, standard diagnostic criteria rely heavily on subjective judgment, leading to challenges and delays in recognition, monitoring, and management. The objective of this study was to develop automated PSH detection and quantification tools that exclusively utilize objective bedside continuous vital s

Implementation of a surgical ward innovation: Telemonitoring controlled by healthdot [SWITCH-trial PROTOCOL].

BACKGROUND: Monitoring patients' vital signs is important to detect abnormalities that may indicate a disturbed postoperative course. However, manual monitoring or so-called spot checks performed by nursing staff require a significant amount and are time-consuming. Wearable devices have been shown to be at least equally effective in collecting these data and have the possibility for continuous monitoring. This technology could enhance improvements in early warning score systems by continuous measurement or ease onward monitoring after earlier discharge. Furthermore, the implementation of weara…

Hemodynamic Parameters in the Assessment of Fluid Status in a Porcine Hemorrhage and Resuscitation Model.

BACKGROUND: Measuring fluid status during intraoperative hemorrhage is challenging, but detection and quantification of fluid overload is far more difficult. Using a porcine model of hemorrhage and over-resuscitation, it is hypothesized that centrally obtained hemodynamic parameters will predict volume status more accurately than peripherally obtained vital signs. METHODS: Eight anesthetized female pigs were hemorrhaged at 30 ml/min to a blood loss of 400 ml. After each 100 ml of hemorrhage, vital signs (heart rate, systolic blood pressure, mean arterial pressure, diastolic blood pressure, pu…

CPR Induced Consciousness During Out-of-Hospital Cardiac Arrest: A Case Report on an Emerging Phenomenon.

BACKGROUND: High quality cardiopulmonary resuscitation (CPR) has produced a relatively new phenomenon of consciousness in patients with vital signs absent. Further research is necessary to produce a viable treatment strategy during and post resuscitation. OBJECTIVE: To provide a case study done by paramedics in the field illustrating the need for sedation in a patient whose presentation was consistent with CPR induced consciousness. Resuscitative challenges are provided as well as potential future treatment options to minimize harm to both patients and prehospital providers. CASE REPORT: A 5…