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1.
Prensa méd. argent ; 105(11): 783-785, dic2019. fig
Article in Spanish | LILACS (Americas), BINACIS | ID: biblio-1049774

ABSTRACT

Background: It is widely established that the extraction of impaled objects should be carried out under direct vision. In the case of stable patients, endoscopic vision can be used as an alternative. Clinical Case: A 70-year-old male is admitted for a 5-hour impaled precordial stab wound. Evolution valued according to ATLS standards. Clinically and hemodynamically compensated patient. On physical examination: left pulmonary hypoventilation, subcutaneous emphysema, no jugular engorgement. Control of vital signs: TA: 110 / 70mmHg, FC: 70min, FR: 20min, Sat02: 97%. Complementary studies: ECO FAST: no pericardial fluid. Rx thorax: mild left pneumothorax heme. Chest CT: Puncture object of 18 cm in the left lung of AP and medial to the lateral path, hematoma of the angle, and hemopneumothorax grade I. Surgery: Patient in dorsal recumbency, under ARM with selective intubation. An incision in 5th left intercostal space, middle axillary line. 10mm trocar placement, 30 ° optics introduction. After discarding the commitment of the pericardium, active bleeding, and observing that the end of the weapon was going through the end of the angle, the weapon is removed under endoscopic vision. Clot washing/aspiration. Verification of hemostasis, absence of air leakage and pulmonary expansion. Drainage with 28 French tubes. Evolution: Derived from UTI extubated. CT scan thorax 72 h post: small intraparenchymal hematoma left, expanded lung. Minimum serohematic debit. Pleural tube and definitive discharge are removed on the 4th post-surgical day. Discussion: The literature suggests in the urgency, the removal of impaled objects under direct vision of the compromised structures. However, in stable patients, the previous study with CT should be unavoidable. Video-thoracoscopy in these wounded can avoid open surgery, but the procedure must be performed in trauma reference centers, with the appropriate means and by a trained surgical team willing to perform an emergency thoracotomy


Subject(s)
Male , Aged , Wounds, Stab/surgery , Chest Pain/surgery , Thoracotomy , Laparoscopy , Thoracic Surgery, Video-Assisted , Vital Signs
2.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 11(5): 1307-1311, out.-dez. 2019. ilus
Article in English, Portuguese | LILACS (Americas), BDENF | ID: biblio-1022248

ABSTRACT

Objective: The study's goal has been to describe the antecedent signs and symptoms of sepsis in patients hospitalized in the Medical Clinic of a Federal Hospital in Rio de Janeiro city, which are identified by a Registered Nurse; to analyze how the Nurse correlates the signs and symptoms with Sepsis-1, Sepsis-2 and Sepsis-3. Methods: It is a descriptive study with a quantitative approach; the population were 10 Registered Nurses who worked daytime shifts in the nursing ward. Data collection was performed through a structured questionnaire, addressing the identification of signs and symptoms that precede sepsis, including the characteristics and peculiarities of sepsis. Results: The Nurses have adequate understanding regarding the concept of sepsis, although they have showed difficulties in correlating some of the signs and symptoms. Conclusion: The Nurses are aware that sepsis is a health problem and that they provide direct care to the patient, therefore, it is important to identify the signs and symptoms that precede it in order to offer quality assistance and to help reducing new cases


Objetivo: Descrever os sinais e sintomas que antecedem a sepse em pacientes internados na Clínica Médica de um Hospital Federal no Rio de Janeiro identificados pelo Enfermeiro; analisar como o Enfermeiro correlaciona os sinais e sintomas com a Sepsis-1, Sepsis-2 e Sepsis-3. Métodos: Estudo descritivo com abordagem quantitativa, a população foram 10 Enfermeiros em plantões diurnos na enfermaria da Clínica. A coleta de dados foi um questionário estruturado, abordando identificação dos sinais e sintomas que antecedem a sepse, englobando as características e particularidades da sepse. Resultados: Evidenciou-se que possuem entendimento sobre o conceito de sepse, entretanto apresentaram dificuldades em correlacionar alguns dos sinais e sintomas dos tipos de sepse. Conclusão: Ciente que a sepse é um problema de saúde e o Enfermeiro presta cuidado direto ao paciente, percebe-se a importância na identificação dos sinais e sintomas que a antecedem para oferecer assistência de qualidade e auxiliar na redução dos casos


Objetivo: Describe los síntomas y antecedentes de la sepsis en pacientes internados en la Clínica Médica de un Hospital Federal en Río de Janeiro por el enfermero; analizar cómo el enfermero correlaciona los signos y síntomas con Sepsis-1, Sepsis-2 y Sepsis-3. Métodos: Estudio descriptivo con abordaje cuantitativo, la población fue 10 enfermeros en turnos diurnos en la enfermería de la Clínica. La recolección de datos fue un cuestionario estructurado, abordando identificación de los signos y síntomas que anteceden a la sepsis, englobando las características y particularidades de la sepsis. Resultados: Tienen un entendimiento adecuado sobre el concepto de sepsis, sin embargo, presentan dificultades en correlacionar algunos de los signos y síntomas. Conclusión: Es consciente de que la sepsis es un problema de salud y el enfermero presta atención directa al paciente, se percibe la importancia en la identificación de los signos y síntomas que la anteceden para ofrecer asistencia de calidad y auxiliar en la reducción de los casos


Subject(s)
Humans , Male , Female , Systemic Inflammatory Response Syndrome/diagnosis , Sepsis/nursing , Sepsis/prevention & control , Diagnosis , Vital Signs
3.
Rev. Bras. Saúde Mater. Infant. (Online) ; 19(3): 545-555, Jul.-Sept. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1041088

ABSTRACT

Abstract Objectives: to evaluate the modified early obstetric warning system (MEOWS) in women after pregnancies in a tertiary hospital in Brazil. Methods: a descriptive study was conducted with 705 hospitalized women. Vital signs (systolic and diastolic blood pressure, heart rate, respiratory rate, temperature) and lochia were registered on medical records and transcribed into the MEOWS chart of physiological parameters. On this graphic chart, yellow alerts were used to present moderate abnormalities in vital signs, while severe abnormalities were presented in red. The presence of at least one red alert or two yellow alerts were triggered to indicate the need for medical evaluation. Results: although abnormalities were found in the physiological parameters of 49.8% of the women identified from MEOWS triggers, medical evaluation was only requested for three patients (0.8%). Conclusions: in a retrospective application of the use of MEOWS showed a significant number of patients had triggered in which the nursing team did not recognize 99.2% of cases. This finding could be attributed to the fact that MEOWS has not been yet adopted in this service as part of the nursing care. The application of this tool would result in a better care because critical situations would be recognized and corrected quickly, avoiding unfavorable outcomes.


Resumo Objetivos: avaliar o modified early obstetric warning system (MEOWS) em mulheres após gestações, em um hospital terciário do Brasil. Métodos: foi realizado um estudo descritivo incluindo 705 mulheres internadas. Os sinais vitais (pressão arterial sistólica e diastólica, frequência cardíaca, frequência respiratória, temperatura) e lóquios, registrados no prontuário, foram transcritos para o gráfico de parâmetros fisiológicos do MEOWS. Neste gráfico, anormalidades moderadas nos sinais vitais eram sinalizadas por alertas amarelos, enquanto anormalidades graves eram sina-lizadas em vermelho. A presença de, pelo menos, um alerta vermelho ou dois alertas amarelos foi chamada de eventos gatilho, indicando necessidade de avaliação médica. Resultados: dentre as mulheres estudadas, 49,8% apresentaram anormalidades nos parâmetros fisiológicos, através da identificação de eventos gatilho no MEOWS, porém avaliação médica foi solicitada para apenas três pacientes, resultando num percentual de 0,8%. Conclusões: a utilização do MEOWS, de forma retrospectiva, evidenciou uma quantidade significativa de pacientes apresentando eventos gatilho, os quais não foram reconhecidos pela equipe de enfermagem em 99,2% dos casos. Este achado pode ser atribuído ao fato de o MEOWS ainda não ser adotado no serviço como parte da rotina dos cuidados de enfermagem. A aplicação dessa ferramenta resultaria numa assistência melhor, pois situações críticas seriam reconhecidas e corrigidas com maior precocidade, evitando desfechos desfavoráveis.


Subject(s)
Humans , Female , Pregnancy , Adult , Young Adult , Pregnancy Complications/diagnosis , Clinical Alarms/standards , Monitoring, Physiologic/methods , Pregnancy Complications/mortality , Maternal Mortality , Indicators of Morbidity and Mortality , Risk , Retrospective Studies , Health Status Indicators , Vital Signs , Near Miss, Healthcare
4.
Rev. ADM ; 76(4): 229-233, jul.-ago 2019. tab
Article in Spanish | LILACS (Americas) | ID: biblio-1023911

ABSTRACT

La medición de los signos vitales es de gran importancia en el consultorio dental, de esta forma podemos obtener una visión objetiva y anticipada del estado funcional del paciente. Según la información obtenida, se tomarán decisiones terapéuticas. El odontólogo debe saber que el seguimiento clínico y el uso de la técnica adecuada para sus mediciones representan un aspecto muy relevante para prevenir emergencias en el consultorio dental. El odontólogo debe medir los signos vitales antes, durante y después del procedimiento dental y, del mismo modo, debe estar involucrado en la situación individual de cada paciente y proporcionar medidas higiénicodietéticas para mejorar su calidad de vida. La evaluación continua de los signos vitales durante el procedimiento quirúrgico dental, en el que se usan anestésicos locales, es particularmente relevante en este caso, ya que puede ayudarnos a prevenir complicaciones como arritmias cardiacas, crisis hipertensivas o angina de pecho. El objetivo de este artículo es promover en toda la profesión odontológica, el monitoreo de los signos vitales, su técnica de medición correcta y su correlación con otros datos de un historial completo médico y dental (AU)


The measurement of vital signs is of great importance in the dental office, this way we can obtain an objective and anticipated vision of the functional state of the patient. According to the information obtained, therapeutic decisions will be made. The dentist must know that monitoring and using the appropriate technique for its measurements, represents a very relevant aspect for the emergency in the dental office. The dentist must measure the vital signs before, during and after the dental procedure, likewise, they must be involved in the individual situation of each patient and provide hygienic-dietetic measures to improve their quality of life. The continuous assessment of vital signs during the dental surgical procedure, in which local anesthetics are used, is particularly relevant in this case since it can help us prevent complications such as cardiac arrhythmias, hypertensive crisis or angor pectoris. The objective of this article is to promote throughout the dental profession, the monitoring of vital signs, their correct measurement technique and their correlation with other data from a complete medical and dental history (AU)


Subject(s)
Humans , Emergencies , Vital Signs , Arrhythmias, Cardiac , Pulse , Vasoconstrictor Agents , Comprehensive Dental Care , Oral Surgical Procedures , Arterial Pressure , Hypertension , Angina Pectoris
5.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-758477

ABSTRACT

OBJECTIVE: The Korean Triage and Acuity Scale (KTAS) has been used in all emergency departments (EDs) since 2016. Medical personnel can provide the treatment priority based on the KTAS levels. The inter-rater agreement with KTAS has not been reported, even though most triage assignments are performed by nurses in Korea. This study was aimed to verify the agreement of triage levels between emergency physicians (EPs) and nurses with KTAS. METHODS: This was a prospective, single-center study of an academic tertiary medical center. If the patient visits the ED, the triage nurse and EP meet the patients together. The nurse performed the history taking and physical examinations including vital signs measurements then recorded the KTAS levels. The EP did not interfere with the nurse's decision. The EP also decided the KTAS levels. The designated codes and levels were compared. The EP recorded the detailed reasons for the disagreement if there was discrepancy. RESULTS: Comparisons were performed with 928 patients. The number of patients in each KTAS level was 95 (10.2%) in level I, 263 (28.3%) in level II, 348 (37.5%) in level III, 144 (15.5%) in level IV, and 78 (8.4%) in level V. The overall agreement was 761 (82%), and the Kappa coefficient was 0.691. The errors of history taking were most frequent (131, 78.4%). Insufficient understanding of the disease pathophysiology, inaccurate neurological examinations, and errors that did not consider the vital signs except for the blood pressure were encountered in 12 (7.2%). CONCLUSION: The agreement rate was high between EPs and nurses using KTAS (K=0.691, substantial agreement).


Subject(s)
Blood Pressure , Emergencies , Emergency Service, Hospital , Humans , Korea , Neurologic Examination , Observer Variation , Physical Examination , Prospective Studies , Triage , Vital Signs
6.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-758453

ABSTRACT

OBJECTIVE: This study examined the utility of combined chest and abdominal computed tomography (CT) for the identification of infection sources in acute febrile patients without clinical clues. The groups for whom combined CT was helpful and not were compared. In addition, the factors that affected the positive infection sources and predictors of the presence of infection sources when performing combined CT was investigated. METHODS: Acute febrile patients without clinical clues from a basic examination and the confirmation procedure were investigated prospectively for 6 months. A range of factors, such as demographic factors, duration of fever, vital signs, presence of prior medical treatment, inflammatory markers, and several sepsis prediction tools, were analyzed. RESULTS: Of the 87 patients, 32 (36.8%) tested positive for infection sources on combined CT, whereas 55 (63.2%) tested negative. The mean age, heart rate, procalcitonin (PCT) level, and proportion of the patients aged ≥65 years showed significant differences between the infection source-positive group and infection source-negative group (P=0.027, P=0.008, P=0.035, and P=0.026, respectively). The factors that affected the positive results for infection sources on combined CT included age (odds ratio [OR], 1.047; P=0.011), absence of chronic disease (OR, 0.157; P=0.045), and heart rate (OR, 1.056; P=0.030). Analysis of the receiver-operating characteristic curve showed that age (area under the curve [AUC], 0.630; P=0.041) and heart rate (AUC, 0.659; P=0.008) were significant predictive factors of positive results for infection sources. On the other hand, their predictive powers were poor, and PCT did not show a significant result (AUC, 0.565; P=0.351). CONCLUSION: In patients with underlying chronic disease, older age, increased heart rate due to fever, or a high PCT level, combined CT can be used to identify infection sources when its possible clinical benefits are considered to be high.


Subject(s)
Chronic Disease , Demography , Emergency Service, Hospital , Fever , Hand , Heart Rate , Humans , Prospective Studies , Sepsis , Thorax , Vital Signs
7.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-758438

ABSTRACT

OBJECTIVE: In the Korean Triage and Acuity Scale (KTAS), the triage of febrile pediatric patients is classified mainly by measuring the vital signs but it has limitations. Therefore, this study was conducted assuming that a better result can be obtained using the duration of fever when triaging a febrile pediatric patient. METHODS: If febrile pediatric patients satisfy the following four rules, the triage level was downgraded and it was defined as the modified Korean Triage and Acuity Scale (mKTAS) and compared with KTAS: age>3 months; alert mental status; patients who visit according to disease; and onset < 24 hours. RESULTS: The total and intensive care unit (ICU) admission rate was highest in triage level 2 in both KTAS and mKTAS (P < 0.001). The length of stay in the febrile pediatric patients increased from triage level 1 to 5 in both KTAS and mKTAS. Resource use also decreased from triage level 1 to 5 in both KTAS and mKTAS. In particular, mKTAS has a better tendency than KTAS. Overall, there was a difference in the total admission rate and ICU admission rate, length of stay, and resource use between KTAS and mKTAS, but there was no significant clinical significance. CONCLUSION: If the KTAS level is down-triaged in febrile pediatric patients who are alert and 3 months or older and within 24 hours of symptom onset, there would be no significant clinical differences in the rates of admission, length of stay, and resource use. The duration of fever needs to be considered in triaging febrile pediatric patients.


Subject(s)
Fever , Humans , Intensive Care Units , Length of Stay , Pediatrics , Triage , Vital Signs
8.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-758416

ABSTRACT

PURPOSE: This study estimated the incidence of delirium and associated risk factors and outcomes in ICU patients with acute poisoning. METHODS: Data were collected from ICU patients over 18 years of age that were admitted via the emergency center after presenting with poisoning from 2010 to 2015. Delirium was assessed retrospectively using the Intensive Care Delirium Screening Checklist (ICDSC). Risk factors were evaluated by univariate and multivariate analysis. RESULTS: A total of 199 patients participated in this study and 68 (34.2%) were diagnosed with delirium based on the ICDSC score. The delirium group showed a significantly higher association with prolonged length of stay in the hospital and ICU in comparison with the non-delirium group. The delirium group was associated with greater use of physical restraint. A statistically greater number of patients with pharmaceutical substance poisoning developed delirium over a short period of time than those with non-pharmaceutical substance poisoning. There was no significant difference between the two groups with respect to age, sex, past history, GCS score, vital signs, application of ventilator care and renal replacement therapy. CONCLUSION: The finding that the delirium group had a greater length of stay in both the hospital and the ICU is consistent with the results of previous worldwide studies of the effects of delirium on the prognosis of patients who were admitted to the ICU, suggesting the possibility for domestic application. Additionally, use of physical restraint was positively related to the incidence of delirium. Thus, interventions for minimizing the use of physical restraints and considering alternatives are needed.


Subject(s)
Checklist , Critical Care , Delirium , Emergencies , Humans , Incidence , Intensive Care Units , Length of Stay , Mass Screening , Multivariate Analysis , Poisoning , Prognosis , Renal Replacement Therapy , Restraint, Physical , Retrospective Studies , Risk Factors , Ventilators, Mechanical , Vital Signs
9.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-758414

ABSTRACT

Glyphosate herbicides, which are widely used worldwide, are known to have low toxicity. However, excessive intake may cause serious life-threatening complications; therefore, caution is needed when using them. A 51-year-old man visited the hospital after ingesting glyphosate herbicide. At the time of admission, his vital signs were 80/60 mmHg-115/min-20/min-37.3℃. Electrocardiogram (ECG) showed QRS widening and corrected QT (QTc) prolongation, and blood tests showed metabolic acidosis. Treatment with gastric lavage, activated charcoal, sodium bicarbonate and intravenous lipid emulsion therapy was performed. After 2 hours, his blood pressure increased to 130/90 mg, and no QRS widening was observed on ECG.


Subject(s)
Acidosis , Blood Pressure , Charcoal , Electrocardiography , Gastric Lavage , Hematologic Tests , Herbicides , Humans , Middle Aged , Poisoning , Sodium Bicarbonate , Vital Signs
10.
Gut and Liver ; : 649-657, 2019.
Article in English | WPRIM (Western Pacific) | ID: wprim-763885

ABSTRACT

BACKGROUND/AIMS: Recent studies have demonstrated that etomidate is a safe sedative drug with noninferior sedative effects. In our recent study, we revealed that etomidate/midazolam was more hemodynamically stable than propofol/midazolam in elderly patients undergoing colonoscopies. We aimed to investigate whether compared with propofol/midazolam, etomidate/midazolam causes fewer cardiopulmonary adverse events with noninferior efficacy for screening colonoscopies in patients of all ages. METHODS: In this single-center, randomized, double-blind study, we prospectively enrolled 200 patients. The patients were divided into etomidate and propofol groups. The primary outcome was the occurrence of cardiopulmonary adverse events. The secondary outcomes were the proportion of patients with fluctuations in vital signs (oxygen desaturation and transient hypotension), adverse events interrupting the procedure, and sedation-related outcomes. RESULTS: Adverse cardiopulmonary events were more common in the propofol group than the etomidate group (65.0% vs 51.0%, respectively; p=0.045). Forty-six patients (46.0%) in the propofol group and 29 (29.0%) in the etomidate group experienced fluctuations in their vital signs (p=0.013). The proportions of patients experiencing adverse events that interrupted the procedure, including myoclonus, were not significantly different between the two groups (etomidate: 20.0% vs propofol: 11.0%; p=0.079). Both groups had similar sedation-related outcomes. Multivariate analysis revealed that compared with the propofol groups, the etomidate group had a significantly lower risk of fluctuations in vital signs (odds ratio, 0.427; 95% confidence interval, 0.230 to 0.792; p=0.007). CONCLUSIONS: Compared with using propofol/midazolam, using etomidate/midazolam for screening colonoscopies results in more stable hemodynamic responses in patients of all ages; therefore, we recommend using etomidate/midazolam for colonoscopies in patients with cardiovascular risk factors.


Subject(s)
Aged , Colonoscopy , Double-Blind Method , Etomidate , Hemodynamics , Humans , Hypnotics and Sedatives , Mass Screening , Midazolam , Multivariate Analysis , Myoclonus , Propofol , Prospective Studies , Risk Factors , Vital Signs
11.
Article in English | WPRIM (Western Pacific) | ID: wprim-763009

ABSTRACT

This article reviews the historical development and up-to-date state of thermometric technologies for measuring human body temperature (BT) from two aspects: measurement methodology and signifi cance interpretation. Since the fi rst systematic and comprehensive study on BT and its relation to human diseases was conducted by Wunderlich in the late 19th century, BT has served as one of the most fundamental vital signs for clinical diagnosis and daily healthcare. The physiological implication of BT set point and thermoregulatory mechanisms are briefl y outlined. Infl uential determinants of BT measurement are investigated thoroughly. Three types of BT measurement, i.e., core body temperature, surface body temperature and basal body temperature, are categorized according to its measurement position and activity level. With the comparison of temperature measurement in industrial fi elds, specialties in technological and biological aspects in BT measurement are mentioned. Methodologies used in BT measurement are grouped into instrumental methods and mathematical methods. Instrumental methods utilize results of BT measurements directly from temperature-sensitive transducers and electronic instrumentations by the combination of actual and predictive measurement, invasive and noninvasive measurement. Mathematical methods use several numerical models, such as multiple regression model, autoregressive model, thermoregulatory mechanism-based model and the Kalman fi lter-based method to estimate BT indirectly from some relevant vital signs and environmental factors. Thermometry modalities are summarized on the dichotomies into invasive and noninvasive, contact and noncontact, direct and indirect, free and restrained, 1-D and n-D. Comprehensive interpretation of BT has an equal importance as the measurement of BT. Two modes to apply BT are classifi ed into real-time applications and long-term applications. With rapid advancement in IoT infrastructure, big data analytics and AI platforms, prospects for future development in thermometry and interpretation of BT are discussed.


Subject(s)
Basal Bodies , Body Temperature , Delivery of Health Care , Diagnosis , Human Body , Humans , Methods , Thermometers , Thermometry , Transducers , Vital Signs
12.
Article in English | WPRIM (Western Pacific) | ID: wprim-762734

ABSTRACT

BACKGROUND: Because many cosmetic surgery clinics are not adequately equipped to handle emergent conditions, patients often come to a university hospital when problems occur during or after cosmetic surgery. However, few in-depth studies have been conducted of this issue. Therefore, we investigated emergency department visits due to complications associated with cosmetic surgery. METHODS: A retrospective chart review was conducted of 38 patients who visited the emergency department of the authors' institution due to complications associated with cosmetic surgery from July 2014 to June 2017. RESULTS: There were more women than men (30 women vs. 8 men). Their mean age was 32.4 years (range, 19–57 years). Upon presentation to the emergency department, patients' vital signs and mental status were usually normal (27 normal vs. 11 abnormal). The types of surgery included blepharoplasty, rhinoplasty, malar/orthognathic surgery, mammaplasty, liposuction, fat grafting, and filler and botulinum toxin injections. Most patients required hospitalization (26 admitted vs. 12 discharged). Eight of the hospitalized patients required intensive care unit care, of whom two died and three experienced brain death or had permanent neurologic sequelae. CONCLUSIONS: The complications were usually minor problems, despite the need for hospitalization, but some complications were life-threatening. We recommend close monitoring and maintaining an adequate injection capacity for intravenous sedative anesthesia. When any symptom or sign of a complication occurs, it is best to transfer the patient to a university hospital as soon as possible. Taking a careful medical history is always needed, even for minor procedures.


Subject(s)
Anesthesia , Blepharoplasty , Botulinum Toxins , Brain Death , Cardiomyopathies , Emergencies , Emergency Service, Hospital , Epinephrine , Female , Hospitalization , Humans , Intensive Care Units , Lipectomy , Male , Mammaplasty , Retrospective Studies , Rhinoplasty , Surgery, Plastic , Transplants , Vital Signs
13.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-739855

ABSTRACT

PURPOSE: This study was conducted to evaluate the effect of breast milk olfactory stimulation on physiological responses, oral feeding progression, and body weight in preterm infants. METHODS: A repeated measures design with nonequivalent control group was used. The participants were healthy, preterm infants born at a gestational age of 28~32 weeks; 12 in the experimental group and 16 in the control group. Data were collected prospectively in the experimental group, and retrospectively in the control group, by the same methods. Breast milk olfactory stimulation was provided 12 times over 15 days. The data were analyzed using the chi-square test, Mann-Whitney U test, Wilcoxon signed rank test and linear mixed models using SPSS 19. RESULTS: The gastric residual volume (GRV) of the experimental group was significantly less than that of the control group. The heart rate, oxygen saturation, respiration rate, transition time to oral feeding, and body weight were not significantly different between the two groups. CONCLUSION: These findings indicate that breast milk olfactory stimulation reduces GRV and improves digestive function in preterm infants without inducing distress.


Subject(s)
Body Weight , Breast , Gastric Emptying , Gestational Age , Heart Rate , Humans , Infant, Newborn , Infant, Premature , Milk, Human , Oxygen , Prospective Studies , Residual Volume , Respiratory Rate , Retrospective Studies , Smell , Vital Signs
14.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-786011

ABSTRACT

PURPOSE: This study was conducted to investigate relationship between delirium, risk factors on delirium, and patient prognosis based on Donabedian's structure-process-outcome model.METHODS: This study utilized a path analysis design. We extracted data from the electronic medical records containing delirium screening data. Each five hundred data in a delirium and a non-delirium group were randomly selected from electronic medical records of medical and surgical intensive care patients. Data were analyzed using SPSS 20 and AMOS 24.RESULTS: In the final model, admission via emergency department (B=.06, p=.019), age over 65 years (B=.11, p=.001), unconsciousness (B=.18, p=.001), dependent activities (B=.12, p=.001), abnormal vital signs (B=.12, p=.001), pressure ulcer risk (B=.12, p=.001), enteral nutrition (B=.12, p=.001), and use of restraint (B=.30, p=.001) directly affecting delirium accounted for 56.0% of delirium cases. Delirium had a direct effect on hospital mortality (B=.06, p=.038), hospital length of stay (B=5.06, p=.010), and discharge to another facility (not home) (B=.12, p=.001), also risk factors on delirium indirectly affected patient prognosis through delirium.CONCLUSION: The use of interventions to reduce delirium may improve patient prognosis. To improve the dependency activities and risk of pressure ulcers that directly affect delirium, early ambulation is encouraged, and treatment and nursing interventions to remove the ventilator and drainage tube quickly must be provided to minimize the application of restraint. Further, delirium can be prevented and patient prognosis improved through continuous intervention to stimulate cognitive awareness and monitoring of the onset of delirium. This study also discussed the effects of delirium intervention on the prognosis of patients with delirium and future research in this area.


Subject(s)
Critical Care , Delirium , Drainage , Early Ambulation , Electronic Health Records , Emergency Service, Hospital , Enteral Nutrition , Hospital Mortality , Humans , Intensive Care Units , Length of Stay , Mass Screening , Nursing , Pressure Ulcer , Prognosis , Risk Factors , Unconsciousness , Ventilators, Mechanical , Vital Signs
15.
Article in English | WPRIM (Western Pacific) | ID: wprim-785605

ABSTRACT

OBJECTIVE: To determine the factors associated with unmet needs in immigrant patients complaining of abdominal pain, by analyzing those associated with the time from symptom onset to emergency room visit.METHODS: We retrospectively reviewed the medical records of immigrants with abdominal pain who visited a tertiary hospital emergency department from January to December 2016. The dependent variable was the time from symptom onset to emergency room visit. The independent variables were age, sex, vital signs, disposition, health insurance status, date of visit, time of visit, level of education, employment status, economic satisfaction, marital status, living with family, duration of residence, having a native spouse, and subjective proficiency in Korean. We analyzed the association of the dependent variable with each independent variable.RESULTS: In total, 102 immigrant patients with abdominal pain were enrolled in this study. The patients who had earlier visits had good subjective proficiency in Korean, high economic satisfaction, longer durations of residence, a tendency to have a native spouse, and a high employment rate. After linear regression analysis, the time from symptom onset to emergency room visit was negatively associated with employment (adjusted odds ratio, -13.67; 95% confidence interval, -23.25 to -4.09; P=0.006) and having a native spouse (adjusted odds ratio, -11.7; 95% confidence interval, -20.61 to -2.8; P=0.011).CONCLUSION: The factors influencing the time from symptom onset to emergency room visit in immigrant patients with abdominal pain are associated with social capital, which improves access to emergency care. Policies that improve immigrant access to emergency care should be considered.


Subject(s)
Abdominal Pain , Adult , Education , Emergencies , Emergency Medical Services , Emergency Service, Hospital , Emigrants and Immigrants , Employment , Health Services Needs and Demand , Humans , Insurance, Health , Korea , Linear Models , Marital Status , Medical Records , Odds Ratio , Retrospective Studies , Social Capital , Spouses , Tertiary Care Centers , Vital Signs
16.
Article in English | WPRIM (Western Pacific) | ID: wprim-785587

ABSTRACT

OBJECTIVE: To test the hypothesis that the quick Sepsis-related Organ Failure Assessment (qSOFA) score, derived from vital signs taken during triage and recommended by current sepsis guidelines for screening patients with infections for organ dysfunction, is not sensitive enough to predict the risk of mortality in emergency department (ED) sepsis patients.METHODS: Patients diagnosed with severe sepsis and septic shock using the old definition between May 2014 and April 2015 were retrospectively reviewed in three urban tertiary hospital EDs. The sensitivities of systemic inflammatory response syndrome (SIRS) criteria, qSOFA, and Sequential Organ Failure Assessment (SOFA) scores ≥2 were compared using McNemar’s test. Diagnostic performances were evaluated using specificity, positive predictive value, and negative predictive value.RESULTS: Among the 928 patients diagnosed with severe sepsis or septic shock using the old definition, 231 (24.9%) died within 28 days. More than half of the sepsis patients (493/928, 53.1%) and more than one-third of the mortality cases (88/231, 38.1%) had a qSOFA score <2. The sensitivity of a qSOFA score ≥2 was 61.9%, which was significantly lower than the sensitivity of SIRS ≥2 (82.7%, P<0.001) and SOFA ≥2 (99.1%, P<0.001). The specificity, positive predictive value, and negative predictive value of a qSOFA score ≥2 for 28-day mortality were 58.1%, 32.9%, and 82.2%, respectively.CONCLUSION: The current clinical criteria of the qSOFA are less sensitive than the SIRS assessment and SOFA to predict 28-day mortality in ED patients with sepsis.


Subject(s)
Emergencies , Emergency Service, Hospital , Humans , Mass Screening , Mortality , Prognosis , Retrospective Studies , Sensitivity and Specificity , Sepsis , Shock, Septic , Systemic Inflammatory Response Syndrome , Tertiary Care Centers , Triage , Vital Signs
17.
Biomedical Engineering Letters ; (4): 425-434, 2019.
Article in English | WPRIM (Western Pacific) | ID: wprim-785531

ABSTRACT

Heart rate variability (HRV) is governed by the autonomic nervous system (ANS) and is routinely used to estimate the state of body and mind. At the same time, recorded HRV features can vary substantially between people. A model for HRV that (1) correctly simulates observed HRV, (2) reliably functions for multiple scenarios, and (3) can be personalised using a manageable set of parameters, would be a significant step forward toward understanding individual responses to external influences, such as physical and physiological stress. Current HRV models attempt to reproduce HRV characteristics by mimicking the statistical properties of measured HRV signals. The model presented here for the simulation of HRV follows a radically different approach, as it is based on an approximation of the physiology behind the triggering of a heart beat and the biophysics mechanisms of how the triggering process—and thereby the HRV—is governed by the ANS. The model takes into account the metabolisation rates of neurotransmitters and the change in membrane potential depending on transmitter and ion concentrations. It produces an HRV time series that not only exhibits the features observed in real data, but also explains a reduction of low frequency band-power for physically or psychologically high intensity scenarios. Furthermore, the proposed model enables the personalisation of input parameters to the physiology of different people, a unique feature not present in existing methods. All these aspects are crucial for the understanding and application of future wearable health.


Subject(s)
Autonomic Nervous System , Biophysics , Heart Rate , Heart , Membrane Potentials , Neurotransmitter Agents , Physiology , Stress, Physiological , Vital Signs
18.
Article in English | WPRIM (Western Pacific) | ID: wprim-785368

ABSTRACT

BACKGROUND: Hydroxyethyl starch (HES), a class of synthetic colloid solutions, has been widely used to treat perioperative hypovolemia. The use of HES, however, is associated with the risk of allergic reactions.CASE: An 83-year-old man was scheduled to undergo an open reduction and internal fixation of a pertrochanteric fracture under spinal anesthesia. He had no history of allergy. Five minutes after HES administration, hypotension, agitation, and skin rash were developed. HES infusion was terminated due to a suspected anaphylactic reaction. The vital signs recovered following administration of phenylephrine, dexamethasone, and hydrocortisone. Serum tryptase and total immunoglobulin E levels were elevated in plasma samples collected following the commencement of the allergic reaction during surgery.CONCLUSIONS: In the present report, the risk of anaphylactic reaction with HES and the laboratory tests needed to support the diagnosis are highlighted.


Subject(s)
Aged, 80 and over , Anaphylaxis , Anesthesia , Anesthesia, Spinal , Colloids , Dexamethasone , Diagnosis , Dihydroergotamine , Exanthema , Humans , Hydrocortisone , Hypersensitivity , Hypotension , Hypovolemia , Immunoglobulin E , Immunoglobulins , Phenylephrine , Plasma , Starch , Tryptases , Vital Signs
19.
Article in English | WPRIM (Western Pacific) | ID: wprim-761758

ABSTRACT

In malaria, splenic rupture is a serious complication potentially leading to death. Subcapsular hemorrhage of spleen is thought to be an impending sign of splenic rupture; however, the characteristics of subcapsular hemorrhage are not well known. We report 3 cases of subcapsular hemorrhage of the spleen in vivax malaria, with varying degrees of severity. Case 1 showed subcapsular hemorrhage without splenic rupture, was treated by antimalarial drug without any procedure. The healing process of the patient's spleen was monitored through 6 computed tomography follow-up examinations, over 118 days. Case 2 presented subcapsular hemorrhage with splenic rupture, treated only with an antimalarial drug. Case 3 showed subcapsular hemorrhage with splenic rupture and hypotension, treated using splenic artery embolization. They all recovered from subcapsular hemorrhage without any other complications. These 3 cases reveal the process of subcapsular hemorrhage leading to rupture and a potentially fatal outcome. The treatment plan of subcapsular hemorrhage should be determined carefully considering the vital signs, changes in hemoglobin, and bleeding tendency.


Subject(s)
Fatal Outcome , Follow-Up Studies , Hemorrhage , Hypotension , Malaria , Malaria, Vivax , Plasmodium vivax , Rupture , Spleen , Splenic Artery , Splenic Rupture , Vital Signs
20.
Kosin Medical Journal ; : 24-29, 2019.
Article in English | WPRIM (Western Pacific) | ID: wprim-760466

ABSTRACT

OBJECTIVES: Vacuum-assisted breast biopsy (VABB) is a widely used technique for the diagnosis of breast lesions. It is carried out with local anesthesia, but procedural pain and stress are still problematic. Dexmedetomidine is a α-2 receptor agonist that can sedate without significant respiratory depression. The study aimed to report the effectiveness of sedation with monitored anesthesia care (MAC) using dexmedetomidine in VABB. METHODS: This was a retrospective chart review of patients who received VABB under MAC with dexmedetomidine. Forty-seven patients during the period of February 2015 to July 2016 were included. We collected data on patient characteristics, infusion drug and dose, induction to incision time, anesthetic, operation, and recovery time and other complications and vital signs. RESULTS: The mean operating time was 50.1 ± 24.9 minutes, and the anesthetic time was 71.2 ± 28.3 minutes. The mean time from induction to incision was 17.0 ± 5.2 minutes, and the recovery time was 20.1 ± 10.3 minutes. None of the patients needed an advanced airway management. Further, none of them showed hemodynamic instability. CONCLUSIONS: VABB was successfully performed with MAC using dexmedetomidine, and there was no respiratory depression or hemodynamic instability.


Subject(s)
Airway Management , Anesthesia , Anesthesia, Local , Biopsy , Breast , Dexmedetomidine , Diagnosis , Hemodynamics , Humans , Respiratory Insufficiency , Retrospective Studies , Vital Signs
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