Improving the improvisational pelvic circumferential compression technique for open-book pelvic fractures using a simulation model and a sphygmomanometer.

BACKGROUND: Open-book pelvic fractures are associated with significant mortality. Emergency management may require a commercial pelvic circumferential compression device to reduce the fracture and compress haemorrhaging pelvic vasculature. Standard, commercial, twin-sized bedsheets are acceptable should commercial devices be unavailable. However, obese victims or personnel with insufficient body strength may impede successful reduction. OBJECTIVE: To demonstrate the value of an improvisational windlass (intravenous pole) in improving the ability to reduce an open-book pelvic fracture. METHODS: The Institutional Review Board-approved study involved 28 diverse healthcare students and emergency medicine residents. Each participant's demographic information and physical characteristics were recorded. A METIman was prepared with knee and ankle binding and a sphygmomanometer set at 40 mm Hg placed over the symphysis pubis. Two-person teams were randomly selected to place a bedsheet at greater trochanter level and atop the sphygmomanometer. The bedsheet was secured with maximum effort by the pairs and the pressure recorded. Following this, the pairs inserted an intravenous pole in the knot and torqued the pole to maximum effort and a repeat pressure recorded. RESULTS: The mean increase in pressure using only the bedsheet was 106.43 mm Hg per team. With bedsheet and intravenous pole, the mean pressure increase was 351.79 mm Hg per team. The difference was statistically significant (independent samples t-test: t = 17.177, p < 0.001, 95% CI (216.65 to 274.07 mm Hg). There was no correlation between pressure increases and the individual physical characteristics of the subjects (r = - 0.183, p = 0.352). CONCLUSIONS: Regardless of personnel's physical attributes, the addition of an improvisational windlass to a pelvic circumferential compression bedsheet can improve the ability to reduce an open-book fracture, especially in obese victims.

Assessing the validity of oscillometric device for blood pressure measurement in a large population-based epidemiologic study.

To evaluate the accuracy of the Omron HBP-1300, an automatic device for blood pressure (BP) measurement, compared with the standard auscultatory method with a mercury sphygmomanometer, we conducted a large population-based survey. From 2012 to 2015, a total of 500,000 participants were randomly selected from the 262 urban cities and rural counties in China, of them BP was measured three times simultaneously with mercury sphygmomanometer and Omron HBP-1300 in 37,816 participants. Bias was estimated as the average of the auscultatory measurements minus the average of the oscillometric measurements, with its corresponding 95% limits of agreement. The Association for the Advancement of Medical Instrumentation standards and British Hypertension Society protocols were used to evaluate the accuracy of the oscillometric device. The results showed that the Omron underestimated systolic BP by 1.0 mm Hg (95% limits of agreement: -9.2, 11.2) and underestimated diastolic BP by 0.2 mm Hg (95% limits of agreement: -8.5, 8.1). The bias in systolic BP values was related to heart rate, systolic BP, and pulse pressure level, while the bias in diastolic BP was related to the heart rate and pulse pressure level. Omron HBP-1300 passed the Association for the Advancement of Medical Instrumentation standards and British Hypertension Society protocol requirements. The sensitivity and specificity of the Omron HBP-1300 to detect hypertension were 86.2% and 98.0%, respectively. Our results showed that the Omron HBP-1300 could be used for measuring BP in large epidemiology studies. The bias of BP measurement was related to the age, systolic BP, and pulse pressure level.

Unsafe health and safety: sphygmomanometer cuffs are not interchangeable.

Unknown to its hypertension specialists, a major teaching hospital changed the cuffs on its sphygmomanometers from manufacturer-validated to a uniform washable alternative, in line with 'Health and Safety' concerns surrounding potential cross-contamination between patients. When clinic doctors suspected serious under-reading with the new cuffs, a systematic comparison was undertaken in 54 patients (mean±s.d. age, 61±17 years), using two UM-101 sphygmomanometers, one using the original, manufacturer-supplied cuff and the other with the washable replacement. The study confirmed an average under-reading of 8±10/5±5 mm Hg using the washable cuff, and a third of patients with poorly controlled hypertension were considered normotensive, after using this cuff. The UM-101 sphygmomanometers have now been re-fitted with the original cuffs. Sphygmomanometer cuffs are not interchangeable between devices and a modicum of common sense should be shown to prevent changes made in the name of Health and Safety from having the opposite effect to that intended.

Sphygmomanometry-evoked allodynia in chronic pain patients with and without fibromyalgia.

BACKGROUND: Fibromyalgia is a chronic pain syndrome that affects about 2% of the U.S. general population, with greater prevalence among women (3.5%) than men (0.5%). Previous research results suggest that the experience of pain (allodynia) upon sphygmomanometry may indicate the presence of fibromyalgia. OBJECTIVE: The aim of this study was to confirm these findings in patients with fibromyalgia and other chronic pain conditions and evaluate the use of sphygmomanometry as a potential screening tool for the identification of patients with fibromyalgia. METHODS: A total of 150 people participated in this multicenter, cross-sectional observational study. The study included a physician-conducted evaluation to determine if the participant met the American College of Rheumatology (ACR) 1990 diagnostic criteria for fibromyalgia. The presence of sphygmomanometry-evoked allodynia was assessed during a seated cuff pressure inflation that was repeated three times on each arm. Each site was provided a sphygmomanometer to ensure standardization, and the pressure of the cuff at the moment of pain initiation was recorded. If the patient did not indicate pain prior to 180 mmHg, then the inflation was stopped, a notation of no pain was made, and a cuff pressure of 180 mmHg was recorded. The mean of the six cuff pressure measurements was used for the analyses. Logistic regression was performed to analyze the relationship between sphygmomanometry-evoked allodynia and fibromyalgia. RESULTS: The evaluable sample was 148 (one participant had too large an arm circumference for the sphygmomanometer and another did not receive the clinician evaluation of ACR-determined fibromyalgia diagnosis). Over half of the participants were determined to have an ACR diagnosis of fibromyalgia. Of these, 71 (91%) were women and had an average age of 54 years. Of the 70 participants with no fibromyalgia diagnosis, 42 (60%) were women and also had an average age of 54 years. Sixty-one (78%) of the fibromyalgia participants, compared with 25 (36%) of those with no fibromyalgia diagnosis, reported sphygmomanometry-evoked allodynia. The participants with fibromyalgia reported pain ata lower cuff pressure compared with those without fibromyalgia (132 mmHg vs. 166 mmHg, p < .01). The logistic regression showed that sphygmomanometry-evoked allodynia predicted an ACR-determined FM diagnosis (χ(2) = 19.4, p < .01). DISCUSSION: These findings support previous research suggesting that patients who report pain upon sphygmomanometry may warrant further evaluation for the presence of fibromyalgia.

Avaliação da acurácia do rastreômetro: um novo equipamento para rastreamento de hipertensão arterial / Evaluation of accuracy of rastreometer: a new equipment for hypertension tracking

Fundamento: A hipertensão arterial sistêmica é um dos principais fatores de risco cardiovascular afetando mais de um bilhão de pessoas. A baixa taxa de conhecimento da doença constitui uma das maiores dificuldades relacionadas à hipertensão. O rastreamento populacional para hipertensão é amplamente reconhecido como estratégia efetiva na detecção de casos novos, porém, até o momento, não se dispõe de nenhum instrumento que torne viável o rastreamento em massa da população. Objetivo: Avaliar a acurácia e a reprodutibilidade do Rastreômetro, um novo instrumento para o rastreamento de hipertensão arterial para agentes comunitários de saúde. Métodos: Estudo transversal com amostra de 436 indivíduos atendidos pela Estratégia de Saúde da Família. A avaliação foi feita comparando-se os resultados de pressão arterial obtidos pelo método oscilométrico e a leitura do Rastreômetro realizada pelos agentes comunitários de saúde. Resultados: o Rastreômetro apresentou sensibilidade de 81,3 por cento e especificidade de 85,6 por cento quando avaliado em relação aos valores de pressão sistólica. O desempenho dos operadores influenciou os resultados do Rastreômetro de forma independente (p = 0,0001). O Rastreômetro apresentou reprodutibilidade substancial (Kendall’s W 0,71). Conclusão: O Rastreômetro, quando operado por agentes comunitários de saúde, apresentou boa sensibilidade, especificidade e reprodutibilidade, especialmente quando avaliados à luz dos valores de pressão sistólica, tendendo a confirmar esse novo instrumento como método de rastreamento para hipertensão arterial na atenção primária a saúde.

Background: Hypertension is one of the major cardiovascular risk factors affecting more than one billion people. The low awareness of the disease is one of the greatest difficulties related to hypertension. The population screening for hypertension is widely recognized as an effective strategy to detect new cases, but until now, there is no instrument that has become feasible for mass screening of the population. Objective: Evaluate the accuracy and reproducibility of the Rastreometer, a new instrument for the screening of hypertension for community health agents. Methods: Cross-sectional study with a sample of 436 individuals served by the Family Health Strategy. The evaluation was conducted comparing the results of blood pressure obtained by the oscillometric method and reading of the Rastreometer performed by community health agents. Results: The Rastreometer presented a sensitivity of 81.3 percent and a specificity of 85.6 percent when assessed in relation to the values of systolic pressure. The operators’ performance influenced the results of the Rastreometer independently (p = 0.0001). The Rastreometer showed substantial reproducibility (Kendall’s W 0.71). Conclusion: The Rastreometer, when operated by community health agents, showed good sensitivity, specificity and reproducibility, especially when evaluated with the values of systolic pressure, tending to confirm this new instrument as a method of screening for hypertension in primary health care.

Evaluation of accuracy of rastreometer: a new equipment for hypertension tracking.

BACKGROUND: Hypertension is one of the major cardiovascular risk factors affecting more than one billion people. The low awareness of the disease is one of the greatest difficulties related to hypertension. The population screening for hypertension is widely recognized as an effective strategy to detect new cases, but until now, there is no instrument that has become feasible for mass screening of the population. OBJECTIVE: Evaluate the accuracy and reproducibility of the Rastreometer, a new instrument for the screening of hypertension for community health agents. METHODS: Cross-sectional study with a sample of 436 individuals served by the Family Health Strategy. The evaluation was conducted comparing the results of blood pressure obtained by the oscillometric method and reading of the Rastreometer performed by community health agents. RESULTS: The Rastreometer presented a sensitivity of 81.3% and a specificity of 85.6% when assessed in relation to the values of systolic pressure. The operators' performance influenced the results of the Rastreometer independently (p = 0.0001). The Rastreometer showed substantial reproducibility (Kendall’s W 0.71). CONCLUSION: The Rastreometer, when operated by community health agents, showed good sensitivity, specificity and reproducibility, especially when evaluated with the values of systolic pressure, tending to confirm this new instrument as a method of screening for hypertension in primary health care.

A new reusable skin-protective sphygmomanometer cuff.

OBJECTIVE: Repeated blood pressure measurement with a sphygmomanometer often produces skin redness and subcutaneous bleeding in clinical settings. Recently, we have produced a new reusable skin-protective cuff with an additional sheet. METHODS: We evaluated skin damage and blood pressure measurement accuracy when using the new cuffs. We also evaluated upper arm deformity by CT scan during cuff inflation. Pulse wave amplitude evaluation was carried out with an NIBP simulator and our original system. RESULTS: The use of this cuff reduced subcutaneous bleeding and pain with cuff inflation and enabled accurate blood pressure measurement. CONCLUSION: We produced a new skin protective reusable sphygmomanometer cuff.

Pathogenesis of rapidly reversible compressive neuropathy: revisiting the classic sphygmomanometer experiment.

OBJECTIVE: Using the sequential inflation of 2 sphygmomanometers, Lewis et al. (Heart 16:1-32, 1931) concluded that compressive neuropathy was secondary to ischemia of the compressed nerve segment. Despite subsequent animal studies demonstrating that compressive lesions are more likely the result of mechanical nerve deformation, disagreement remains as to the etiology of rapidly reversible compressive neuropathy. Our hypothesis is that, during the classic sphygmomanometer experiments, the areas of nerve compression at the cuff margins overlapped, so that a region of transient nerve deformation persisted during the second cuff inflation. If true, the original results by Lewis et al. would be consistent with a mechanical pathogenesis. METHODS: In our study, 6 patients underwent sequential upper extremity dual-sphygmomanometer inflation with serial assessment by grip-dynamometer and 2-point discrimination. The order of cuff inflation, as well as the distance between cuffs, was varied. Mean grip force and 2-point discrimination values were statistically compared between conditions. RESULTS: Patients with overlapping cuffs maintained their neurological deficits, whereas those with separated cuffs experienced an improvement in both grip force (P = 0.02) and 2-point discrimination (P < 0.001) when cuff inflation was switched. CONCLUSION: Rapidly reversible compressive neuropathy seems to be secondary to mechanical nerve deformation at the margins of the compressive force rather than the result of ischemia of the compressed nerve segment. Overlap of the mechanically deformed nerve segments likely explains why neurological deficits persisted despite sequential cuff inflation in the classic experiments by Lewis et al.

Effects of forearm venous drainage on responses to the volume provocation test.

The volume provocation test (VPT) has been shown to induce a transitory increase of forearm and hand volume. Although these changes have been quantified in previous studies, the postulated mechanism underlying the VPT required further investigation. This study used a test-retest design in which the VPT was applied to 20 subjects before and during blood donation. During the standard VPT, the experimental arm was cuffed for 4 minutes at 15 mm Hg less than diastolic blood pressure, but a cannula siphoned blood from a superficial forearm vein during blood donation. Subjects rated the level of discomfort for each protocol, and reported data regarding symptom quality and location. Discomfort data during the VPT (1.95/10) was higher (p(1-tailed) < 0.005) than during blood donation (1.1/10), and subjects reported fewer volume-related symptoms during blood donation. These findings support the hypothesis that the VPT operates through a vascular mechanism, which is milder during blood donation.

Anxiety moderates cardiovascular responses to painful stimuli during sphygmomanometry.

Sphygmomanometry is the most common technique of blood pressure (BP) determination. We were interested in the role of anxiety as a predictor of BP changes induced by painful stimuli during sphygmomanometry. We studied 141 normotensive healthy subjects who were asked to complete a State-Trait-Anxiety-Inventory (STAI) prior to the experiment. BP was determined continuously and non-invasively using a Finapres device (Penaz-technique) and by arm sphygmomanometry. Five sphygmomanometric measurements took place, during the fourth the arm cuff was inflated to 300 mmHg (unpredictable to the subject), the others were done with a pressure of 175 mmHg. State and trait anxiety (STAI X1 and X2) correlated positively with diastolic BP changes during inflation of the arm cuff (state anxiety: r = 0.26, P < 0.05; trait anxiety: r = 0.20, P < 0.05). Our results suggest that anxiety may have an impact on cardiovascular responses following painful stimuli.