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Physiological signs if deterioration

James Waldie, Tina Day, Stephen Tee
This article provides a critical discussion examining why adult patients continue to unnecessarily deteriorate and die despite repeated healthcare policy initiatives. After considering the policy background and reviewing current trends in the data, it proposes some solutions that, if enacted, would, the authors believe, have a direct impact on survival rates. Health professionals working in hospitals are failing to recognise signs of physiological deterioration. As a result, adult patients are dying unnecessarily, estimated to be in the region of 1000 a month...
July 14, 2016: British Journal of Nursing: BJN
M Cardona-Morrell, M Prgomet, R Lake, M Nicholson, R Harrison, J Long, J Westbrook, J Braithwaite, K Hillman
BACKGROUND: High profile safety failures have demonstrated that recognising early warning signs of clinical and physiological deterioration can prevent or reduce harm resulting from serious adverse events. Early warning scoring systems are now routinely used in many places to detect and escalate deteriorating patients. Timely and accurate vital signs monitoring are critical for ensuring patient safety through providing data for early warning scoring systems, but little is known about current monitoring practices...
April 2016: International Journal of Nursing Studies
Jarrad Martland, Diane Chamberlain, Alison Hutton, Michael Smigielski
Objective Patients commonly show signs and symptoms of deterioration for hours or days before cardiorespiratory arrest. Rapid response teams (RRT) were created to improve recognition and response to patient deterioration in these situations. Activation criteria include vital signs or 'general concern' by a clinician or family member. The general concern criterion for RRT activation accounts for nearly one-third of all RRT activity, and although it is well established that communication deficits between staff can contribute to poorer outcomes for patients, there is little evidence pertaining to communication and its effects on the general concern RRT activation...
November 30, 2015: Australian Health Review: a Publication of the Australian Hospital Association
Gerd Flodgren, Antoine Rachas, Andrew J Farmer, Marco Inzitari, Sasha Shepperd
BACKGROUND: Telemedicine (TM) is the use of telecommunication systems to deliver health care at a distance. It has the potential to improve patient health outcomes, access to health care and reduce healthcare costs. As TM applications continue to evolve it is important to understand the impact TM might have on patients, healthcare professionals and the organisation of care. OBJECTIVES: To assess the effectiveness, acceptability and costs of interactive TM as an alternative to, or in addition to, usual care (i...
2015: Cochrane Database of Systematic Reviews
R Teodoreanu, S A Popescu, I Lascar
RATIONALE: Taking into account the incidence and the severity of electrocutions, we consider it extremely necessary to find effective, appropriate and particularized therapeutic solutions aimed at improving the survival, decreasing the mortality, ensuring a superior functional and aesthetic effect and facilitating the social reintegration. Given the severity of the general condition of the electrically injured patient and the fact that any worsening of the lesions has a systemic echo, the selection of the timing for re-excision is very important...
June 15, 2014: Journal of Medicine and Life
Mandy Odell
AIMS AND OBJECTIVES: To audit ward nursing practice in the adherence to an early warning scoring protocol in the detection and initial management of the deteriorating ward patient and investigate factors that may impact on practice. BACKGROUND: Hospital inpatients can experience unexpected physiological deterioration leading to poor outcomes and death. Although deterioration can be signalled in the patients' physiological symptoms, evidence suggests that ward staff can miss, misinterpret or mismanage the signs...
January 2015: Journal of Clinical Nursing
Daine T Bennett, T Brett Reece, Phillip D Smith, Miral Sadaria Grandhi, Jessica A Yu Rove, George A Justison, John D Mitchell, David A Fullerton, Martin R Zamora, Michael J Weyant
BACKGROUND: Donor lungs acquired from victims of asphyxiation by hanging are not routinely used for lung transplantation because of the associated lung injury. Ex vivo lung perfusion (EVLP) is a technique to evaluate marginal donor lungs before transplantation. We report here our experience with the use of EVLP in donor lungs procured from victims of asphyxia by hanging. METHODS: Lungs from 5 donors who became brain dead secondary to hanging were evaluated by EVLP...
September 2014: Annals of Thoracic Surgery
Julie Considine, Judy Currey
AIMS AND OBJECTIVES: To argue that if all nurses were to adopt the primary survey approach (assessment of airway, breathing, circulation and disability) as the first element of patient assessment, they would be more focused on active detection of clinical deterioration rather than passive collection of patient data. BACKGROUND: Nurses are the professional group that carry the highest level of responsibility for patient assessment, accurate data collection and interpretation...
January 2015: Journal of Clinical Nursing
Colleen M Stoeppel, Evert A Eriksson, Rafael Diaz-Flores, Pamela Coffie, Jojo Koshy, Cory Kacir, Kenneth Hawkins, Joseph Minei, Christian Minshall
BACKGROUND: We evaluated the role of serial catheter-directed bronchoalveolar lavage (CDBAL) in the diagnosis and management of pneumonia in ventilated surgical intensive care unit patients. METHODS: Intubated surgical intensive care unit patients were prospectively evaluated with serial CDBALs from September 1, 2012, to May 31, 2013. Initial CDBALs were performed if patients developed the following signs of pneumonia: white blood cell count greater than 11 or less than 4, temperature greater than 38...
May 2014: Journal of Trauma and Acute Care Surgery
Abilio Reis, Richard Bransford, Tom Penoyar, Jens R Chapman, Carlo Bellabarba
STUDY TYPE:  Case series Introduction:  Craniocervical dissociation (CCD) is an uncommon and frequently fatal injury with few reports in the literature of survivors. Advances in automobile safety and improved emergency medical services have resulted in increased survival. Timely diagnosis and treatment are imperative for optimal outcome. Regrettably, the presence of multiple life threatening injuries, low clinical suspicion, and lack of familiarity with the upper cervical radiographic anatomy frequently lead to missed or delayed diagnosis...
August 2010: Evidence-based Spine-care Journal
Marta Oñate, Maria B García, Sergi Munné-Bosch
It is still an unsolved question of fundamental biology if, and how, perennial plants senesce. Here, age- and sex-related changes in phytohormones were tested in Borderea pyrenaica, a small dioecious geophyte relict of the Tertiary with one of the longest lifespan ever recorded for any non-clonal herb (more than 300 years). Biomass allocation, together with levels of cytokinins, auxins and absicisic acid, and other indicators of leaf physiology (chlorophylls, lipid peroxidation and F (v)/F (m) ratio) were measured in juvenile and mature plants, including both males and females of three age classes (up to 50 years, 50-100 years, and over 100 years)...
February 2012: Planta
T Wartzek, S Weyer, S Leonhardt
Although respiratory rate is an important vital sign for early detection of deterioration, on general wards it is not routinely monitored. Since patients may not tolerate cables attached to their chest, we developed an unobtrusive and contactless measurement method which can be placed under a mattress. The sensor array uses the Maxwell-Wagner relaxation effect by capacitive injection of a high-frequency voltage into the torso and subsequent measurement of respiratory-induced phase shift. Simulations of the entire measurement scenario indicate an improved signal-to-noise ratio if a differential method is applied with specific positioning of the electrodes...
October 2011: Physiological Measurement
M S Patel, M A Jones, M Jiggins, S C Williams
INTRODUCTION: Despite the lack of robust evidence, numerous different "track and trigger" warning systems have been implemented. These have only been validated in an emergency medical admissions setting. The Modified Early Warning Score (MEWS) is the chosen track and trigger system used in the University Hospitals of Leicester trauma unit, but has not been validated in trauma patients. A considerable proportion of all trauma admissions are elderly patients with proximal femoral fractures and significant co-morbidities...
December 2011: Injury
Georgios F Giannakopoulos, Teun Peter Saltzherr, Wouter D Lubbers, Herman M T Christiaans, Pieternel van Exter, Elly S M de Lange-de Klerk, Frank W Bloemers, Wietse P Zuidema, J Carel Goslings, Fred C Bakker
INTRODUCTION: The Revised Trauma Score is used worldwide in the prehospital setting and provides a snapshot of patient's physiological state. Several studies have shown that the reliability of the RTS is high in trauma outcomes. In the Netherlands, Helicopter Emergency Medical Services (HEMS) are mostly used for delivery of specialized trauma teams on-scene and occasionally for patient transportation. In our trauma system, the Emergency Medical Services crew performs triage after arrival on-scene and cancels the HEMS-dispatch if deemed unnecessary...
August 2011: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Mandy Odell, Karin Gerber, Melanie Gager
Patients can experience unexpected deterioration in their physiological condition that can lead to critical illness, cardiac arrest, admission to the intensive care unit and death. While ward staff can identify deterioration through monitoring physiological signs, these signs can be missed, interpreted incorrectly or mismanaged. Rapid response systems using early warning scores can fail if staff do not follow protocols or do not notice or manage deterioration adequately. Nurses often notice deterioration intuitively because of their knowledge of individual patients...
December 9, 2010: British Journal of Nursing: BJN
A Scott Keller, Lisa L Kirkland, Smita Y Rajasekaran, Stephen Cha, Mohamed Y Rady, Jeanne M Huddleston
BACKGROUND: Unplanned (unexpected) transfers to the intensive care unit (ICU) are typically preceded by physiologic instability. However, trends toward instability may be subtle and not accurately reflected by changes in vital signs. The shock index (SI) (heart rate/systolic blood pressure as an indicator of left ventricular function, reference value of 0.54) may be a simple alternative means to predict clinical deterioration. OBJECTIVE: To assess the association of the SI with unplanned ICU transfers...
October 2010: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
N J White, C J Lindsell, B S Bassin, A Venkat
BACKGROUND: Hospitalised patients requiring cardiopulmonary resuscitation (CPR) have better outcomes in intensive care units (ICUs) than wards. Survival could potentially be improved for patients at high risk for CPR if they can be identified while in the emergency department (ED) and admitted to an ICU setting. It is currently unknown whether patients requiring CPR who are admitted to the ward show a similar pattern of physiological deterioration to those admitted to the ICU, and thus whether future research should consider these two patients groups as distinct...
February 2008: Emergency Medicine Journal: EMJ
H Hirschberg, G N Wu, S J Madsen
OBJECTIVE: The characteristics of an ideal contrast agent for use in the intraoperative MRI would be tumor-specificity and intracellular localization, combined with extended tumor enhancement, but with rapid elimination from the blood. The radiation sensitizing properties of Motexafin gadolinium (MGd) have been investigated in a number of clinical trials involving patients with brain metastases. These studies clearly show that MGd is detectable in magnetic resonance images many days following administration...
December 2007: Minimally Invasive Neurosurgery: MIN
Chris Carter
Sepsis is not a new challenge facing the health care team, it remains a complex disease, which is difficult to identify and treat. Mortality from sepsis remains high and continues to be a common cause of death among critically ill patients, despite advances in critical care. Sepsis accounts for an estimated 27% of all intensive care admissions in England, Wales and Northern Ireland, and accounted for 46% of all intensive care bed days. Recent research studies and the surviving sepsis campaign have shown that identifying and providing key interventions to patients with severe sepsis and septic shock prior to their admission to the intensive care unit significantly improve outcomes...
September 2007: Nursing in Critical Care
Irma Fiordalisi, William E Novotny, Donald Holbert, Laurence Finberg, Glenn D Harris
BACKGROUND: During the late 1900s, raised intracranial pressure (ICP) during treatment of pediatric diabetic ketoacidosis (DKA) surfaced as the most important cause of morbidity and mortality in pediatric DKA. The contribution of fluid and electrolyte therapy to neurologic deterioration during treatment remains controversial. METHODS: We proposed a physiologic approach to treatment of DKA, incorporating the principles of rehydration of hypertonic states. Consecutive episodes of pediatric DKA were managed using continuous intravenous insulin, an individualized assessment of the degree of dehydration, and rehydration solutions of tonicity approximating that of the patient...
June 2007: Pediatric Diabetes
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