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Physiological signs if deterioration

F Andrea Sass, Michael Fuchs, Matthias Pumberger, Sven Geissler, Georg N Duda, Carsten Perka, Katharina Schmidt-Bleek
Soft tissue trauma of skeletal muscle is one of the most common side effects in surgery. Muscle injuries are not only caused by accident-related injuries but can also be of an iatrogenic nature as they occur during surgical interventions when the anatomical region of interest is exposed. If the extent of trauma surpasses the intrinsic regenerative capacities, signs of fatty degeneration and formation of fibrotic scar tissue can occur, and, consequentially, muscle function deteriorates or is diminished. Despite research efforts to investigate the physiological healing cascade following trauma, our understanding of the early onset of healing and how it potentially determines success or failure is still only fragmentary...
March 13, 2018: International Journal of Molecular Sciences
C Haahr-Raunkjær, C S Meyhoff, H B D Sørensen, R M Olsen, E K Aasvang
Surgical interventions come with complications and highly reported mortality after major surgery. The mortality may be a result of delayed detection of severe complications due to lower monitoring frequency in the general wards. Several studies have shown that continuous monitoring is superior to the manually intermittent recorded monitoring in terms of detecting abnormal physiological signs. Hopefully improved observations may result in earlier detection and clinical intervention. This narrative review will describe current monitoring possibilities for postoperative patients and how it may prevent complications...
November 2017: European Journal of Internal Medicine
Tracey K Bucknall, Gill Harvey, Julie Considine, Imogen Mitchell, Jo Rycroft-Malone, Ian D Graham, Mohammadreza Mohebbi, Jennifer Watts, Alison M Hutchinson
BACKGROUND: Vital signs are the primary indicator of physiological status and for determining the need for urgent clinical treatment. Yet, if physiological signs of deterioration are missed, misinterpreted or mismanaged, then critical illness, unplanned intensive care admissions, cardiac arrest and death may ensue. Although evidence demonstrates the benefit of early recognition and management of deteriorating patients, failure to escalate care and manage deteriorating patients remains a relatively frequent occurrence in hospitals...
July 11, 2017: Implementation Science: IS
Kristin Salottolo, Matthew Carrick, Jacob Johnson, Mark Gamber, David Bar-Or
OBJECTIVE: The modified early warning score (MEWS) is a 'track and trigger' score using routine physiological vital signs. The objective is to determine if the pretransfer MEWS can be used for predicting outcomes in trauma patients requiring interfacility transfer to higher levels of care. DESIGN, SETTING AND PARTICIPANTS: Retrospective study of consecutively transferred trauma patients into a level-II trauma centre from 2013 to 2014. INTERVENTIONS: None...
May 9, 2017: BMJ Open
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 2016: 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...
September 7, 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
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