One Doctor 's Hope for Better Patient Monitoring

Anyone who has ever been a hospital patient on a general care floor should be familiar with the standard vital check routine in which a nurse enters the room every four- to six-hours to chart your blood pressure and other vital signs to monitor your condition. But what if your condition suddenly deteriorates in between those routine checks? Is there a better way to monitor these patients? Ashish Khanna, MD, an anesthesiologist and researcher at the Cleveland Clinic believes there is. "The problem with that approach is that we are essentially seeing our patients at a snapshot of time and ignoring large chunks of time where they are possibly showing signs of deterioration," Khanna told MD+DI. In a manuscript recently published by the Journal of Critical Care, Khanna described how challenging it is to predict episodes or severity of cardiorespiratory decompression in patients who appear to be in stable condition and staying on the general care floor. The paper also describes the protocol for an ongoing global trial that could go a long way toward better monitoring protocols to detect signs of deterioration earlier. The PRODIGY trial builds on an earlier study at Cleveland Clinic that Khanna was involved with. The investigators put all of the institution's post-surgical patients who were recovering on the general care floor on continuous monitoring but blinded the clinicians to the monitoring by covering up the device and silencing the monitor's alarms. &...
Source: MDDI - Category: Medical Devices Authors: Tags: Cardiovascular Tubing Source Type: news

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JJ Abstract A decision by a society to sanction assisted dying in any form should logically go hand-in-hand with defining the acceptable method(s). Assisted dying is legal in several countries and we have reviewed the methods commonly used, contrasting these with an analysis of capital punishment in the USA. We expected that, since a common humane aim is to achieve unconsciousness at the point of death, which then occurs rapidly without pain or distress, there might be a single technique being used. However, the considerable heterogeneity in methods suggests that an optimum method of achieving unconsciousness rem...
Source: Pain Physician - Category: Anesthesiology Authors: Tags: Anaesthesia Source Type: research
ConclusionThe use of dexmedetomidine and local anesthetic in pediatric tonsillectomy is a safe and effective protocol that allows for the reduction of opiate use and improved post-operative pain control.Key pointsQuestion: Can the combination of dexmedetomidine and infiltration of local anesthetic reduce overall opioid use for peediatric patients undergoing tonsillectomy?Findings: In this case-control study, use of dexmedetomidine and local anesthetic injected into the tonsillar fossa led to a decrease in intraoperative opiate use by 49.6%, a decrease in intraoperative sevofluorane use by 18%, and a lower reported maximum ...
Source: American Journal of Otolaryngology - Category: Endocrinology Source Type: research
RA patients assigned to yoga plus DMARD therapy also had a drop in depression symptoms
Source: The Doctors Lounge - Psychiatry - Category: Psychiatry Tags: Family Medicine, Internal Medicine, Neurology, Psychiatry, Rheumatology, Anesthesiology & amp; Pain, Journal, Source Type: news
This study tested the hypothesis that perioperative epidural use would be associated with decreased risk of delirium through postoperative day 3. METHODS: This was a secondary, observational, nonrandomized analysis of data from The Prevention of Delirium and Complications Associated With Surgical Treatments Trial (PODCAST; NCT01690988). The primary outcome of the current study was the incidence of delirium (ie, any positive delirium screen, postanesthesia care unit through postoperative day 3) in surgical patients (gastrointestinal, hepatobiliary-pancreatic, gynecologic, and urologic) receiving postoperative epidural ...
Source: Anesthesia and Analgesia - Category: Anesthesiology Authors: Tags: Anesth Analg Source Type: research
Conclusion: Low-dose S-ketamine did not reduce the total cumulative morphine consumption in patients undergoing major open gynaecological surgeries with remifentanil–propofol TCI.
Source: Indian Journal of Anaesthesia - Category: Anesthesiology Authors: Source Type: research
DiscussionBrugada Type 1 ECG changes are associated with sudden cardiac death (SCD) and the occurrence of ventricular dysrhythmias. Patients that develop a Type 1 pattern without any precipitating or provoking factors have a risk of SCD of 0.5-0.8% per year. In patients that only have this pattern induced by a sodium channel blocking agent have a lower rate of SCD (0 - 0.35% per year)[1]. Drugs that have been associated with Brugada ECG patterns include tricyclic antidepressants, anesthetics,cocaine, methadone, antihistamines, electrolyte derangements, and even tramadol. [2]. Our patient had a Brugada Type 1 patt...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
This article is protected by copyright. All rights reserved. PMID: 30689208 [PubMed - as supplied by publisher]
Source: The Journal of Physiology - Category: Physiology Authors: Tags: J Physiol Source Type: research
The objective of this study was to investigate the effects of bupivacaine and bupivacaine plus dexmedetomidine on postoperative pain score and analgesic consumption in thoracotomy patients who had undergone ultrasonography-guided paravertebral blockade. MATERIAL AND METHOD: 93 ASA I-II patients aged 18-65 years were included in the study and scheduled for thoracic surgery. Prior to anesthesia induction, the paravertebral blockade procedure was performed by an anesthetist with ultrasonography. Cases were randomly stratified into three groups. The paravertebral blockade procedure was performed with 20mL 0.5% bupivacaine ...
Source: Revista Brasileira de Anestesiologia - Category: Anesthesiology Tags: Rev Bras Anestesiol Source Type: research
With all the news media accounts and reports from governmental health organizations about the opioid epidemic, including the 70,237 drug overdose deaths in 2017, a newly emerging threat is gaining attention: use and misuse of benzodiazepines, opioid drugs and Z-drugs. Specifically, combining these three drugs can create a deadly combination that snuffs out lives. Benzodiazepine Overdose Deaths on the Rise Benzodiazepines, a class of sedative narcotic drugs including Xanax and Valium used to treat anxiety, insomnia and other disorders and classified as Schedule IV under the Controlled Substances Act by the Drug Enforcement ...
Source: Psych Central - Category: Psychiatry Authors: Tags: Addictions Substance Abuse Suicide Source Type: news
In our current context of a national opioid shortage, Palliative Care teams need to look at alternative options that can provide equal or better analgesia. While there is an emerging evidence base for the use of ketamine in the treatment of refractory depression1, the evidence base for the use of ketamine for palliation of pain remains thin, though primarily positive.2, 3 Ketamine has been used topically, orally and intravenously for the palliation of pain, and orally and intravenously for the treatment of refractory depression, though it is FDA approved only as an anesthetic.
Source: Journal of Pain and Symptom Management - Category: Palliative Care Authors: Source Type: research
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