Open Access Emergency Medicine / Can Venous Blood Gas Be Used as an Alternative to Arterial Blood Gas in Intubated Patients at Admission to the Emergency Department? A Retrospective Study

Objective: Blood gas analysis plays an important role in both diagnosis and subsequent treatment of critically ill patients in the emergency department and the ICU. Historically, arterial blood is predominantly used for blood gas analysis. The puncture is painful and complications may occur. The purpose of the present study was to evaluate the agreement between arterial and venous blood gas analysis and whether the sole use of venous blood gas analysis would have changed therapy. Methods: Adult patients who were intubated in the field and received an arterial and venous blood gas analysis within 15 mins after admission to the ED were eligible for inclusion. The values for pH, pCO, HCO-, base excess and lactate levels were collected retrospectively. Mean differences were calculated by subtracting venous from arterial values. The agreement between venous and arterial measurements was assessed using the method of Bland and Altman. Blood gases were assessed by two independent physicians using a standardized questionnaire to determine whether the use of venous blood gases would have led to a different interpretation of the situation (other diagnostic path) or a change of therapy (eg. respirator adjustment). Acceptable limits were defined before the collection of data started. Results: Fifty patients (62% male, median age 63years) who were treated at the Emergency Department between June 1, 2014 and December 31, 2014 were included in the study. Following average differences and limits of agreement (LOA) were documented: pH 0.02312 with LOA from 0.048 to 0.094; pCO 3.612 mmHg with LOA from 15 to 8.1 mmHg; BE 0.154 mmol/l with LOA from 3.7 to 3.4 mmol/l; HCO0.338 mmol/l with LOA from 2.27 to 2.9 mmol/l; Lactate 0.124 mg/dl with LOA from 2.28 to 2.03 mg/dl. Using venous blood gas results 100% of the patients with metabolic alkalosis were correctly diagnosed. Metabolic acidosis was detected with a high sensitivity (80.64%), specificity (89.47%) and positive predictive value (92.59%). The answers to lactate and acidosis due to AKI showed a specificity and positive predictive value of 100%. The respiratory adjustment showed a high sensitivity (91.89%) but a low specificity (38.46%). Conclusion: For pH, bicarbonate, BE and lactate venous blood gases can be used as surrogates for arterial measurements. Venous pCO can be used for screening of hypercapnia and trending. Respirator adjustments may be done too often if the venous blood gas is used.(VLID)490086

From the lab to the OB truck: Object-based broadcasting at the FA Cup in Wembley Stadium

While traditional live-broadcasting is typically comprised of a handful of well-defined workflows, these become insufficient when targeting multiple screens and interactive companion devices on the viewer side. In this case study, we describe the development of an end-to-end system enabling immersive and interactive experiences using an object-based broadcasting approach. We detail the deployment of this system during the live broadcast of the FA Cup Final at Wembley Stadium in London in May 2018. We also describe the trials and interviews we ran in the run-up to this event, the infrastructure we used, the final software developed for controlling and rendering on-screen graphics and the system for generating and configuring the live broadcast-objects. In this process, we learned about the workflows inside an OB truck during live productions through an ethnographic study and the challenges involved in running an object-based broadcast over the Internet, which we discuss alongside other gained insights.Multimedia Computin