Use of capnographic waveform indices in monitoring non - intubated asthmatic patients within the emergency department

Untuk mengkaji sama ada kecuraman Fasa II dan Ill dan sudut alpha (Q) gelombang kapnografi yang dikaji dapat menunjukkan perubahan dalam keadaan pesakit dengan serangan asma; dan untuk mengkaji sama ada perubahan ini berkaitan dengan peru bah an dari segi klinikal dan pengukuran 'peak flow'. Kami menjalankan kajian prospektif di Jabatan Kecemasan Hospital Universiti Sains Malaysia. 30 pesakit yang mengalami serangan asma akut dikaji dari segi klinikal(kebolehan bertutur, kadar pernafasan, kadar nadi, pulsus paradoxus, bunyi 'wheeze' dan 'pulse oximetry') dan pengukuran 'peak flow' diikuti dengan pengawasan 'sidestream' dengan kapnografi menggunakan 'nasal cannula'. Gelombang kapnografi dicatitkan di dalam kad memori komputer (PC card). Pesakit dirawati dengan 'beta-agonists' dan 'steroids' mengikuti protokol jabatan. Selepas rawatan, bila pesakit dianggap sihat untuk discaj, kajian semula dilakukan dengan kaedah klinikal, pengukuran 'peak flow' dan gelombang kapnografi. Kajian sebelum rawatan dan selepas rawatan dikaji dengan ujian 'paired samples t-test'. Kajian 'correlations' dilakukan untuk mengetahui kaitan antara ketiga-tiga kaedah pengawasan ini. Nilai p < 0.05 dianggap ketara (significant). To determine if the slope of Phase II and Phase Ill, and the alpha angle (Angle Q) of the expiratory capnographic waveform measured via computerrecognizable algorithms, can reflect changes in bronchospasm in acute asthmatic patients presenting to the Emergency Department; and to assess the correlation of these changes with clinical severity scoring and peak flow measurements. We carried out a prospective study in a university hospital Emergency Department. 30 patients with acute asthma were monitored with clinical severity scoring (speech pattern, respiratory rate, pulse rate, presence of pulsus paradoxus and wheeze, and pulse oximetry) and peak flow measurements, and then had a nasal cannula attached for sidestream sampling of expired carbon dioxide. The capnographic waveform was recorded onto a PC card for analysis. The patients were treated with inhaled beta-agonists and steroids according to departmental protocols. After treatment, when they were adjudged well for discharge, a second set of results was obtained for clinical severity scoring, peak flow measurements and capnographic waveform recording. The pre-treatment and post-treatment results were then compared with paired samples t-test analysis. Sin1ple and canonical correlations were performed to determine correlations between the 3 assessment methods. A p value of below 0.05 was taken to be significant

Evaluating emergency department resource capacity using simulation

Emergency departments open 24 hours every day and may receive patients at any time most unexpectedly.Adequate resource planning to meet the various demands in emergency departments is arguably amongst the most critical challenges faced by hospital administrators due to the complexity of the system and diverse patient flows.In this paper, we present a computer simulation model to evaluate resource utilization among personnel and physical resources in a typical emergency department (ED) of a government hospital in Malaysia.The model allows administrators to see patient movement flows as well as how these flows are affected by resource capacity level in the ED.The use of this simulation model helps to evaluate ED operations, provides useful insight for possible areas of improvement, and directs the allocation of specific resources for maximal impact. Three scenarios were tested to find out the impact of patient surge on ED performance measures. Results from the scenarios show that a 30% increase of attendances according to triage zones affects most of the performance measures.In addition, medical assistants are the critical resources with average utilization greater than 70%

The use of end-tidal capnography to monitor non-intubated patients presenting with acute exacerbation of asthma in the emergency department.

STUDY OBJECTIVE To determine if the slope of Phase II and Phase III, and the alpha angle of the expiratory capnographic waveform, as measured via computer-recognizable algorithms, can reflect changes in bronchospasm in acute asthmatic non-intubated patients presenting to the emergency department (ED). METHODS In this prospective study carried out in a university hospital ED, 30 patients with acute asthma were monitored with clinical severity scoring and peak flow measurements, and then had a nasal cannula attached for sidestream sampling of expired carbon dioxide. The capnographic waveform was recorded onto a personal computer card for analysis. The patients were treated according to departmental protocols. After treatment, when they had improved enough for discharge, a second set of results was obtained for capnographic waveform recording. The pre-treatment and post-treatment results were then compared with paired-samples t-test analysis. RESULTS On the capnographic waveform pre- and post-treatment, there was a significant difference in the slope of Phase III (p < 0.001) and alpha angle (p < 0.001), but not in the Phase II slope (p = 0.35). There was significant change in peak flow meter reading, but it was poorly correlated with all the capnographic indices. CONCLUSION The study provides some preliminary data showing that capnographic waveform indices can indicate improvement in airway diameter in acute asthmatics in the ED. Capnographic waveform analysis presents several advantages in that it is effort-independent, and provides continuous monitoring of normal tidal respiration. With further refined studies, it may serve as a new method of monitoring non-intubated asthmatics in the ED

Evaluating Emergency Department Resource Capacity Using Simulation

Emergency departments open 24 hours every day and may receive patients at any time most unexpectedly. Adequate resource planning to meet the various demands in emergency departments is arguably amongst the most critical challenges faced by hospital administrators due to the complexity of the system and diverse patient flows. In this paper, we present a computer simulation model to evaluate resource utilization among personnel and physical resources in a typical emergency department (ED) of a government hospital in Malaysia. The model allows administrators to see patient movement flows as well as how these flows are affected by resource capacity level in the ED. The use of this simulation model helps to evaluate ED operations, provides useful insight for possible areas of improvement, and directs the allocation of specific resources for maximal impact. Three scenarios were tested to find out the impact of patient surge on ED performance measures. Results from the scenarios show that a 30% increase of attendances according to triage zones affects most of the performance measures. In addition, medical assistants are the critical resources with average utilization greater than 70%

The Correlation Of Optic Neural Sheath Diameter With Severity And Mortality In Patients With Non-Traumatic Intracranial Haemorrhage

Purpose:To study the optic neural sheath diameter in non-traumatic intracranial hemorrhage patient in order to identify if this bedside non-invasive ultrasonographic investigation may provide some guidance to subsequent clinical decisions. We evaluated the correlation between Optic neural sheath Diameter (ONSD), haemorrhage volume, Glasgow Coma Scale, and Intracerebral haemorrhage Score (ICH score).Materials and Method:This was a prospective single center, single operator, observational study carried out for 6 months from September 2017 till February 2018. Total of 50 patients were approached, out of which 5 were excluded due to ineligibility. ONSD was measured using standard technique as described in literature. The data was analysed using SPSS 24. Correlation between ONSD-haemorrhage volume, ONSD-GCS and ONSD-ICH Score were assessed using Pearson correlation.Results:The study included 45 patients (mean age: 59.9 +/- 13.4 years old, 26(57.8%) Male), with the mean ONSD value 0.5919 +/- 0.046 cm. The statistical assessment yielded positive correlation value of 0.303 (p-value = 0.043) between ONSD-Haemorrhage volume and correlation between ONSD-ICH was 0.372 (p-value = 0.012). Moreover, a negative correlation value of - 0.351 (p-value = 0.018) were shown between ONSD-GCS.Conclusion:Our study, indicate that as haemorrhage volume increases the ONSD increases as well. This correlation is similarly seen with increases in ICH score suggesting increase in mortality risk. ONSD is a non-invasive method to evaluate severity and mortality risk in patients with non traumatic intracranial haemorrhage