ABSTRACT
Despite aggressive care, patients with cardiopulmonary failure and COVID-19 experience unacceptably high mortality rates. The use of mechanical circulatory support devices in this population offers potential benefits but confers significant morbidity and novel challenges for the clinician. Thoughtful application of this complex technology is of the utmost importance and should be done in a multidisciplinary fashion by teams familiar with mechanical support devices and aware of the particular challenges provided by this complex patient population.
Subject(s)
Assisted Circulation , COVID-19 , Humans , COVID-19/epidemiology , COVID-19/therapyABSTRACT
INTRODUCTION: In-Hospital Cardiac Arrest (IHCA) after ST-segment Elevation Myocardial Infarction (STEMI) is a subset of IHCA with high morbidity. While information on this selected group of patients is limited, closer inspection reveals that this is a challenging patient population with certain risk factors for IHCA following treatment of STEMI. AREAS COVERED: In this review article, strategies for prevention of IHCA post STEMI are reviewed, as well as best-practices for the care of STEMI patients post-IHCA. EXPERT OPINION: Early and successful reperfusion is key for the prevention of IHCA and has a significant impact on in-hospital mortality. A number of pharmacological treatments have also been studied that can impact the progression to IHCA. Development of cardiogenic shock post-STEMI increases mortality and raises the risk of cardiac arrest. The treatment of IHCA follows the ACLS algorithm with some notable exceptions.
ABSTRACT
Workplace temperature screening has become standard practice during the SARS-CoV-2 pandemic. The objective was to determine the consistency of four temperature devices during exposure to simulated and actual environmental conditions reflective of a workplace. An infrared (IR) digital thermometer (accuracy(A)±0.2), IR laser thermometer (A±1), and thermal imaging camera (A±0.3) were used to measure forehead and tympanic (digital only) temperatures. The first experiment was conducted in a controlled simulated environment (-20 to 20 °C) with three participants (32-YOF, 27-YOM, 20-YOF). The second experiment used actual outdoor conditions (-0.48 to 45.6 °C) with two participants (32-YOF, 27-YOM). The tympanic measurement was the least impacted by environmental temperature (mean(±SD)): simulated (36.8(±0.18) °C) and actual (36.9(±0.16) °C). The thermal imaging camera had the lowest RMSE values (0.81-0.97 °C), with outdoor temperatures ranging from 0 to 45 °C. Environmental temperature influenced forehead temperature readings and required a resting period in a thermoneutral environment (5-9 min (-20 to -10 °C) to immediate (15-20 °C)).
Subject(s)
COVID-19 , SARS-CoV-2 , Body Temperature , Fever , Humans , Seasons , Temperature , WorkplaceABSTRACT
Despite aggressive care, patients with cardiopulmonary failure and COVID-19 experience unacceptably high mortality rates. The use of mechanical circulatory support devices in this population offers potential benefits but confers significant morbidity and novel challenges for the clinician. Thoughtful application of this complex technology is of the utmost importance and should be done in a multidisciplinary fashion by teams familiar with mechanical support devices and aware of the particular challenges provided by this complex patient population.
Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , Heart-Assist Devices , Humans , Shock, CardiogenicABSTRACT
BACKGROUND: Recent evidence suggest that extracorporeal cardiopulmonary resuscitation (ECPR) may improve survival rates for nontraumatic out-of-hospital cardiac arrest (OHCA). Eligibility criteria for ECPR are often based on patient age, clinical variables, and facility capabilities. Expanding access to ECPR across the U.S. requires a better understanding of how these factors interact with transport time to ECPR centers. METHODS: We constructed a Geographic Information System (GIS) model to estimate the number of ECPR candidates in the U.S. We utilized a Resuscitation Outcome Consortium (ROC) database to model time-dependent rates of ECPR eligibility and the Cardiac Arrest Registry to Enhance Survival (CARES) registry to determine the total number of OHCA patients who meet pre-specified ECPR criteria within designated transportation times. The combined model was used to estimate the total number of ECPR candidates. RESULTS: There were 588,203 OHCA patients in the CARES registry from 2013 to 2020. After applying clinical eligibility criteria, 22,104 (3.76%) OHCA patients were deemed eligible for ECPR. The rate of ROSC increased with longer resuscitation time, which resulted in fewer ECPR candidates. The proportion of OHCA patients eligible for ECPR increased with older age cutoffs. Only 1.68% (9,889/588,203) of OHCA patients in the U.S. were eligible for ECPR based on a 45-minute transportation time to an ECMO-ready center model. CONCLUSIONS: Less than 2% of OHCA patients are eligible for ECPR in the U.S. GIS models can identify the impact of clinical criteria, transportation time, and hospital capabilities on ECPR eligibility to inform future implementation strategies.
ABSTRACT
Simposio sobre una eficiente práctica dental. Prólogo. Simplificación del trabajo al ejercicico de la odontología: los progresos realizados. Ordenamiento de la circulación. Eficiencia junto al sillón dental mediante aparatología auxiliar y muebles rodantes: informe de progresos efectuados. Selección y uso de sillones dentales contorneados y banquetas para operadores. Cómo emplear con efectividad al personal. Una eficiente con efectividad al personal. Una eficiente relación con los pacientes. Procedimientos eficientes de restauración. Preparaciones para recubrimiento total simplificadas. Terapéutica pulpar vital eficaz. Procedimientos endodóncicos eficientes mediante el uso de la jeringa a presión. Simplificación del trabajo y eficiencia en el ejercicio de la periodoncia
Simposio sobre Odontología Preventiva. Prólogo. Diagnóstico y plan de tratamiento bucal. Papel de la biopsia y la citología en el diagnóstico bucal. Periodoncia preventiva. Prevención y conservación en odontología restauradora (parte I y II). Prevención y conservación: el desafío al servicio de prótesis parciales removibles. El papel de la cirugía bucal en la odontología preventiva. Máxima prevención y conservación: mérito de los protectores bucales. Tres técnicas eficaces para la aplicación tópica de una solución de fluoruros. Utilización de fluoruros por la vía general en zonas carentes de fluoración de las aguas. Asesoramiento dietético en el consultorio privado. Motivación de los pacientes para la aceptación de los servicios preventivos
Subject(s)
Dentistry , Preventive Dentistry , Professional PracticeABSTRACT
Simposio sobre una eficiente práctica dental. Prólogo. Simplificación del trabajo al ejercicico de la odontología: los progresos realizados. Ordenamiento de la circulación. Eficiencia junto al sillón dental mediante aparatología auxiliar y muebles rodantes: informe de progresos efectuados. Selección y uso de sillones dentales contorneados y banquetas para operadores. Cómo emplear con efectividad al personal. Una eficiente con efectividad al personal. Una eficiente relación con los pacientes. Procedimientos eficientes de restauración. Preparaciones para recubrimiento total simplificadas. Terapéutica pulpar vital eficaz. Procedimientos endodóncicos eficientes mediante el uso de la jeringa a presión. Simplificación del trabajo y eficiencia en el ejercicio de la periodoncia
Simposio sobre Odontología Preventiva. Prólogo. Diagnóstico y plan de tratamiento bucal. Papel de la biopsia y la citología en el diagnóstico bucal. Periodoncia preventiva. Prevención y conservación en odontología restauradora (parte I y II). Prevención y conservación: el desafío al servicio de prótesis parciales removibles. El papel de la cirugía bucal en la odontología preventiva. Máxima prevención y conservación: mérito de los protectores bucales. Tres técnicas eficaces para la aplicación tópica de una solución de fluoruros. Utilización de fluoruros por la vía general en zonas carentes de fluoración de las aguas. Asesoramiento dietético en el consultorio privado. Motivación de los pacientes para la aceptación de los servicios preventivos