PURPOSE: The appropriate treatment of pulseless pink supracondylar humerus fractures (SCHF) remains controversial. In this study, the outcomes of two treatment approaches (with and without vascular surgery) were compared. MATERIAL AND METHODS: This was a retrospective multicenter study of patients with pulseless pink SCHFs treated in ten pediatric surgery, trauma, or orthopedics departments in the Czech and Slovak Republic between 2014 and 2018. RESULTS: Of the total 3608 cases of displaced SCHF, 125 had the pulseless pink SCHF. Of those, 91% (114/125) did not undergo vascular surgery and 9% (11/125) underwent vascular surgery. The patients who did undergo vascular surgery had radial artery pulsation restored more frequently in the operating room (73% vs. 36%; p = 0.02), within 6 h (91% vs. 45%; p = 0.004), and within 24 h of surgery (91% vs. 57%; p = 0.05). However, 72 h after surgery, there was no significant difference in palpable radial artery pulsation between the vascular surgery and the non-vascular surgery groups (91% vs. 74%; p = 0.24). Additionally, no significant differences in long-term neurological (9% vs. 22%; p = 0.46) or circulatory (9% vs. 7%; p = 0.57) deficits were found between the two groups. CONCLUSION: While vascular surgery in patients with pulseless pink SCHFs is associated with a more prompt restoration of radial artery pulsation, no statistical significant differences in terms of the restoration of neurological deficits or the risks of long-term neurological or circulatory deficits were found between patients with and without vascular surgery.
- MeSH
- Brachial Artery * injuries surgery MeSH
- Child MeSH
- Humeral Fractures * complications MeSH
- Humerus MeSH
- Humans MeSH
- Pulse MeSH
- Retrospective Studies MeSH
- Hand blood supply MeSH
- Treatment Outcome MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Keywords
- intrastenotické rychlosti,
- MeSH
- Aneurysm diagnostic imaging pathology MeSH
- Arterial Occlusive Diseases diagnostic imaging classification pathology MeSH
- Arteries diagnostic imaging pathology MeSH
- Plaque, Atherosclerotic MeSH
- Blood Vessels diagnostic imaging pathology MeSH
- Carotid Intima-Media Thickness MeSH
- Humans MeSH
- Vascular Diseases * diagnostic imaging classification pathology MeSH
- Renal Artery Obstruction diagnostic imaging pathology MeSH
- Pulse MeSH
- Carotid Stenosis diagnostic imaging pathology MeSH
- Severity of Illness Index MeSH
- Ultrasonography, Doppler MeSH
- Ultrasonography * methods instrumentation MeSH
- Nerve Compression Syndromes diagnostic imaging pathology MeSH
- Veins diagnostic imaging pathology MeSH
- Vertebrobasilar Insufficiency diagnostic imaging pathology MeSH
- Venous Thrombosis diagnostic imaging pathology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- Keywords
- rozštěp, klapnutí, Valsavův manévr,
- MeSH
- Aortic Valve Insufficiency diagnosis classification physiopathology pathology MeSH
- Aortic Valve Stenosis diagnosis etiology physiopathology pathology MeSH
- Abdomen pathology MeSH
- Cyanosis diagnosis etiology classification physiopathology pathology MeSH
- Heart Septal Defects, Ventricular diagnosis pathology MeSH
- Heart Septal Defects, Atrial diagnosis physiopathology pathology MeSH
- Diastole physiology MeSH
- Diagnosis, Differential MeSH
- Ebstein Anomaly diagnosis physiopathology pathology MeSH
- Eisenmenger Complex diagnosis pathology MeSH
- Tetralogy of Fallot diagnosis pathology MeSH
- Physical Examination * classification MeSH
- Head pathology MeSH
- Thorax pathology MeSH
- Pulmonary Valve Insufficiency diagnosis physiopathology pathology MeSH
- Aortic Coarctation diagnosis physiopathology pathology MeSH
- Extremities pathology MeSH
- Myocardial Contraction physiology MeSH
- Skin Manifestations MeSH
- Neck pathology MeSH
- Humans MeSH
- Mitral Valve Insufficiency diagnosis etiology classification physiopathology pathology MeSH
- Mitral Valve Stenosis diagnosis etiology physiopathology pathology MeSH
- Heart Diseases * diagnosis etiology classification physiopathology pathology MeSH
- Heart Valve Diseases diagnosis etiology classification physiopathology pathology MeSH
- Ventricular Outflow Obstruction diagnosis pathology MeSH
- Ductus Arteriosus, Patent diagnosis physiopathology pathology MeSH
- Palpation MeSH
- Pericarditis diagnosis pathology MeSH
- Percussion classification MeSH
- Heart Auscultation MeSH
- Auscultation MeSH
- Posture physiology MeSH
- Pulse classification MeSH
- Heart Murmurs diagnosis etiology classification pathology MeSH
- Ventricular Function MeSH
- Atrial Function MeSH
- Heart physiopathology MeSH
- Heart Valve Prosthesis classification MeSH
- Heart Sounds physiology MeSH
- Heart Failure diagnosis etiology classification physiopathology pathology MeSH
- Pulmonary Valve Stenosis diagnosis pathology MeSH
- Stethoscopes MeSH
- Systole physiology MeSH
- Tricuspid Valve Insufficiency diagnosis etiology pathology MeSH
- Tricuspid Valve Stenosis diagnosis pathology MeSH
- Jugular Veins pathology MeSH
- Heart Defects, Congenital diagnosis classification physiopathology pathology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
BACKGROUND: The minimum duration of pulselessness required before organ donation after circulatory determination of death has not been well studied. METHODS: We conducted a prospective observational study of the incidence and timing of resumption of cardiac electrical and pulsatile activity in adults who died after planned withdrawal of life-sustaining measures in 20 intensive care units in three countries. Patients were intended to be monitored for 30 minutes after determination of death. Clinicians at the bedside reported resumption of cardiac activity prospectively. Continuous blood-pressure and electrocardiographic (ECG) waveforms were recorded and reviewed retrospectively to confirm bedside observations and to determine whether there were additional instances of resumption of cardiac activity. RESULTS: A total of 1999 patients were screened, and 631 were included in the study. Clinically reported resumption of cardiac activity, respiratory movement, or both that was confirmed by waveform analysis occurred in 5 patients (1%). Retrospective analysis of ECG and blood-pressure waveforms from 480 patients identified 67 instances (14%) with resumption of cardiac activity after a period of pulselessness, including the 5 reported by bedside clinicians. The longest duration after pulselessness before resumption of cardiac activity was 4 minutes 20 seconds. The last QRS complex coincided with the last arterial pulse in 19% of the patients. CONCLUSIONS: After withdrawal of life-sustaining measures, transient resumption of at least one cycle of cardiac activity after pulselessness occurred in 14% of patients according to retrospective analysis of waveforms; only 1% of such resumptions were identified at the bedside. These events occurred within 4 minutes 20 seconds after a period of pulselessness. (Funded by the Canadian Institutes for Health Research and others.).
- MeSH
- Adult MeSH
- Electrocardiography MeSH
- Airway Extubation MeSH
- Heart Function Tests MeSH
- Blood Pressure physiology MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Withholding Treatment * MeSH
- Prospective Studies MeSH
- Pulse * MeSH
- Life Support Care MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Death MeSH
- Heart physiology MeSH
- Heart Arrest * MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Observational Study MeSH
- Research Support, Non-U.S. Gov't MeSH
Pulsus paradoxus (PP) představuje pokles systolického krevního tlaku při nádechu o více než 10 mmHg. Vzniká patologicky v důsledku alterace fyziologicky se vyskytujících kardiopulmonálních interakcí, které vedou k přechodnému poklesu tepového objemu a tlakové amplitudy (rozdílu mezi systolickým a diastolickým tlakem). PP je snadno zjistitelný fenomén, typický pro řadu patologických stavů (např. srdeční tamponáda, astmatický záchvat, masivní plicní embolie, hypovolemický šok). Změny PP lze orientačně využít i pro hodnocení reakce oběhu na tekutiny. Mimo vlastní palpaci pulzu lze PP objektivizovat na pletyzmografické křivce pulzní oxymetrie.
Pulsus paradoxus (PP) represents a decrease in systolic blood pressure during inspiration of more than 10 mmHg. It is caused by pathologically altered cardiopulmonary interactions that lead to a transient decrease in stroke volume and pressure wave amplitude (systolic – diastolic pressure difference). PP can be easily examined. It is an important sign of a number of pathological conditions (e.g. cardiac tamponade, severe asthma, massive pulmonary embolism, hypovolemic shock). The dynamics of PP can also be used to monitor response to fluid treatment. In addition to the actual pulse palpation, PP can be objectified on the plethysmographic curve of pulse oximetry.
- Keywords
- KLÍČOVÁ SLOVA: pulzus paradoxus – srdeční tamponáda – astma – hypovolémie,
- MeSH
- Arterial Pressure MeSH
- Asthma diagnosis physiopathology MeSH
- Hypovolemia diagnosis physiopathology MeSH
- Pericarditis, Constrictive diagnosis physiopathology MeSH
- Humans MeSH
- Pulse * MeSH
- Cardiac Tamponade diagnosis physiopathology MeSH
- Systole MeSH
- Emergency Medical Services MeSH
- Check Tag
- Humans MeSH
INTRODUCTION: Long-term use of continuous-flow left ventricular assist devices may have negative consequences for autonomic, cardiovascular and gastrointestinal function. It has thus been suggested that non-invasive monitoring of arterial pulsatility in patients with a left ventricular assist device is highly important for ensuring patient safety and longevity. We have developed a novel, semi-automated frequency-domain-based index of arterial pulsatility that is obtained during suprasystolic occlusions of the upper arm: the 'cuff pulsatility index'. PURPOSE: The purpose of this study was to evaluate the relationship between the cuff pulsatility index and invasively determined arterial pulsatility in patients with a left ventricular assist device. METHODS: Twenty-three patients with a left ventricular assist device with end-stage heart failure (six females: age = 65 ± 9 years; body mass index = 30.5 ± 3.7 kg m-2) were recruited for this study. Suprasystolic occlusions were performed on the upper arm of the patient's dominant side, from which the cuff pressure waveform was obtained. Arterial blood pressure was obtained from the radial artery on the contralateral arm. Measurements were obtained in triplicate. The relationship between the cuff pressure and arterial blood pressure waveforms was assessed in the frequency-domain using coherence analysis. A mixed-effects approach was used to assess the relationship between cuff pulsatility index and invasively determined arterial pulsatility (i.e. pulse pressure). RESULTS: The cuff pressure and arterial blood pressure waveforms demonstrated a high coherence up to the fifth harmonic of the cardiac frequency (heart rate). The cuff pulsatility index accurately tracked changes in arterial pulse pressure within a given patient across repeated measurements. CONCLUSIONS: The cuff pulsatility index shows promise as a non-invasive index for monitoring residual arterial pulsatility in patients with a left ventricular assist device across time.
- MeSH
- Arteries physiopathology MeSH
- Assisted Circulation instrumentation methods MeSH
- Diagnostic Techniques, Cardiovascular MeSH
- Blood Pressure physiology MeSH
- Middle Aged MeSH
- Humans MeSH
- Heart-Assist Devices * MeSH
- Pulse methods MeSH
- Pulsatile Flow physiology MeSH
- Reproducibility of Results MeSH
- Aged MeSH
- Heart Failure * physiopathology therapy MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- MeSH
- Blood Pressure MeSH
- Humans MeSH
- Lung * physiology MeSH
- Pulse MeSH
- Heart * physiology MeSH
- Check Tag
- Humans MeSH
Introduction: The skin to skin method in the care of newborn has the crucial importance in his postnatal adaptation. In the article we characterize adduced method and point out to the possitive influence of early skin to skin contact on postnatal adaptation of physiological newborn. Aim: The aim of the paper is to point out to benefits of incorporating the skin to skin method into the standard nursing care of newborn. Methods: To obtain the empirical data, we used the method of observation and measurement to monitor pulse, body temperature and self-latching in the control group of physiological newborns using the skin to skin method. In the control group the care of newborn was provided with the standard nursing procedure. We recorded the selected indicators in the observation sheets and then compared them. Results: The study included 90 respondents, physiological newborns. The results point out to better postnatal adaptation of physiological newborns using the skin to skin method. From the average pulse values ensue that the newborns treated with the skin to skin method have lower values of pulse during the whole monitoring process than the newborn treated by the standard method. The average body temperature values on the back of skin to skin newborns are higher throughout the whole time period. Conclusion: Based on the comparison we have confirmed our assumption that the physiological newborn in skin to skin contact has more favourable values in the selected monitoring indicators than the newborn treated with the standard care method and because of that we recommend incorporating this method into the standard nursing care of newborn.
- Keywords
- skin to skin, bonding,
- MeSH
- Humans MeSH
- Infant, Newborn MeSH
- Maternal-Child Nursing methods MeSH
- Postpartum Period * physiology psychology MeSH
- Postnatal Care methods MeSH
- Cross-Sectional Studies MeSH
- Pulse psychology statistics & numerical data MeSH
- Sucking Behavior MeSH
- Statistics as Topic MeSH
- Body Temperature MeSH
- Mother-Child Relations * MeSH
- Check Tag
- Humans MeSH
- Infant, Newborn MeSH
- Keywords
- pulzní vlna, sfygmografie,
- MeSH
- Pulse Wave Analysis MeSH
- Arteries physiology MeSH
- Humans MeSH
- Palpation MeSH
- Plethysmography * methods MeSH
- Pulse * MeSH
- Pulsatile Flow physiology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
