Clinical Scenarios

[MedEngr]

Hello,
I found this site a few days ago and immediately became excited and have been reading posts for three days. I want to do a quick introduction of myself before I ask my question. I am an engineer by education and a Certified Clinical Engineer. For those who don't know what that is I am a Biomedical and Mechanical Engineer who has specialized in designing, understanding, implementing and manging clinical technology in the clinical enviroment. I am very interested in how technology impacts the system (for better or worse). The system is everything from the enviroment, the clinicians, the patient, medical devices, supplies. A little over a year ago I founded a medical device company focusing on developing technologies which provide process management, closed loop control, safety interlocks, and device/equipment integration. Our initial product is focusing in the ICU (product launch next July), but we are beginning to research other enviroments including trauma and battlefield medicine.

I have been reading and analyzing the case studies posted on here in every moment of free time I've had over the past few days. The question I have for the post is where in your day to day activities could integrated technology improve your efficiency, patient safety?

By asking for examples of connectivity that could a) solve current clinical problems, b) improve safety or efficiency, or c) enable innovative clinical systems of the future, is the initial step in developing systems which meet the end users needs and decreasing the amount of steps required to complete the task. Assume that there are no technical, economic, legal, or regulatory obstacles to deploying a comprehensive system.

An example of a scenario is:
Current State: A 32-year-old woman had a laparoscopic cholecystectomy performed under general anesthesia. At the surgeon’s request, a plane film x-ray was shot during a cholangiogram. The anesthesiologist stopped the ventilator for the film. The x-ray technician was unable to remove the film because of its position beneath the table. The anesthesiologist attempted to help her, but found it difficult because the gears on the table had jammed. Finally, the x-ray was removed, and the surgical procedure recommenced. At some point, the anesthesiologist glanced at the EKG and noticed severe bradycardia. He realized he had never restarted the ventilator. This patient ultimately expired. (Lofsky, 2004)

Proposed State: The portable X-Ray is connected to the anesthesia machine ventilator as part of the setup and positioning. The technician is prompted to shoot the image at either inspiration or expiration per order. Once the technician is ready they X-ray machine is activated, the ventilator is then pause at either inspiration or expiration. The pause time is determined by the necessary exposure time and then the ventilation is resumed at the pre-image respiration rate.


So after this really long post my question is
What clinical challenges exist today that could be solved by utilizing integration, device to device control, automated documentation, closed loop control, etc? I am very interested in situations in the field, and trauma situations, but anywhere in the hospital enviroment works.

With all scenarios posted I will make sure the person who posts or the entire list receives feedback.

Thanks in Advance,
Tracy

[Red Flag 1]

Intresting case with the intra-operative cholangiogram. Not uncommon for the one at the head of the table to place and remove x-ray plate. Two thoughts tech and practice.

Tech: Ventilators on anesthesia machines have gone from noisy to silent then drifting back to " controlled audibility". There was a time when everyone in the room could hear the vent. That went away over the years. When I retired a few years ago, Ohmeda had designed user controlled audio sounds to work along with the vents. Disconnect and apnea alarms were also present.

Practice: Knowing that I was primarily responsable for patient ventilation, that task was high on my to do list. If my patient was vent dependant, and I turned off the vent, my hand NEVER left the on/off switch until it was turned back on....NEVER! If x-ray thought I was a jerk for not helping with the x-ray tray when they wanted, that was thier problem! I wouldt take the seconds required for the patient, then help the x-ray tech. No one ever complained.

A third thought is that airing cases such as this in open forum is a great learning tool for health care pros. Professional discussion of the one in a million case helps keep folks focused, as they do in professional journals. Open public forum can also just flat scare the be-Jesus out of folks who are going to surgery tomorrow, next week or never.

It is my most humble opinion, that some things are best discussed by PM. Second, I do not know who you are, for all I know, you may be a malpractice attorney fishing for info to hang a pretty good Doc.

My humble $.02.

RF 1

[JJ_BPK]

Originally Posted by Red Flag 1

I do not know who you are, for all I know, you may be a malpractice attorney fishing for info to hang a pretty good Doc.

My humble $.02

RF 1

+1 RF 1..

Biography: A biomedical engineer working on developing mililtary medical solutions
Location: Boston, MA
Occupation: President of Medical Device Company
How did you hear about Professional Soldiers?: google

"developing (profitable) military(sic) medical solutions "

My $00.0002

[Red Flag 1]

JJ,

Yep!

Medengr, IMHO could be a valuable site member. I do miss the mark at times, however, I do try to keep the 18s and 18D's in mind with posts here.

Perhaps some posts aimed at 18D's in thier work environment. I don't think you'll see many 18 gas passers; well not in the present context anyway.

RF 1

[Semper gumby]

Not sure if my .02 is needed, but as an X-ray tech performing in the OR, whenever I needed a film on inspiration or expiration, all I would have to do is time it with the ventilator. (Use High KV/Low MAS for quicker picture) Never had any problems, and never had to stop the ventilator...

[MedEngr]

The only reason I posted the example is because it is an example that the academic research team I also work as part of has fully developed this example and built an early prototype for proof of concept. I was hoping it would clarify what I was asking for and focus thinking. I am looking for examples and feedback from 18S and 18D's, and anyone else who would like to provide feedback.

By the way, I'm NOT a medical malpractice attorney and I am the founder of a medical device startup company, but anyone who has founded a company realizes you can't be successful and do it just for the money. The US military health care system is one of the most innovative systems in the world and the opportunties that I have had working with them throughout my career has been some of the most fulfilling medical engineering work I've ever done. Which is why I continue to engage them and look for feedback from the people who make up the system.


T

[cold1]

The anesthesiologist attempted to help her, but found it difficult because the gears on the table had jammed. Finally, the x-ray was removed, and the surgical procedure recommenced.

Next time call the BMET shop and get someone up there to remove the film.

[Red Flag 1]

From the anesthesia chair at the head of the table, I have had the benefit of safer practice with the aid of technology. Advances it the tech world do bring advances in the med/surg world, of that there is no doubt. Not all tech devices help, some hinder and can take us back some.

I do appreciate the Bioeng field. I just have a little trouble with this as a Medical Pearls thread. My opinion, really up to the Mods. I also hope your driving purpose here is not to troll for business, nod to JJ.

Back to my lane, I think.

RF 1

[Doc Dutch]

Hmmm. Interesting.

I cannot find the relevance in all of this thread. To be honest and direct, Tracy, this is the wrong place for this "fishing expedition" or "line of questioning".

The Society of Critical Care Medicine, The American Association for the Surgery on Trauma, The Eastern Association for the Surgery on Trauma, plus numerous other organizations from Anesthesia, Surgery, Critical Care, Emergency Medicine that deal with systems issues and trauma and critical care, etc, have venues much more appropriate than on this site.

I question the judgment to come to this site and ask such questions. If you are who you claim to be, Tracy, you should have much better leads and ideas from clinical congresses that have national meetings annually that discuss such topics. There are countless ideas in this area you discuss on line with us but coming to this site seems very out of place. I feel your time might be better spent at other national meetings or at other websites.

Sincerely,

MRM

[Eagle5US]

Originally Posted by Doc Dutch

Hmmm. Interesting.

I cannot find the relevance in all of this thread. To be honest and direct, Tracy, this is the wrong place for this "fishing expedition" or "line of questioning".

The Society of Critical Care Medicine, The American Association for the Surgery on Trauma, The Eastern Association for the Surgery on Trauma, plus numerous other organizations from Anesthesia, Surgery, Critical Care, Emergency Medicine that deal with systems issues and trauma and critical care, etc, have venues much more appropriate than on this site.

I question the judgment to come to this site and ask such questions. If you are who you claim to be, Tracy, you should have much better leads and ideas from clinical congresses that have national meetings annually that discuss such topics. There are countless ideas in this area you discuss on line with us but coming to this site seems very out of place. I feel your time might be better spent at other national meetings or at other websites.

Sincerely,

MRM

Well said, direct and to the point.
Thread closed.

Eagle