Ghazali D, Stephan O, Choquet C, Antoniol S, Casalino E
The American Journal of Emergency Medicine December 2018
Usually, patients hospitalized for community-acquired pneumonia requiring oxygen therapy but without vital distress, are not monitored in an intensive or critical care unit after their visit to ED. This situation can be life-threatening, especially if patients are unable to call for help until the nurse arrives for scheduled surveillance.
In this case a 36 year old patient presented with hyperthermia. Following physical examination and thoracic radiography, a diagnosis of right lower lobe pneumonia was established. Laboratory tests showed white blood cell count of 14.7 · 109 L−1 (N: 4–10.109) and procalcitonin was 0.39 μg·L−1 indicating a bacterial infection. Treatment with systemic amoxicillin 1000 mg was started, three times per day for seven days.
The patient was monitored using Sensium® technology and manual nurse observations every 8 h. Three hours after he was admitted, the emergency physician received a Sensium® alert by E-mail indicating a sudden increase of RR from 22 min−1 to 51 min−1 , HR from 75 to 157 bpm, and temperature from 38.0 to 39.5 °C. Clinical examination found a severe acute respiratory failure with severe sepsis. The patient had an increase in bronchial congestion. He was immediately admitted to the critical care unit. Because of early care due to the alarm signal, the patient quickly received reinforcement in oxygenation therapy without requiring mechanical ventilation and the treatment for the sepsis resulting from pneumonia. His medical condition improved within only three days before going back to the medicine unit. The patient was discharged from the hospital after seven days.
The present case demonstrated how E-health technology using the Sensium® device might be helpful to early diagnose these clinical deteriorations by alerting doctors and nurses of early signs of acute respiratory failure and sepsis which are RR and HR. Continuous vital signs monitoring outside the critical care setting is feasible and may provide a benefit in terms of improved patient outcomes and cost efficiency.
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