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Lethal Pressure Mini Movie 30 Gu
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Marylee Gruman
Dec 8, 2023, 12:02:38 AM12/8/23
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Prehospital management of gunshot wounds varies somewhat based on the location of the injury, but almost all ballistic injury patients require immediate transport to a trauma center. Two large retrospective Canadian studies have suggested that direct transport to a Level I trauma center instead of a closer, non-trauma center results in better outcomes.23,24 Emergency medical services (EMS) providers should follow common ATLS prehospital guidelines to control the airway, provide oxygen as needed, and control bleeding with direct pressure as well as obtain vital signs and intravenous (IV) access as soon as possible. Although EMS protocols will vary from region to region and each crew has varying capabilities, the EMS crew should perform lifesaving procedures as indicated but should primarily do their best to minimize transport time to the nearest trauma center.
Measurements of static versus pulsatile ICP. The static ICP (mean ICP) is an absolute pressure value measured against a reference pressure (here illustrated by the green line), not considering the pressure changes occurring during the cardiac cycle. The pulsatile ICP is the pulse pressure or the pressure changes occurring during the cardiac cycle (here illustrated by the blue line). A single ICP wave is characterized by an increase in pressure from diastolic minimum pressure to systolic maximum pressure (the peaks are illustrated by the red dots). The single ICP wave amplitude is the peak-to-peak pressure difference. Illustration: Øystein Horgmo, University of Oslo
Lethal Pressure Mini Movie 30 Gu
Download https://tlniurl.com/2wJ45y
The term pulsatile ICP refers to the pressure changes occurring during the cardiac cycle. Each heartbeat results in intracranial pressure variations in accordance with the cardiac cycle measured as the ICP waveforms (see Fig. 3 and Additional file 1: Movie 1). Typically, a continuous ICP signal varies over time, characterized by a diastolic minimum pressure value and a systolic maximum pressure value, causing the calculated ICP scores to vary. This is further illustrated in Additional file 2: Movie 2. Established attributes from the single wave amplitudes are the amplitude (pressure difference between diastolic and systolic pressures), the rise time (time from diastolic to systolic pressures) and rise time coefficient (amplitude divided by rise time, providing a measure of the steepness of the ICP waveform) [32]. With regard to the morphology of the ICP wave, the most commonly studied ICP waveform attributes are the relative height of peaks P1, P2 and P3.
Lumbar CSF pressure measurements during so-called infusion tests also have a long tradition [137]. In such procedures, the CSF pressure is measured during infusion of a fluid to the lumbar compartment and the pressure change in response to the administered fluid is interpreted as resistance to outflow of CSF. This is performed on a routine basis in several centers [63]. The main indication is to assess shunt dependency or shunt failure in individuals with tentative CSF circulation failure.
With regard to non-invasive ICP monitoring, there are currently no clinically useful source signals available for continuous ICP estimates. At best, single point values of ICP may be obtained. This would be useful in the pre-hospital setting, and to indicate whether abnormal ICP is present or not. However, for continuous nICP monitoring, new and yet unknown source signals need to be introduced. Given the lack of available nICP source signals, we would recommend that scientists focus more attention on developing implantable miniature pressure sensors, even biodegradable pressure sensors, utilizing wireless technologies. Given the opportunity to assess both static and pulsatile ICP, they might be placed epidurally. In addition, telemetric sensors/biodegradable sensors in the lumbar region with a focus on ICC measurements seems within reach. Long-term monitoring of ICP could become feasible. Such implantable miniature ICP sensors could become tools for surveillance of individuals with brain disease or injury, as well as in diagnostic assessment of individuals with neurological disease. At this moment, we therefore believe development of implantable miniature ICP sensors has a far greater potential than searching for means to measure nICP.
A continuous ICP signal. A continuous ICP signal is pulsatile and characterized by the pressure changes occurring during each cardiac beat (illustrated by the light blue line). During each cardiac contraction the ICP increases from a diastolic minimum pressure (illustrated by red filled circle) to a systolic maximum pressure (illustrated dark blue X). The mean ICP is given by the dark blue line, and represents the average pressure of all data points, relative to a reference pressure, i.e. the pressure sensor is zeroed against the atmospheric pressure before being inserted to the intracranial compartment.
Continuous ICP signals from two ICP sensors placed nearby in the brain parenchyma reveals constant shift in baseline reference pressure. The continuous ICP signals, characterized by diastolic minimum (red dots) and systolic maximum (blue x) pressures, from two different Codman ICP sensors placed nearby in the brain, wherein the mean ICP (dark blue lines) is diverging while the ICP waveforms of the two signals are close to identical.
eebf2c3492
Measurements of static versus pulsatile ICP. The static ICP (mean ICP) is an absolute pressure value measured against a reference pressure (here illustrated by the green line), not considering the pressure changes occurring during the cardiac cycle. The pulsatile ICP is the pulse pressure or the pressure changes occurring during the cardiac cycle (here illustrated by the blue line). A single ICP wave is characterized by an increase in pressure from diastolic minimum pressure to systolic maximum pressure (the peaks are illustrated by the red dots). The single ICP wave amplitude is the peak-to-peak pressure difference. Illustration: Øystein Horgmo, University of Oslo
Lethal Pressure Mini Movie 30 Gu
Download https://tlniurl.com/2wJ45y
The term pulsatile ICP refers to the pressure changes occurring during the cardiac cycle. Each heartbeat results in intracranial pressure variations in accordance with the cardiac cycle measured as the ICP waveforms (see Fig. 3 and Additional file 1: Movie 1). Typically, a continuous ICP signal varies over time, characterized by a diastolic minimum pressure value and a systolic maximum pressure value, causing the calculated ICP scores to vary. This is further illustrated in Additional file 2: Movie 2. Established attributes from the single wave amplitudes are the amplitude (pressure difference between diastolic and systolic pressures), the rise time (time from diastolic to systolic pressures) and rise time coefficient (amplitude divided by rise time, providing a measure of the steepness of the ICP waveform) [32]. With regard to the morphology of the ICP wave, the most commonly studied ICP waveform attributes are the relative height of peaks P1, P2 and P3.
Lumbar CSF pressure measurements during so-called infusion tests also have a long tradition [137]. In such procedures, the CSF pressure is measured during infusion of a fluid to the lumbar compartment and the pressure change in response to the administered fluid is interpreted as resistance to outflow of CSF. This is performed on a routine basis in several centers [63]. The main indication is to assess shunt dependency or shunt failure in individuals with tentative CSF circulation failure.
With regard to non-invasive ICP monitoring, there are currently no clinically useful source signals available for continuous ICP estimates. At best, single point values of ICP may be obtained. This would be useful in the pre-hospital setting, and to indicate whether abnormal ICP is present or not. However, for continuous nICP monitoring, new and yet unknown source signals need to be introduced. Given the lack of available nICP source signals, we would recommend that scientists focus more attention on developing implantable miniature pressure sensors, even biodegradable pressure sensors, utilizing wireless technologies. Given the opportunity to assess both static and pulsatile ICP, they might be placed epidurally. In addition, telemetric sensors/biodegradable sensors in the lumbar region with a focus on ICC measurements seems within reach. Long-term monitoring of ICP could become feasible. Such implantable miniature ICP sensors could become tools for surveillance of individuals with brain disease or injury, as well as in diagnostic assessment of individuals with neurological disease. At this moment, we therefore believe development of implantable miniature ICP sensors has a far greater potential than searching for means to measure nICP.
A continuous ICP signal. A continuous ICP signal is pulsatile and characterized by the pressure changes occurring during each cardiac beat (illustrated by the light blue line). During each cardiac contraction the ICP increases from a diastolic minimum pressure (illustrated by red filled circle) to a systolic maximum pressure (illustrated dark blue X). The mean ICP is given by the dark blue line, and represents the average pressure of all data points, relative to a reference pressure, i.e. the pressure sensor is zeroed against the atmospheric pressure before being inserted to the intracranial compartment.
Continuous ICP signals from two ICP sensors placed nearby in the brain parenchyma reveals constant shift in baseline reference pressure. The continuous ICP signals, characterized by diastolic minimum (red dots) and systolic maximum (blue x) pressures, from two different Codman ICP sensors placed nearby in the brain, wherein the mean ICP (dark blue lines) is diverging while the ICP waveforms of the two signals are close to identical.
eebf2c3492
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