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2 results

  • 5 - Adoptions and Adaptations

  • James L. A. Webb, Jr, Colby College, Maine
  • Book:
    The Guts of the Matter
    Published online:
    18 November 2019
    Print publication:
    12 December 2019, pp 85-102

  • Summary

    Chapter five, “Adoptions and Adaptations,” explores the evidence for the adoption of modern sewerage and water purification systems beyond the early centers in northern Europe and North America. The principal constraints to adoption of modern sanitation were fiscal, although ecological, political, and cultural forces also played large roles. The overall result was that the sanitation revolution beyond the North Atlantic was adopted piecemeal and that the benefits were generally concentrated in the core urban areas inhabited by those with political and economic power. Into the mid-twentieth century, the flush toilet and the disposal of human waste via water carriage made little impact on the overall problem of excreta disposal, and even the provision of piped water was generally limited to the cities and large towns in which Europeans, local elites of European ancestry, and/or non-European elites had an authoritative presence.

  • Prehospital Invasive Arterial Pressure: Use of a Minimized Flush System

  • Jonas Karlsson, Joacim Linde, Christer Svensen, Mikael Gellerfors
  • Journal:
    Prehospital and Disaster Medicine / Volume 33 / Issue 5 / October 2018
    Published online by Cambridge University Press:
    31 August 2018, pp. 490-494
    Print publication:
    October 2018
  • Introduction

    Invasive blood pressure (IBP) monitoring could be of benefit for certain prehospital patient groups such as trauma and cardiac arrest patients. However, there are disadvantages with using conventional IBP devices. These include time to prepare the transducer kit and flush system as well as the addition of long tubing connected to the patient. It has been suggested to simplify the IBP equipment by replacing the continuous flush system with a syringe and a short stopcock.

    Hypothesis

    In this study, blood pressures measured by a standard IBP (sIBP) transducer kit with continuous flush was compared to a transducer kit connected to a simplified and minimized flush system IBP (mIBP) using only a syringe.

    Methods

    A mechanical, experimental model was used to create arterial pressure pulsations. Measurements were made simultaneously using a sIBP and mIBP device, respectively. This was repeated four times using different mean arterial pressure (MAP): 40, 70, 110, and 140mm Hg. For each series, 16 measurements were taken during 20 minutes. Data were analyzed using Bland-Altman plots. Measurement error greater than five percent was regarded as clinically significant.

    Results

    Mean bias and standard deviation (SD) for systolic blood pressure (SBP), diastolic blood pressure (DBP), and MAP was -3.05 (SD = 2.07), 0.2 (SD = 0.48), and -0.3 (SD = 0.55) mmHg, respectively. Bland-Altman plots revealed that the bias and SD for systolic pressures was mainly due to an increased under-estimation of pressures in lower ranges. All MAP and 98.4% of diastolic pressure measurements had an error of less than five percent. Systolic pressures in the MAP 40 series all had an error of greater than five percent. All other systolic pressures had an error of less than five percent.

    Conclusion

    Thus, IBP with the mIBP flush system provides accurate measurement of MAP and DBP in a wide range of physiological pressures. For SBP, there was a tendency to under-estimate pressures, with larger error in lower pressures. Implementation of a simplified flush system could allow further development and potentially simplify the use of IBP for prehospital critical care teams.

    KarlssonJ, LindeJ, SvensenC, GellerforsM. Prehospital Invasive Arterial Pressure: Use of a Minimized Flush System. Prehosp Disaster Med. 2018;33(5):490–494.