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41. Failed Interpretation of Screening Tool: Delayed Treatment | PSNet
    psnet.ahrq.gov/web-mm/failed-interpretation-screening-tool-delayed-treatment
    June 30, 2021 - His initial vital signs showed a blood pressure of 130/75 mm hg, heart rate of 65 beats per minute, respiratory … or >10% bands 0–4 ≥ 2 qSOFA (quick Sequential Organ Failure Assessment score) Systolic blood … pressure <90 mm Hg Respiratory rate $gt;22 breaths per min Altered mental status 0–3 ≥ 2 … pressure Heart rate Respiratory rate Temperature AVPU score (alert, voice, pain, unresponsive) 0–15 … pressure)   Renal (BUN, creatinine, urine output)   Pulmonary (PaO2/FiO2 ratio)   Hematologic (WBC,

42. Microsoft PowerPoint - Spotlight Case_Hindsight is 2020_SLIDES_FINAL.pptx (pdf file)
    psnet.ahrq.gov/sites/default/files/2024-04/spotlight_case_hindsight_is_2020_slides_final.pdf
    January 01, 2024 - • His blood pressure was elevated at 156/96, but other vital signs were normal, with heart rate 71 … findings, consent to treatment, absent bleeding diathesis (laboratory results), TNK checklist, and blood … pressure … Systolic blood pressure < 150 mmHg at presentation (B) 5. History of seizures (S) 6.

43. National Comparative Audit of Blood Transfusion. | PSNet
    psnet.ahrq.gov/issue/national-comparative-audit-blood-transfusion
    May 11, 2005 - intensification, missed visits, and scheduled follow-up interval with racial or ethnic disparities in blood … pressure control.

44. Effectiveness and efficiency of root cause analysis in medicine. | PSNet
    psnet.ahrq.gov/issue/effectiveness-and-efficiency-root-cause-analysis-medicine
    July 22, 2020 - intensification, missed visits, and scheduled follow-up interval with racial or ethnic disparities in blood … pressure control.

45. Factors associated with wrong blood in tube errors: an international case series - The BEST collaborative study. | PSNet
    psnet.ahrq.gov/issue/factors-associated-wrong-blood-tube-errors-international-case-series-best-collaborative-study
    September 29, 2021 - intensification, missed visits, and scheduled follow-up interval with racial or ethnic disparities in blood … pressure control.

46. Hindsight is 20/20: Thrombolytics for Alcohol Intoxication | PSNet
    psnet.ahrq.gov/web-mm/hindsight-2020-thrombolytics-alcohol-intoxication
    April 24, 2024 - His blood pressure was elevated at 156/96, but other vital signs were normal, with heart rate 71, respiratory … findings, consent to treatment, absent bleeding diathesis (laboratory results), TNKase checklist, and blood … pressure. … Absence of facial droop (F) Negative history of atrial fibrillation (A) Age < 50 years (A) Systolic blood … pressure < 150 mmHg at presentation (B) History of seizures (S) Isolated sensory symptoms without weakness

47. Missing Trauma | PSNet
    psnet.ahrq.gov/web-mm/missing-trauma
    December 01, 2016 - This includes assessing for blood pressure, heart rate, and capillary refill, and establishing IV access … Signs of hemorrhagic shock are low blood pressure, tachycardia, flat neck veins (no central venous filling … penetrating cardiac wounds who have some sign of life at the time of EMS arrival (pulse, respiration, blood … pressure, organized cardiac rhythm) and who can be transported to a trauma center expeditiously should

48. PowerPoint Presentation (ppt file)
    psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.2_slideshow.ppt
    February 01, 2003 - the error in drug administration is recognized immediately after injection: Stop the IV If there is blood … pressure cuff on arm of IV, inflate to slow entry of drug to central circulation Clinical Management … changes, apnea, muscle weakness, or visual disturbances Extreme or unexpected increase or decrease in blood … pressure or heart rate Unexpected or persistent muscle relaxation Unexpected change or lack of change

49. An Inadvertent Bolus of Norepinephrine. | PSNet
    psnet.ahrq.gov/web-mm/inadvertent-bolus-norepinephrine
    May 27, 2020 - At 08:00 on postoperative day 2, the patient’s blood pressure was 98/59 mmHg and a 250 mL fluid bolus … The next day, the patient's blood pressure stabilized, and she was transferred to a stepdown unit, and … Vasopressors are indicated for a MAP < 60 mmHg, a decrease in systolic blood pressure > 30 mmHg from … In contrast, for patients with labile blood pressure, when vasopressors are being titrated on and off … pressure.

50. PowerPoint Presentation (ppt file)
    psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.362_slideshow.ppt
    December 01, 2015 - a change in cardiac rhythm Parameter violation alarms: detect when a vital sign (e.g., heart rate, blood … pressure, etc.) exceeds the alarm limit settings Technical alarms: indicate poor signal quality (e.g … could minimize number of false alarms Algorithms that integrate parameters (e.g., link heart rate and blood … pressure) check to see if there was a physiologic response with the alarm For instance, an algorithm-defined … asystole event not associated with a simultaneous drop in blood pressure would be re-defined as false

51. Spotlight Case Hindsight Is 2020 Slides Final Revised 05.03.2024 (pdf file)
    psnet.ahrq.gov/sites/default/files/2024-05/spotlight_case_hindsight_is_2020_slides_final_revised_05.03.2024.pdf
    January 01, 2024 - • His blood pressure was elevated at 156/96, but other vital signs were normal, with heart rate 71 … findings, consent to treatment, absent bleeding diathesis (laboratory results), TNKase checklist, and blood … pressure … Systolic blood pressure < 150 mmHg at presentation (B) 5. History of seizures (S) 6.

52. Why pediatricians fail to diagnose hypertension: a multicenter survey. | PSNet
    psnet.ahrq.gov/issue/why-pediatricians-fail-diagnose-hypertension-multicenter-survey
    August 26, 2020 - In this observational study, investigators found that pediatricians often fail to measure blood pressure … and misclassify elevated blood pressure as normal.

53. PowerPoint Presentation (ppt file)
    psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.383_slideshow.ppt
    September 01, 2016 - system, including empty slots for upcoming days as well as slots that contained a higher number of blood … pressure medications than the patient was supposed to take. … The resident also discovered that an old blood pressure medication (a beta-blocker), which had been stopped … pressure pills when she was only supposed to be taking two. … pressure medications.

54. Blood and blood products transfusion errors: what can we do to improve patient safety. | PSNet
    psnet.ahrq.gov/issue/blood-and-blood-products-transfusion-errors-what-can-we-do-improve-patient-safety
    September 23, 2020 - Review Blood and blood products transfusion errors: what can we do to improve patient safety. Citation Text: Brown C, Brown M. Blood and blood products transfusion errors: what can we do to improve patient safety? Br J Nurs. 2023;32(7):326-332. doi:10.12968/bjon.2023.32.7.326. Copy Cit…

55. Transfusion Thresholds in Gastrointestinal Bleeding | PSNet
    psnet.ahrq.gov/web-mm/transfusion-thresholds-gastrointestinal-bleeding
    September 06, 2023 - Over the course of the night, his blood pressure began to drop. … He was given 2 liters of normal saline with some improvement in his blood pressure.

56. The Forgotten Turn | PSNet
    psnet.ahrq.gov/web-mm/forgotten-turn
    August 01, 2018 - At our facility, having small portable mirrors attached to the blood pressure machines has assisted staff

57. Managing Ascites: Hazards of Fluid Removal | PSNet
    psnet.ahrq.gov/web-mm/managing-ascites-hazards-fluid-removal
    August 31, 2022 - If a patient develops a large fall in blood pressure, as occasionally occurs, I would give vasopressor … Large volume paracentesis is generally safe, but blood pressure may fall and require treatment.

58. Dissecting the Presentation | PSNet
    psnet.ahrq.gov/web-mm/dissecting-presentation
    July 01, 2017 - pressure differential between arms, focal neurologic deficit) are seen in fewer than half of all patients … ( 4 ) For example, data from the IRAD database of 2538 patients found a pulse deficit in one arm or blood … pressure differential between arms in only 20% of patients.( 7 ) Although these findings cannot be used … pressure differential, or a widened mediastinum on chest radiograph. … pressure in both arms (>20 mmHg) (19%–34% in type A; 9%–21% in type B) Chest pain with new

59. Spotlight Case July 2008 (ppt file)
    psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.248_slideshow.ppt
    September 01, 2011 - She was febrile to 102oF and had a blood pressure of 110/70 mm Hg, which was lower than her usual.

60. Pressure Injury Prevention in Hospitals Training Program. | PSNet
    psnet.ahrq.gov/issue/pressure-injury-prevention-hospitals-training-program
    November 19, 2014 - Multi-use Website Pressure Injury Prevention in Hospitals Training Program. Citation Text: Rockville, MD: Agency for Healthcare Research and Quality; September 2017. Copy Citation Save Save to your library Print Share Facebook Twitter L…