Introduction In disaster or mass casualty situations, access to remote burn care experts, communication, or resources may be limited. Furthermore, burn injuries are complex and require substantial training and knowledge beyond basic clinical care. Development and use of decision support (DS) technologies may provide a solution for addressing this need. Devices capable of delivering burn management recommendations can enhance the provider’s ability to make decisions and perform interventions in complex care settings. When coupled with merging augmented reality (AR) technologies these tools may provide additional capabilities to enhance medical decision-making, visualization, and workflow when managing burns. For this project, we developed a novel AR-based application with enhanced integrated clinical practice guidelines (CPGs) to manage large burn injuries for use in different environments, such as disasters. Methods We identified an AR system that met our requirements to include portability, infrared camera, gesture and voice control, hands-free control, head-mounted display, and customized application development abilities. Our goal was to adapt burn CPGs to make use of AR concepts as part of an AR-enabled burn clinical decision support system supporting four sub-applications to assist users with specific interventional tasks relevant to burn care. We integrated relevant CPGs and a media library with photos and videos as additional references. Results We successfully developed a clinical decision support tool that integrates burn CPGs with enhanced capabilities utilizing AR technology. The main interface allows input of patient demographics and injuries with step-by-step guidelines that follow typical burn management care and workflow. There are four sub-applications to assist with these tasks, which include: 1) semi-automated burn wound mapping to calculate total body surface area; 2) hourly burn fluid titration and recommendations for resuscitation; 3) medication calculator for accurate dosing in preparation for procedures and 4) escharotomy instructor with holographic overlays. Conclusions We developed a novel AR-based clinical decision support tool for management of burn injuries. Development included adaptation of CPGs into a format to guide the user through burn management using AR concepts. The application will be tested in a prospective research study to determine the effectiveness, timeliness, and performance of subjects using this AR-software compared to standard of care. We fully expect that the tool will reduce cognitive workload and errors, ensuring safety and proper adherence to guidelines.
is a minimum of 120 minutes of haemostasis. However studies have shown that increasing haemostasis times are associated with increased incidence of radial artery occlusions. Methods: The departmental policy at Wollongong Hospital is for a TR band removal time of less than 120 minutes. A retrospective analysis of a registry-style database of 730 cases of trans-radial haemostasis (CA n=590, PCI n=140) radial artery approach cardiac catheterisation were analysed according to the band times and outcomes including bleeding complications in patients. Results: The average time of band removal was 62.7 minutes overall (PCI t=79.2 minutes, CA t=46.2 minutes) with 80% (n=670) of cases recorded to have no complications. Overall 20% of PCI (n=27) and 21.2%of CA (n=124) were noted to have bleeding events ranging from slight to large haematoma or bruising. The overall incidence of large haematoma or bruising was 0.8% (n=6). There were no documented cases of radial artery occlusion in our dataset. Conclusion: Accelerated band removal time may be justified but with careful consideration in regards to accepting risk of minor bleeding complications. Our study can be expanded to prospectively assess for hypoplastic radial artery in conjunction with accelerated removal times.
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