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Some years ago I was in the hospital for six weeks with a very ill child ( all is well ) and they were monitoring vitals every hour and later every four hours.

Some years ago I was in the hospital for six weeks with a very ill child ( all is well ) and they were monitoring vitals every hour and later every four hours. It is a type of torture to be awoken to do this all the time. During that season I wanted to build a solution that would collect vitals and allow the patient to rest without disturbance and see it cheap enough to become ubiquitous. But when I looked into what has to be done to get medical devices certified I backed away.

Aeolun 3y ago
Aren’t patients where they just do not check the vitals during sleep better off anyway?
- thaumasiotes 3y ago
  Hospitals aren't optimizing for average health of patients. They're trying to get the best minimum performance, not the best overall performance. Injuring most patients by depriving them of sleep for no good reason is felt to be justified by the chance of catching an extremely urgent problem in time to do something about it once or twice over the lifetime of the hospital. An example of this with a lot of popular misunderstood awareness is the idea that you shouldn't sleep if you have a concussion. Preventing the patient from sleeping is detrimental to their health; it inhibits healing. The reason hospitals do it is that their way of diagnosing whether the concussion patient has just experienced a catastrophic complication is to talk to them and see whether they are capable of producing normal language. This diagnostic mode is not available if the patient is asleep. So the patient isn't allowed to sleep.
- matheusmoreira 3y ago
  It depends. Early detection of worsening conditions are absolutely vital for the safety of the patient. Vital signs monitoring is the simplest way to detect them. For example, respiratory rate increasing to over 20 per minute is a bad sign. This stuff is literally part of the criteria for diagnosing sepsis and septic shock. They will absolutely be checked if such conditions are suspected or expected.
  - golem14 3y ago
    Respiratory monitoring can be done with a mic taped to the chest, at least for some applications. That's pretty uninvasive and continuous
  - Aeolun 3y ago
    I think realizing that respiratory rate has risen to over 20 does not require waking the patient though? It’ll generally be quite obvious if someone is breathing that fast, even when asleep. But yeah, there’s probably different things that work the same way.
    - matheusmoreira 3y ago
      > It’ll generally be quite obvious It's harder than it seems. Increased respiratory frequency can be subtle, it won't be full dyspnea every time. The signs can be missed if not explicitly looked for. Observing respirations requires a well lit room for the examination. > But yeah, there’s probably different things that work the same way. Sepsis diagnosis also includes assessment of mental state. Mental confusion is a symptom of sepsis. Glasgow Coma Scale is a component of Sequential Organ Failure Assessment scores: it includes talking to the patient and evaluating the coherence of verbal responses. https://en.wikipedia.org/wiki/SOFA_score https://en.wikipedia.org/wiki/SOFA_score Can't be done if the patient is asleep or sedated.
      - salad-tycoon 3y ago
        There are rate sensors you can put on a chest like an ekg lead. Though being covered in wires is also pretty awful. Or you can use a pen light and watch for rise and fall of chest. Also, Glasgow Coma Scale absolutely can be administered to someone who isn’t awake but this is really just me nit picking, your point about needing to be intrusive or waking people up is correct overall. Certain things are bothersome, some are painful, most of it will wage people up.
        matheusmoreira 3y ago
        > Glasgow Coma Scale absolutely can be administered to someone who isn’t awake Of course, it is a coma scale after all. Actually applying it to sleeping patients though? Will get you false positives at best: even healthy patients will fail to respond verbally (-4), blink their eyes (-1) and obey commands (-1) if they're asleep. That's a maximum GCS of 9 even if you stop there. If you don't stop there, you might just get punched in the face when they are rudely awakened to the sight of you testing their pain response.
- MrRolleyes 3y ago
  [dead]

Aeolun 3y ago

Aren’t patients where they just do not check the vitals during sleep better off anyway?

thaumasiotes 3y ago
Hospitals aren't optimizing for average health of patients. They're trying to get the best minimum performance, not the best overall performance. Injuring most patients by depriving them of sleep for no good reason is felt to be justified by the chance of catching an extremely urgent problem in time to do something about it once or twice over the lifetime of the hospital. An example of this with a lot of popular misunderstood awareness is the idea that you shouldn't sleep if you have a concussion. Preventing the patient from sleeping is detrimental to their health; it inhibits healing. The reason hospitals do it is that their way of diagnosing whether the concussion patient has just experienced a catastrophic complication is to talk to them and see whether they are capable of producing normal language. This diagnostic mode is not available if the patient is asleep. So the patient isn't allowed to sleep.
matheusmoreira 3y ago
It depends. Early detection of worsening conditions are absolutely vital for the safety of the patient. Vital signs monitoring is the simplest way to detect them. For example, respiratory rate increasing to over 20 per minute is a bad sign. This stuff is literally part of the criteria for diagnosing sepsis and septic shock. They will absolutely be checked if such conditions are suspected or expected.
- golem14 3y ago
  Respiratory monitoring can be done with a mic taped to the chest, at least for some applications. That's pretty uninvasive and continuous
- Aeolun 3y ago
  I think realizing that respiratory rate has risen to over 20 does not require waking the patient though? It’ll generally be quite obvious if someone is breathing that fast, even when asleep. But yeah, there’s probably different things that work the same way.
  - matheusmoreira 3y ago
    > It’ll generally be quite obvious It's harder than it seems. Increased respiratory frequency can be subtle, it won't be full dyspnea every time. The signs can be missed if not explicitly looked for. Observing respirations requires a well lit room for the examination. > But yeah, there’s probably different things that work the same way. Sepsis diagnosis also includes assessment of mental state. Mental confusion is a symptom of sepsis. Glasgow Coma Scale is a component of Sequential Organ Failure Assessment scores: it includes talking to the patient and evaluating the coherence of verbal responses. https://en.wikipedia.org/wiki/SOFA_score https://en.wikipedia.org/wiki/SOFA_score Can't be done if the patient is asleep or sedated.
    - salad-tycoon 3y ago
      There are rate sensors you can put on a chest like an ekg lead. Though being covered in wires is also pretty awful. Or you can use a pen light and watch for rise and fall of chest. Also, Glasgow Coma Scale absolutely can be administered to someone who isn’t awake but this is really just me nit picking, your point about needing to be intrusive or waking people up is correct overall. Certain things are bothersome, some are painful, most of it will wage people up.
      - matheusmoreira 3y ago
        > Glasgow Coma Scale absolutely can be administered to someone who isn’t awake Of course, it is a coma scale after all. Actually applying it to sleeping patients though? Will get you false positives at best: even healthy patients will fail to respond verbally (-4), blink their eyes (-1) and obey commands (-1) if they're asleep. That's a maximum GCS of 9 even if you stop there. If you don't stop there, you might just get punched in the face when they are rudely awakened to the sight of you testing their pain response.
MrRolleyes 3y ago
[dead]