Use of Non Invasive Hemodynamic Cardiovascular Monitoring to Evaluate Emergency Department Patients

• To elucidate the hemodynamics of the cohort of four different groups of patients in the early hours of their presentation [ Time Frame: Emergency Department (ED) arrival to 2 hours ] [ Designated as safety issue: No ]
  

• Comparison of clinical estimation of hemodynamics and values estimated by the NexfinHD on arrival and for up to 6 hours [ Time Frame: ED arrival to 6 hours ] [ Designated as safety issue: No ]
  
• To compare if abnormal hemodynamics as measured by the NexfinHD and clinical assessment after arrival to the ED in the 4 groups predicts life saving interventions within 2 hours [ Time Frame: ED arrival to 2 hours ] [ Designated as safety issue: No ]
  
• To calculate short term hemodynamic variability parameters and their prediction of life saving interventions within 2 hours and subjective/objective estimation of clinical improvement [ Time Frame: ED arrival to 2 hours ] [ Designated as safety issue: No ]
  
• Estimation of bias and precision of the non invasive hemodynamic trends in unselected patient group by assessing the validity of measurements with invasive measurements if used [ Time Frame: ED arrival to 2 hours ] [ Designated as safety issue: No ]
  

There has been little very early (after Emergency Department presentation) hemodynamic monitoring of acutely ill or injured patients secondary to the lack of non invasive technologies that could be reliably applied to this patient population.Thus all assessments of hemodynamics have been made by physicians on clinical information including intermittent pulse and blood pressure measurements. It is not known what the underlying continuous cardiac output, systemic vascular resistance, etc are in these patients and how these change with current Emergency Medicine therapeutic interventions. Currently there is available a finger cuff devise (NexfinHD Monitor, BMEYE, Amsterdam) that can measure these hemodynamics on a beat to beat basis and that can be easily applied to acutely ill individuals. This prospective pilot study of 48 patients (4 groups of 12 each) will document the hemodynamics of patients on arrival and continuously for 2 hours, blinded to the treating physician. Treating physicians will be asked to estimate these hemodynamic parameters at various time points. The study will characterize the hemodynamics of patients, compare them to the estimates of treating physicians and determine whether they predict the need for life saving interventions.