Biju Cherian

University of Hull

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Srikanth Katragadda

Mercy St. Vincent Medical Center

Rohit Arora

Innsbruck Medical University

Naga Meka

Hurley Medical Center

T.P. Singh

Thapar Institute of Engineering & Technology

Arun Mathai Mani

Christian Medical College

Bobby Chacko

John Hunter Hospital

Binila Chacko

Aravind Eye Hospital

Clifford Qualls

University of New Mexico

Andrew Blackmore

Umkhuseli Innovation and Research Management

Antonios H. Tzamaloukas

University of New Mexico

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Christian Medical College

Christian Medical College & Hospital

University of New Mexico

Raymond G. Murphy VA Medical Center

University of Hull

The University of Texas Health Science Center at Houston

Institute of Medical Sciences

New Mexico VA Health Care System

University of New Mexico Hospital

University of Utah

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PP7 Using in situ simulation to manage changes to an emergency department’s processes during the COVID-19 pandemic

Poster presentations (2020)

Andrew Blackmore Elizabeth Herrieven Paul M. Stewart Biju Cherian

Background

The first positive COVID-19 tests in the UK were in our Trust. We were fortunate that there was a significant time delay between the first identified cases and the surge in cases that was seen across the UK in early 2020. Our department had been designed for maximal ease of access to equipment but the pandemic required us to change our layout and pathways.

Summary of Work

Across our adult and paediatric emergency departments we used targeted simulation scenarios to train staff, to help in the design of new pathways and expose latent errors. A series of basic scenarios with a member of staff as a simulated patient were used to train existing and redeployed staff in basic skills such as donning/doffing, entering and exiting a barriered room and passing samples out of the room without cross-contamination. Another series of simulated patient scenarios were used to train clinicians in the clinical management of a COVID-19 patient with an escalating oxygen requirement. We also practiced transfer of a deteriorating patient to Resus. Other simulation scenarios used an intubatable manikin to practice scenarios involving aerosol generating procedures. ED intubation simulations contributed to the design of our Trust's COVID-19 intubation checklist. We ran simulated cardiac arrest scenarios in adult and paediatric Majors cubicles and in Resus. In situ simulations were used to design our new 'Cold Majors' area in what was our Emergency Care Area. We designed scenarios to test transfer pathways from the ambulance bay to the new area and from Cold Majors to X ray and CT.

Summary of Results

In all, more than 50 scenarios were run over a six week period. Orientation simulations ran most frequently and highlighted any lapses in infection control practices that could be addressed. Deteriorating patient, intubation, cardiac arrest and fitting patient scenarios highlighted latent errors around storage of equipment and preparation of airway trollies. They also directly informed the new layout of our resus cubicles and the ever-evolving departmental COVID-19 policies. In Cold Majors, they helped to plan the flow of patients within the new area and helped to orientate staff within the new environment.

Discussion and Conclusions

In situ simulation is an effective tool to help an emergency department adapt to the new demands placed on it by the COVID-19 pandemic; from maintaining standards in infection control to designing pathways and even the layout of the department itself.

Pandemic

10.1136/bmjstel-2020-aspihconf.26

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Review: Endurance exercise and resistance training in cardiovascular disease

Therapeutic Advances in Cardiovascular Disease (2008)

Naga Meka Srikanth Katragadda Biju Cherian Rohit Arora

Contrary to the age old taboo of exercise in cardiac patients, resistance training has been gaining importance recently as a safe, healthy fitness option in prevention of cardiovascular diseases, the leading killer disease in the population above 45 years in the United States. Endurance or aerobic exercise helps improve overall stamina and the ability of the heart to pump oxygenated blood in those with and without prior cardiovascular disease. In addition to modifying cardiovascular risks, resistance training has profound beneficial effects on improving muscle strength and endurance, preventing osteoporosis and improving quality of life both in the healthy and cardiovascular patients including women and heart failure patients. So resistance training should be regarded as a complementary fitness program rather that a substitute to endurance training. This review discusses the physiological phenomenon and benefits of exercise training programs on cardiovascular disease patients focusing on endurance exercise and resistance training.

Endurance Training

Aerobic Exercise

Cardiovascular fitness

10.1177/1753944708089701

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Citations (40)

Combination Therapy in Hypertension: A Focus on Angiotensin Receptor Blockers and Calcium Channel Blockers

American Journal of Therapeutics (2010)

Naga Meka Srikanth Katragadda Biju Cherian Rohit Arora

Every third adult in the United States has hypertension. Hypertension is a continuous, independent, potent risk factor for cardiovascular events like stroke, myocardial infarction, and heart failure. The blood pressure control achieved with most hypertensives is way below the recommended goal. Recent trials suggest that for nearly half of hypertensive patients, a monotherapy regimen is not adequate to control blood pressure. Investigators recommend from randomized, controlled studies that combination therapy be considered when blood pressure is above the goal of 20/10 mm Hg. In this review we discuss clinical trials that establish the need for combination therapy, with the primary focus on a new combination: calcium channel blockers (CCBs) and angiotensin receptor blockers (ARBs). ARBs and CCBs in combination can complement each other in lowering blood pressure, with a lower incidence of adverse effects, as compared with individual monotherapy components at high doses.

Combination therapy

Angiotensin Receptor Blockers

Stroke

Regimen

10.1097/mjt.0b013e31815db6c0

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Citations (3)

Sensorineural hearing loss following acute bacterial meningitis in non-neonates

The Indian Journal of Pediatrics (2002)

Biju Cherian T.P. Singh Binila Chacko Ananth P. Abraham

10.1007/bf02726011

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Therapeutic Implications of Diabetes in Cardiovascular Disease

American Journal of Therapeutics (2009)

Biju Cherian Naga Meka Srikanth Katragadda Rohit Arora

Insulin-resistant diabetes is becoming more prevalent among the general U.S. population. Approximately 20 million people had diabetes in 2005, of which one third of the population had impaired fasting glucose. The prevalence rate is 9%, a more alarming rate in the 20- to 39-year age group, which suggests a significant degree of how even the young are affected. We review how the prediabetic stage (impaired glucose tolerance-impaired fasting glucose and impaired glucose tolerance-impaired glucose tolerance) plays a vital role as a risk factor for cardiovascular disease, and the effectiveness of lifestyle modifications with drug therapy reduces the cardiovascular risk of early diabetes and its complications. A lifestyle modification like effective weight loss and exercise, with or without antidiabetic drugs, prevents the proatherogenic effects of diabetes. Controlled, randomized studies have shown that progression to diabetes among those with prediabetes is not inevitable; people with prediabetes who lose weight and increase their physical activity can prevent or delay diabetes and could even return their blood glucose levels to normal. Although prevention of prediabetes is a huge challenge, a tight glycemic control with lifestyle modifications and antihyperglycemics like thiazolidinediones play a vital role in increasing the insulin sensitivity of tissues and decreasing the cardiovascular risk factor of diabetes.

Prediabetes

Impaired fasting glucose

10.1097/mjt.0b013e31815db924

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Citations (7)

Cardiovascular response in Anemia

The Indian Journal of Pediatrics (2005)

Arun Mathai Mani T.P. Singh Rajneesh Calton Bobby Chacko Biju Cherian

Treadmill

Metabolic equivalent

10.1007/bf02724008

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