Southern Hills Medical Center

Despite significant advances in real-time physiologic monitoring, most hospitals continue to rely on manual vital sign documentation, a process prone to delays, transcription errors, and increased clinician workload. This paper presents a modular software-based middleware solution that enables seamless real-time transmission of vital signs from FDA-cleared monitoring devices to cloud-based electronic medical records (EMR). By leveraging Health Level Seven (HL7) and Fast Healthcare Interoperability Resources (FHIR) standards for interoperability, the system connects existing devices with major EMR platforms using standardized application programming interfaces, reducing infrastructure burden and improving documentation accuracy. We examine current barriers to adoption, including cost, workflow disruption, and compliance challenges, and highlight real-world examples of successful integration. Our analysis suggests that an interoperable and nurse-friendly architecture with built-in audit trails can enhance early warning system performance, reduce documentation errors, and alleviate clinician burnout by automating routine charting. This approach supports the transition to predictive, real-time clinical decision support in modern healthcare.

Management of patients with rare anaphylaxis to COVID-19 vaccines creates a challenge. Desensitization to medications and vaccines has proven to be effective in managing anaphylactic reactions in selected individuals with a high benefit-to-risk ratio. A previous report described the successful administration of the Moderna modified messenger RNA (MmRNA) COVID-19 vaccine via a graded dose protocol to a patient with previous anaphylaxis to the MmRNA vaccine. Our report describes successful desensitization to the MmRNA vaccine followed by administration of the full dose MmRNA vaccine. A patient with a history of chronic allergies and anaphylaxis due to insect sting venom reported anaphylaxis after her first dose of the MmRNA vaccine, for which she was premedicated. She was subsequently clinically diagnosed with anaphylaxis to skin testing of the MmRNA vaccine-meeting Brighton's criteria for level 1 certainty of diagnosis-and underwent a desensitization protocol to the vaccine. After the desensitization protocol, the patient was administered the full second dose of the MmRNA vaccine via intramuscular injection, without systemic allergic reactions, and with elicitation of an immunological response. This severely allergic patient developed 2 separate anaphylactic reactions to the MmRNA vaccine despite being treated with omalizumab. The patient was then desensitized to the MmRNA vaccine and was subsequently administered the full second dose of MmRNA vaccine via intramuscular injection without systemic allergic reactions and with elicitation of an immunological response. Our patient's case illustrates the ability to desensitize patients who desire administration of the MmRNA vaccine, but are unlikely to prevent anaphylaxis with premedication.

HISTORY: An 18-year old senior high school offensive linemen presented to the emergency department complaining of shortness of breath, tachycardia, chest tightness, and fatigue. He has a past medical history of prediabetes, obesity, and well controlled mild intermittent asthma without complication. Symptoms were sudden onset and awoke him from sleep. PHYSICAL EXAM: Initial examination reveals an obese male in moderate distress. He is alert, awake, and oriented. He is tachypneic and tachycardic on exam but is breathing comfortably on room air. He has no chest wall tenderness to palpation. He has full range of motion of the neck, bilateral upper extremities, and bilateral lower extremities. He has trace nonpitting lower extremity edema. DIFFERENTIAL DIAGNOSIS: 1.Costochondritis2.Pericarditis3.Congestive heart failure4. NSTEMITEST AND RESULTS: -EKG reveals atrial flutter with 2:1 AV conduction and ventricular rate 144-One view portable chest radiograph: Diffuse cardiomegaly concerning for possible pericardial effusion-Computerized tomography chest without contrast: Constellation of findings suggestive of congestive heart failure with interstitial edema and small pleural effusions. No pericardial effusion-high sensitivity troponin within normal limits times three: 11 ng/L, 9 ng/L, 9 ng/L respectively-NT-Pro-B Natriuretic Peptide elevated: 1650-Transthoracic echocardiogram: Systolic function severely reduced with calculated ejection fraction 20-25%. Small pericardial effusion. -Transesophageal echocardiogram: Systolic function severely reduced with calculated ejection fraction of 15-20%. FINALWORKING DIAGNOSIS: Atrial flutter and tachyarrhythmia cardiomyopathyTREATMENT AND OUTCOMES1.Successful electrical cardioversion of atrial flutter to normal sinus rhythm2.Medical optimization and discharge from hospital with metoprolol 25 mg every 8 hours, rivaroxaban 20 mg daily for 3 months, and sacubitril/valsartan 24-26 mg daily3.Close follow-up with primary care and cardiology4.Repeat transthoracic echocardiogram 3 months following discharge reveals ejection fraction 30-35%. Patient reports clinical improvement and has been able to tolerate exercise.

This case report presents the elecrocardiographic findings of a man in his 50s with dizziness, shortness of breath, and tachycardia in whom electrical cardioversion was unsuccessful until the sixth attempt.