1. Introduction to StO 2 Monitoring

3. Assess Tissue Perfusion Rapidly & Noninvasively

4. 2 of 10 InSpectra StO 2 Systems Ardolic, Ann Emerg Med. 2010;56:S131. Cohn, J Trauma. 2007;62:44. Moore, Int Proc TSIS 2007;111. Quick assessment helps identify hypoperfused patients in seconds Continuous monitor tracks a patient’s response to interventions

5. 3 of 10 What Is StO 2 ? SaO 2 and SpO 2 measure O 2 saturation in the arteries. ScvO 2 measures O 2 saturation in the superior vena cava. SvO 2 measures O 2 saturation in the pulmonary artery. StO 2 measures O 2 saturation in the microcirculation, where O 2 diffuses to tissue cells. Direct measure of tissue oxygenation and sensitive indicator of tissue perfusion status. InSpectra StO 2 StO 2 = hemoglobin oxygen saturation of the microcirculation SaO 2 SpO 2 ScvO 2 SvO 2 Cohn, J Trauma. 2007;62:44 Lima, Crit Care. 2009;13(Suppl 5):S13

6. 4 of 10 Why Measure Thenar Muscle? During shock, blood flow to peripheral muscles and core organs (liver, gut and kidneys) is reduced in order to preserve brain and heart oxygenation Thenar muscle group is peripheral muscle StO 2 measured in thenar allows noninvasive monitoring of early changes in perfusion status during shock and resuscitation Thenar muscles Chalmers, J Physiol. 1967;192:561. Beilman, Shock. 1999;12:196.

7. 5 of 10 StO 2 measurement site Thenar site minimally affected by – age – gender – edema – adipose StO 2 not confounded by hypothermia Crookes, J Trauma. 2005;58:806. Poeze, Int Care Med. 2006;32:788. Beilman, Ann Surg. 2009;249:845.

8. 6 of 10 How Does the Technology Work? Animation image to be inserted

9. 7 of 10 Watching the Value; Watching the Trend Low StO 2 is associated with poor outcomes and should be investigated 75% 100% 0% StO 2 low; assess patient; resuscitate if indicated StO 2 rising toward normal; assess continued resuscitation StO 2 falling; assess patient; resume resuscitation if indicated StO 2 high; usually seen in systemic vasodilation and high CO StO 2 adequate; assess need for further resuscitation; stop if indicated StO 2 Cohn, J Trauma. 2007;62:44.Leone, Anesthesiology. 2009;111:366. Lima, Crit Care. 2009;13(Suppl 5):S13.Sagraves, J Trauma. 2009;67:441.

10. 8 of 10 Stratify Risk & Guide Resuscitation Low StO 2 is associated with poor outcomes Organ dysfunction Mortality Incidence of low StO 2 is high even when vital signs are not alarming Cohn, J Trauma. 2007;62:44.Veening, Crit Care. 2010;14(Suppl 1):P151. Lima, Crit Care. 2009;13(Suppl 5):S13Leone, Anesthesiology. 2009;111:366. Sagraves, J Trauma. 2009;67:441

11. 9 of 10 Emergency Medicine Patients Who May Benefit High Acuity Elderly Trauma Any age Mechanism of injury puts at risk for bleeding May have non-alarming vital signs Medical Bleeding All patients at risk for bleeding/suspected of internal bleeding: -Gastrointestinal -Vaginal -Nasal Over 65 years old with: -Shortness of breath -Chest pain -Abdominal pain -Falls -Weakness -Syncope Critical Care  Patients described above  Patients considered to be resuscitated; have non-alarming clinical signs  Patients requiring active treatment Veening, Crit Care. 2010;14(Suppl 1):P151. Ardolic, Ann Emerg Med. 2010;56:S131.

12. 10 of 10 References Ardolic B et al. The Incidence of Hypoperfusion In Patients Waiting for a Medical Floor Bed. Annals Emerg Med. 2010;56(3):S131. Beilman GJ et al. Early hypothermia in severely injured trauma patients is a significant risk factor for multiple organ dysfunction syndrome but not mortality. Ann Surg. 2009;249(5):845-850. Beilman GJ et al. Near-infrared spectroscopy measurement of regional tissue oxyhemoglobin saturation during hemorrhagic shock. Shock. 1999;12(3):196-200. Chalmers JP et al. Effects of hemorrhage on the distribution of the peripheral blood flow in the rabbit. J Physiol. 1967;192:561-574. Cohn SM et al. Tissue oxygen saturation predicts the development of organ dysfunction during traumatic shock resuscitation. J Trauma. 2007;62(1):44-55. Crookes BA et al. Can near-infrared spectroscopy identify the severity of shock in trauma patients? J Trauma. 2005;58(4):806-816. Leone et al. Oxygen Tissue Saturation Is Lower in Nonsurvivors than in Survivors after Early Resuscitation of Septic Shock. Journal of the American Society of Anesthesiologists. August 2009: Vol 111 issue 2 Lima et al. Low tissue oxygen saturation at the end of early goal-directed therapy is associated with worse outcome in critically ill patients. Crit Care. 2009;13(Suppl 5):S13. Moore FA. Tissue oxygen saturation predicts the development of organ failure during traumatic shock resuscitation. In: Faist E, ed. International Proceedings of the 7th World Congress on Trauma, Shock, Inflammation and Sepsis. Munich, Germany, 13-17 March 2007. Bologna, Italy: Medimond; 2007:111–114. Poeze, M. Tissue-oxygenation assessment using near-infrared spectroscopy during severe sepsis: confounding effects of tissue edema on StO 2 values. Int Care Med. 2006;32(5):788-789. Sagraves et al. Tissue Oxygenation Monitoring in the Field: A New EMS Vital Sign, J Trauma. September 2009: Vol 67 No. 3 Veening et al. Incidence of a low tissue oxygen saturation in a mixed population of critically ill patients. Crit Care. 2010;14 (Suppl 1):P151. InSpectra TM StO 2 Measurement Systems noninvasively measure an approximated value of percent hemoglobin oxygen saturation in thenar skeletal muscle tissue (StO 2 ). Visit us online at www.htibiomeasurement.com for full Instructions for use. www.htibiomeasurement.com ©2011 Hutchinson Technology Inc. 5027648 G 07/12 All Rights Reserved. Rx Only.