The diagnosis of vibration-induced white finger (VWF) is difficult, often relying on medical interview and history. The condition is characterized by an exaggerated vasoconstriction of digital arteries in response to cold. The complete closure of digital arteries is episodic and results in a characteristic blanching that is rarely observed by a clinician. Objective measurements of the response of the digital circulation to cold can assist in evaluating a patient for VWF. Finger systolic blood pressure (FSBP) following local cooling is a measure of cold-induced vasoconstriction in digital arteries and is an assessment of vasomotor tone. Low FSBPs following cooling are indicative of dysfunction. Finger skin temperature (FST) following hand cooling is a measure of cutaneous blood flow. The mechanism underlying the recovery of cutaneous blood flow following cooling is as yet not fully understood, but a delayed recovery is believed to arise from persistent vascular disturbances of the fingers or from a resulting in conflicting opinions concerning the utility of the measurements, a scarcity of comparable data from epidemiological investigations, and limited normative data to aid clinicians in decision-making. This review of evidence on which the tests are based is aimed at providing clinicians and researchers with an understanding of the factors that must be considered when conducting the tests, interpreting the results, and comparing results between different studies.

BACKGROUND: Numerous medical conditions require timely medication administration in the emergency department (ED). Automated dispensing systems (ADSs) store premixed common doses at the point-of-care to minimize time to administration, but the use of such automation to improved time to medication administration has not been studied. Since vancomycin is a commonly used empiric antimicrobial, we sought to quantify the effect of using an ADS on time to drug delivery in patients presenting to the ED. The study aimed to determine the efficacy of utilizing an ADS to improve time to administration of vancomycin and determine any negative effects on dosing appropriateness.METHODS: The institional review board approved the retrospective quality improvement study took place in a single, urban academic tertiary care ED with an annual census of 80000. Study subjects were all patients receiving vancomycin for the management of sepsis between March 1 to September 30, 2008 and the same time period in 2009. The primary outcome was the proportion of patients who received vancomycin within one hour of bed placement and the secondary outcome was dosing appropriateness.RESULTS: Sixty-three patients had weight and dosing information available (29 before and 34 after intervention) and were included in the study. Before intervention, no patient received vancomycin in less than 60 minutes, while after intervention 14.7％ of the patients received it in less than 60 minutes (difference in proportions 14.7％, 95％ CI 0.39％-30.0％, P=0.04). A similar proportion of the patients received correct dosing before and after intervention (44.8％ vs. 41.2％, difference in proportions 3.7％, 95％ CI -20.0％-26.7％, P=0.770).CONCLUSION: The use of an ADS may improve the timing of medication administration in patients presenting to the ED without affecting dosing appropriateness.