Creado apartir del commit b888de6c92056de294456f581a56e25e734d4ab7 de develop
This commit is contained in:
jrojas
@@ -0,0 +1,641 @@
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using adas_core.Application.Services.Interfaces;
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using adas_core.Domain.Enums;
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using adas_core.Domain.Models;
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using adas_core.Domain.Models.AppSettings;
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using adas_core.Domain.Models.Pumps;
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using Microsoft.Extensions.DependencyInjection;
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using Microsoft.Extensions.Logging;
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using Microsoft.Extensions.Options;
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using MongoDB.Bson;
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using Serilog;
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namespace adas_core.Application.Customizations.HPAZ;
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public class CalculatedObservations(IServiceProvider serviceProvider) : ICalculatedObservations
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{
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private readonly Lazy<IAlarmService> _alarmService = serviceProvider.GetRequiredService<Lazy<IAlarmService>>();
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private readonly ApiSettings
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_apiSettings = serviceProvider.GetRequiredService<IOptions<ApiSettings>>().Value; //apiSettings;
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private readonly IConfigObservationService _configObservationService =
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serviceProvider.GetRequiredService<IConfigObservationService>(); //configObservationService;
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private readonly ILogger<CalculatedObservations> _logger =
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serviceProvider.GetRequiredService<ILogger<CalculatedObservations>>();
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//Use GroupedObservation to avoid circular dependency with _observationService
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private readonly Lazy<IObservationService> _observationService =
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serviceProvider.GetRequiredService<Lazy<IObservationService>>(); //observationService;
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private readonly List<string> _pressBloodArteryMean = ["TAm"];
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public Task CalculateActiveBolus(ObjectId patientId)
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{
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return Task.CompletedTask;
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}
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public Task CalculateMedicineObservation(List<Medicine> activeMedicines, ObjectId patientId)
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{
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return Task.CompletedTask;
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}
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public Task<IEnumerable<PatientTreatment?>> GetActiveTreatmentsByPatient(ObjectId id)
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{
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return Task.FromResult<IEnumerable<PatientTreatment?>>(new List<PatientTreatment?>());
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}
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/// <summary>
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/// Maps the obs to an event or alarm depending on its type and inserts it if needed
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/// </summary>
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/// <typeparam name="T">Type</typeparam>
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/// <param name="source">Observation</param>
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/// <param name="onlyByName">True if the observation needs to generate an alert</param>
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/// <returns>Mapped observation</returns>
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public async Task<T?> Map<T>(T source, bool onlyByName) where T : BasePatientObservation
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{
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_logger.LogDebug("Mapping {obsName} mode observation {obs}", source.Name, source);
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if (source is not BasePatientObservationValue obs) return source;
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var name = obs is PatientObservationAlarm obsAlarm ? obsAlarm.Event : obs.Name;
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name ??= string.Empty;
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//No generamos alertas si viene onlyByName
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if (name == "Resp_Mode")
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obs = CalculateVentilationMode(obs);
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if (name is "Sattc" or "FiO2") await CalculateSf(obs, name);
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if (name is "FiO2" or "P_VAM" or "PaO2_Tidal") await CalculateOxygenationIndex(obs, name);
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if (name is "FiO2" or "PaO2_Tidal") await CalculatePf(obs, name);
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if (name == "TEST_ALARMA") await _alarmService.Value.CalculateAlarmTest(obs, name);
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obs = await CheckObsWithSameTimeExistsAndIncrementTime(obs);
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if (obs is PatientObservation pobs)
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{
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pobs = await CheckAlarmConfig(pobs);
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return pobs as T;
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}
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return obs as T;
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}
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public async Task<PumpObservation> Map(PumpObservation pumpObservation)
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{
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try
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{
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if (pumpObservation.Status is PumpEnum.Status.Alarm or PumpEnum.Status.Warning)
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{
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PatientObservation? patientObservation = null;
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string? name = null;
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//La oclusión es para todos los tipos
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var volumetricAirOcclusionAlarm = _apiSettings.VolumetricAirOcclusionAlarm ?? null;
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if (volumetricAirOcclusionAlarm != null && pumpObservation.AlarmType != null &&
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volumetricAirOcclusionAlarm.Contains(pumpObservation.AlarmType.ToString() ?? string.Empty))
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{
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name = "VolumetricAirOcclusion";
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//alerta oclusión aire para bombas volumétricas
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patientObservation = await CreatePumpAlarmObservation(name, pumpObservation);
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}
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var listInotropicMedicines = _apiSettings.InotropicMedicines ?? null;
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if (listInotropicMedicines is { Count: > 0 } && pumpObservation.DrugName != null &&
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listInotropicMedicines.Contains(pumpObservation.DrugName)) //INOTRÓPICOS
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{
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var inotropicEndInfusionAlarm = _apiSettings.InotropicEndInfusionAlarm ?? null;
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if (inotropicEndInfusionAlarm != null && pumpObservation.AlarmType != null &&
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inotropicEndInfusionAlarm.Contains(pumpObservation.AlarmType.ToString() ?? string.Empty))
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{
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//Inotrópicos próxima a fin de infusión
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// Y
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//proximo fin de infusión, oclusión, y presencia aire….
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//Solo inotrópicos
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//Está en la línea 19 del excel y abarca la que hay en la línea 9
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// TODO: revisar en los logs que nombre de type (Buscar por crud xmlns)
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name = "InotropicEndInfusion";
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patientObservation = await CreatePumpAlarmObservation(name, pumpObservation);
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}
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}
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else
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{
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var pumPressureAlarm = _apiSettings.PumPressureAlarm ?? null;
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if (pumPressureAlarm != null && pumpObservation.AlarmType != null &&
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pumPressureAlarm.Contains(pumpObservation.AlarmType.ToString() ?? string.Empty))
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{
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name = "Pressure";
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//alerta de presión(la alerta de la bomba se programa + -30mmHg por encima de la presión de la línea).
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patientObservation = await CreatePumpAlarmObservation(name, pumpObservation);
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}
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var endContinuousInfusionAlarm = _apiSettings.EndContinuousInfusionAlarm ?? null;
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if (endContinuousInfusionAlarm != null && pumpObservation.AlarmType != null &&
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endContinuousInfusionAlarm.Contains(pumpObservation.AlarmType.ToString() ?? string.Empty))
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{
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name = "EndContinuousInfusion";
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//próximo a fin de infusión /fin de infusión
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//información de bombas solo perfusión continua
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patientObservation = await CreatePumpAlarmObservation(name, pumpObservation);
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}
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var volumetricAirInLineAlarm = _apiSettings.VolumetricAirInLineAlarm ?? null;
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if (volumetricAirInLineAlarm != null && pumpObservation.AlarmType != null &&
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volumetricAirInLineAlarm.Contains(pumpObservation.AlarmType.ToString() ?? string.Empty))
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{
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name = "VolumetricAirInLine";
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//alerta aire para bombas volumétricas (burbujas de aire para la bomba)
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patientObservation = await CreatePumpAlarmObservation(name, pumpObservation);
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}
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}
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if (patientObservation != null && name != null)
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{
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_ = _observationService.Value.InsertObservation(patientObservation);
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_ = _alarmService.Value.SendAlarm(patientObservation, name, AlarmEnum.Name.Pump,
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AlarmEnum.Severity.None, AlarmEnum.Type.Auto);
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}
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}
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}
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catch (Exception ex)
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{
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_logger.LogError("Error mapping alarm pump observation. Exception: {exMessage}", ex.Message);
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}
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return pumpObservation;
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}
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public Task<PatientTreatment> Map(PatientTreatment treatment)
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{
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throw new NotImplementedException();
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}
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public Task<PatientDiagnosis> Map(PatientDiagnosis diagnosis)
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{
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throw new NotImplementedException();
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}
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public async Task<PatientObservation?> FixTimeInconsistencyWithLast(PatientObservation newObservation)
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{
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if (string.IsNullOrEmpty(newObservation.Name))
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{
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_logger.LogError(
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"Error FixTimeInconsistencyWithLast new observation name is null or empty: {newObservation}.",
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newObservation);
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return newObservation;
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}
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var lasObservations = await _observationService.Value.FindLastObservations(newObservation.PatientId, 1,
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[newObservation.Name]);
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var lastObservation = lasObservations.FirstOrDefault();
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if (lastObservation != null && DateTime.Compare(
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new DateTime(lastObservation.Time.Year, lastObservation.Time.Month,
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lastObservation.Time.Day, lastObservation.Time.Hour,
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lastObservation.Time.Minute, lastObservation.Time.Second),
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new DateTime(newObservation.Time.Year, newObservation.Time.Month,
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newObservation.Time.Day, newObservation.Time.Hour,
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newObservation.Time.Minute, newObservation.Time.Second)
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) >= 0)
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newObservation.Time = lastObservation.Time.AddSeconds(1);
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return newObservation;
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}
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public Task<List<PatientObservation>> PreMapList(List<PatientObservation> listToMap)
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{
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var mappedObsList = listToMap
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.Select(obs => obs.DeepCopy())
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.Select(obs => _configObservationService.Map(obs).Result)
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.Where(obs => obs != null)
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.ToList();
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// mappedObsList contains observation mapped
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// Check blue code
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_ = CalculateBlueCodeList(mappedObsList);
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return Task.FromResult(listToMap);
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}
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public Task<PatientObservation> MapSourceAlarm(PatientObservation obs, PatientObservationAlarm alarmToInsert)
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{
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if (!string.IsNullOrEmpty(alarmToInsert.EventId))
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obs.Code = alarmToInsert.EventId;
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if (!string.IsNullOrEmpty(alarmToInsert.Event))
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obs.Name = alarmToInsert.Event;
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obs.Value = alarmToInsert.Value;
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return Task.FromResult(obs);
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}
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Task ICalculatedObservations.SendAlarm(PatientObservation obs, string name, AlarmEnum.Name? code)
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{
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throw new NotImplementedException();
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}
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private async Task SendAlarm(PatientObservation obs, string name, AlarmEnum.Name? code, AlarmEnum.Type type)
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{
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await _alarmService.Value.SendAlarm(obs, name, code, AlarmEnum.Severity.None, type);
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}
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/// <summary>
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/// Initial check to ignore old observations generating blue codes
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/// </summary>
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/// <param name="obs">Observation</param>
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/// <returns>True if it needs to be ignored</returns>
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private bool CheckIfObservationIsOlderAndShouldBeIgnored(PatientObservation obs)
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{
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if (obs.Time.ToUniversalTime().AddMinutes(_apiSettings.IgnoreCalcObservationsOlderInMinutesThan) <
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DateTime.UtcNow)
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{
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Log.Debug(
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"ignoring calc old observation: name:{obsName} obs_time:{obsTime} system_time {DateTimeNow} id:{obsId}",
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obs.Name ?? "null", obs.Time, DateTime.Now, obs.Id);
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return true;
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}
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return false;
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}
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private async Task<PatientObservation> CheckAlarmConfig(PatientObservation pobs)
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{
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var configObs = await _configObservationService.Get(new PatientObservation
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{
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Name = pobs.Name,
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PatientId = pobs.PatientId
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});
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pobs.Alarm = configObs?.Alarm ?? null;
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return pobs;
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}
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private static PatientObservation CreateAlarmObservation(string name, PatientObservation pobs)
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{
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return new PatientObservation
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{
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CodingSystem = "ADAS_ALARM",
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Code = name,
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Name = $"Alarm_{name}",
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Value = pobs.Value,
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PatientId = pobs.PatientId,
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Time = pobs.Time,
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Alarm = pobs.Alarm
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};
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}
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/// <summary>
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/// Checks if a blue code observation Lists needs to be generated and inserts it.
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/// </summary>
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/// <param name="obsList"></param>
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public async Task CalculateBlueCodeList(List<PatientObservation?>? obsList)
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{
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//Las 3 observaciones vienen siempre juntas en el mismo mensaje
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//Solo se comprueba si se cumplen 2 de las 3 condiciones
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var condition = 0;
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var patientId = obsList?.FirstOrDefault()?.PatientId;
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if (patientId == null) return;
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var fcObs = obsList?.FirstOrDefault(o => o is { Name: "FC" });
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var sattcObs = obsList?.FirstOrDefault(o => o is { Name: "Sattc" });
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var tamObs = obsList?.FirstOrDefault(o => o is { Name: "TAm" });
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// FC < 60
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if (fcObs != null && !CheckIfObservationIsOlderAndShouldBeIgnored(fcObs) &&
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double.TryParse(fcObs.Value.ToString(), out var cardiacBeatRate) && cardiacBeatRate < 60)
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{
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Log.Debug("BlueCode condition: FC {fc} for patient: {obsPatientid} fc increase limit", cardiacBeatRate,
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fcObs.PatientId);
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condition++;
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}
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// SpO2 < 80 (Sattc)
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if (sattcObs != null && !CheckIfObservationIsOlderAndShouldBeIgnored(sattcObs) &&
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double.TryParse(sattcObs.Value.ToString(), out var spO2Value) && spO2Value < 80)
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{
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Log.Debug("Blue code condition: SpO2 {sp} for patient: {obsPatientid} Sattc increase limit", spO2Value,
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sattcObs.PatientId);
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condition++;
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}
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if (condition == 0) return;
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// Early exit if 2 conditions are met
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if (condition == 2)
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{
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_ = SendBlueCode(fcObs);
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return;
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}
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// TAm actual es un 50% por debajo de la medición de 30 seg antes
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if (tamObs != null && !CheckIfObservationIsOlderAndShouldBeIgnored(tamObs) &&
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double.TryParse(tamObs.Value.ToString(), out var tamObsValue))
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{
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// Buscamos el anterior
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var lastPressBloodObsList =
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await _observationService.Value.FindLastObservations(tamObs.PatientId, 1, _pressBloodArteryMean);
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var lastPressBloodObs = lastPressBloodObsList.FirstOrDefault();
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// Diferencia entre la última observación es < 30 s
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if (lastPressBloodObs != null &&
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double.TryParse(lastPressBloodObs.Value.ToString(), out var lastPressBloodValue) &&
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(tamObs.Time - lastPressBloodObs.Time).TotalSeconds <= 35 &&
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tamObsValue <= lastPressBloodValue / 2)
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{
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Log.Debug("Blue code condition: TAm decrease limit over 30s for patient: {obsPatientid}",
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tamObs.PatientId);
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condition++;
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}
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}
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if (condition >= 2) _ = SendBlueCode(tamObs);
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}
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private async Task SendBlueCode(PatientObservation? pobs)
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{
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if (pobs == null)
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return;
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Log.Debug("Blue code Alarm for patient: {obsPatientid}", pobs.PatientId);
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var blueCodeObservation = CreateAlarmObservation("BlueCode", pobs);
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blueCodeObservation = await CheckAlarmConfig(blueCodeObservation);
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_ = _observationService.Value.InsertObservation(blueCodeObservation);
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_ = SendAlarm(blueCodeObservation, "BlueCode", AlarmEnum.Name.Blue, AlarmEnum.Type.Auto);
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}
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//PRVC : donde aparezca cambiar y mostrar en su lugar: VCRP
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//FLUJO ALTO: poner OAF en su lugar
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private BasePatientObservationValue CalculateVentilationMode(BasePatientObservationValue obs)
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{
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var value = obs is PatientObservationAlarm oAlarm ? oAlarm.Value
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: obs is PatientObservation o ? o.Value : null;
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if (value != null && value.ToString()!.Contains("PRVC"))
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obs.Value = value.ToString()!.Replace("PRVC", "VCRP");
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else if (value != null && value.ToString()!.Contains("FLUJ.ALTO")) obs.Value = "OAF";
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_logger.LogDebug("Calculating patient id: {id} ventilation mode: {obsName}, value : {obsValue}", obs.PatientId,
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obs.Name, obs.Value);
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return obs;
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}
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//TODO duplicado con el calculated del 12o, sacar a un utils
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private async Task<BasePatientObservationValue> CheckObsWithSameTimeExistsAndIncrementTime(
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BasePatientObservationValue obs)
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{
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if (obs is not PatientObservation pobs) return obs;
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var existObsWithSameTime =
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await _observationService.Value.FindAnyWithSameDate(pobs.PatientId, pobs.Time, pobs.Name);
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if (existObsWithSameTime != null && existObsWithSameTime.Any()) pobs.Time = pobs.Time.AddSeconds(1);
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return pobs;
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}
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//S/F Calc ( craneal saturation / FiO2
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private async Task CalculateSf(BasePatientObservationValue obs, string name)
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{
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try
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{
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PatientObservation? saturation = null;
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PatientObservation? fio2 = null;
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var values = await _observationService.Value.FindLastObservations(obs.PatientId, 1, ["FiO2", "Sattc"]);
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switch (name)
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{
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case "FiO2":
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fio2 = (PatientObservation)obs;
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saturation = values.FirstOrDefault(o => o.Name == "Sattc");
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break;
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case "Sattc":
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saturation = (PatientObservation)obs;
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fio2 = values.FirstOrDefault(o => o.Name == "FiO2");
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break;
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}
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if (fio2 != null && saturation != null && !fio2.Expired &&
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double.TryParse(fio2.Value.ToString(), out var fio) && !saturation.Expired &&
|
||||
double.TryParse(saturation.Value.ToString(), out var sat) && sat <= 97)
|
||||
{
|
||||
if (fio == 0)
|
||||
{
|
||||
_logger.LogError("Error calculating SF. FiO2: {fio}", fio);
|
||||
return;
|
||||
}
|
||||
|
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var sfValue = sat / fio;
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||||
|
||||
sfValue = Math.Round(sfValue, 4);
|
||||
|
||||
var sfObs = new PatientObservation
|
||||
{
|
||||
PatientId = obs.PatientId,
|
||||
Name = "Sattc_FiO2",
|
||||
CodingSystem = "ADAS",
|
||||
Value = sfValue,
|
||||
Time = obs.Time
|
||||
};
|
||||
|
||||
await _observationService.Value.InsertObservation(sfObs);
|
||||
}
|
||||
}
|
||||
catch (Exception ex)
|
||||
{
|
||||
_logger.LogError("Error calculate S/F observation. Exception: {exMessage}", ex.Message);
|
||||
}
|
||||
}
|
||||
|
||||
|
||||
/// <summary>
|
||||
/// Oxygenation index is calculated => P_VAM x FiO2 x 100 / PaO2_Tidal
|
||||
/// the method is called when it receives P_VAM or FiO2 or PaO2_Tidal and tries to take the other values to perform the
|
||||
/// calculation if they are not
|
||||
/// in database then does nothing.
|
||||
/// </summary>
|
||||
public async Task CalculateOxygenationIndex(BasePatientObservationValue obs, string name)
|
||||
{
|
||||
var toSearchList = new List<string>();
|
||||
PatientObservation? pVam = null;
|
||||
PatientObservation? fiO2 = null;
|
||||
PatientObservation? paO2 = null;
|
||||
|
||||
toSearchList.AddRange(new List<string> { "P_VAM", "FiO2", "PaO2_Tidal" });
|
||||
|
||||
var values = await _observationService.Value.FindLastObservations(obs.PatientId, 1, toSearchList);
|
||||
|
||||
try
|
||||
{
|
||||
switch (name)
|
||||
{
|
||||
case "P_VAM":
|
||||
pVam = (PatientObservation)obs;
|
||||
fiO2 = values.FirstOrDefault(o => o.Name == "FiO2");
|
||||
paO2 = values.FirstOrDefault(o => o.Name == "PaO2_Tidal");
|
||||
break;
|
||||
|
||||
case "FiO2":
|
||||
fiO2 = (PatientObservation)obs;
|
||||
pVam = values.FirstOrDefault(o => o.Name == "P_VAM");
|
||||
paO2 = values.FirstOrDefault(o => o.Name == "PaO2_Tidal");
|
||||
break;
|
||||
|
||||
case "PaO2_Tidal":
|
||||
paO2 = (PatientObservation)obs;
|
||||
fiO2 = values.FirstOrDefault(o => o.Name == "FiO2");
|
||||
pVam = values.FirstOrDefault(o => o.Name == "P_VAM");
|
||||
break;
|
||||
}
|
||||
|
||||
//Controlar que FiO2 no haya expirada al recogerla
|
||||
if (fiO2 != null && paO2 != null && pVam != null &&
|
||||
int.TryParse(pVam.Value.ToString(), out var pvam) &&
|
||||
int.TryParse(fiO2.Value.ToString(), out var fio2) &&
|
||||
int.TryParse(paO2.Value.ToString(), out var pao2))
|
||||
{
|
||||
if (pao2 == 0)
|
||||
{
|
||||
_logger.LogError(
|
||||
"Error calculate Oxygenation Index observation. PaO2: {pao2}, observation: {obsName}", pao2,
|
||||
name);
|
||||
return;
|
||||
}
|
||||
|
||||
var oxygenationIndexValue = pvam * fio2 * 100 / pao2;
|
||||
|
||||
var oxygenationIndexObs = new PatientObservation
|
||||
{
|
||||
PatientId = obs.PatientId,
|
||||
Name = "Oxygenation_Index",
|
||||
CodingSystem = "ADAS",
|
||||
Value = oxygenationIndexValue,
|
||||
Time = obs.Time
|
||||
};
|
||||
|
||||
await _observationService.Value.InsertObservation(oxygenationIndexObs);
|
||||
}
|
||||
}
|
||||
catch (Exception ex)
|
||||
{
|
||||
_logger.LogError("Error calculate Oxygenation Index observation. Exception: {exMessage}", ex.Message);
|
||||
}
|
||||
}
|
||||
|
||||
//P/F Calc ( PaO2_Tidal / FiO2
|
||||
private async Task CalculatePf(BasePatientObservationValue obs, string name)
|
||||
{
|
||||
try
|
||||
{
|
||||
PatientObservation? paO2 = null;
|
||||
PatientObservation? fio2 = null;
|
||||
|
||||
var values = await _observationService.Value.FindLastObservations(obs.PatientId, 1,
|
||||
["FiO2", "PaO2_Tidal"]);
|
||||
|
||||
switch (name)
|
||||
{
|
||||
case "FiO2":
|
||||
fio2 = (PatientObservation)obs;
|
||||
paO2 = values.FirstOrDefault(o => o.Name == "PaO2_Tidal");
|
||||
break;
|
||||
|
||||
case "PaO2_Tidal":
|
||||
paO2 = (PatientObservation)obs;
|
||||
fio2 = values.FirstOrDefault(o => o.Name == "FiO2");
|
||||
break;
|
||||
}
|
||||
|
||||
if (fio2 != null && paO2 != null && !fio2.Expired && !paO2.Expired &&
|
||||
double.TryParse(paO2.Value.ToString(), out var pa) &&
|
||||
double.TryParse(fio2.Value.ToString(), out var fi))
|
||||
{
|
||||
if (fi == 0)
|
||||
{
|
||||
_logger.LogError("Error Calculating PF. FiO2 value is 0. Observation:{obs}", obs);
|
||||
return;
|
||||
}
|
||||
|
||||
var sfValue = pa / fi;
|
||||
|
||||
sfValue = Math.Round(sfValue, 4);
|
||||
|
||||
var sfObs = new PatientObservation
|
||||
{
|
||||
PatientId = obs.PatientId,
|
||||
Name = "PaO2_FiO2",
|
||||
CodingSystem = "ADAS",
|
||||
Value = sfValue,
|
||||
Time = obs.Time
|
||||
};
|
||||
|
||||
await _observationService.Value.InsertObservation(sfObs);
|
||||
}
|
||||
}
|
||||
catch (Exception ex)
|
||||
{
|
||||
_logger.LogError("Error calculate P/F observation. Exception: {exMessage}", ex.Message);
|
||||
}
|
||||
}
|
||||
|
||||
|
||||
private async Task<PatientObservation?> CreatePumpAlarmObservation(string name,
|
||||
PumpObservation pumpObservation)
|
||||
{
|
||||
var positionPump = pumpObservation.IsAux != null && !pumpObservation.IsAux.Value
|
||||
? $"Rack {pumpObservation.GatewayNumber} Bomba {pumpObservation.Number}"
|
||||
: $"Rack Aux {pumpObservation.GatewayNumber} Bomba {pumpObservation.Number}";
|
||||
|
||||
|
||||
|
||||
PatientObservation patientObservation = new()
|
||||
{
|
||||
CodingSystem = "ADAS_ALARM",
|
||||
Code = $"Pump_{name}",
|
||||
Name = $"Alarm_Pump_{name}",
|
||||
Value = pumpObservation.DrugName ?? positionPump,
|
||||
Time = pumpObservation.Time
|
||||
};
|
||||
|
||||
if (pumpObservation.PatientId != null)
|
||||
patientObservation.PatientId = pumpObservation.PatientId.Value;
|
||||
|
||||
return await CheckAlarmConfig(patientObservation);
|
||||
|
||||
}
|
||||
}
|
||||
Reference in New Issue
Block a user