Anaesthesia and intensive care
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Anaesth Intensive Care · Dec 1998
Case ReportsDisconnect alarm failure in detection of common gas outlet disconnection.
This laboratory study was prompted by two paediatric cases where low pressure alarms and capnography failed to detect common gas outlet disconnection when using a T-piece pump ventilator. A carbon dioxide producing model lung was ventilated using the Clare ventilator (a T-piece pump type ventilator) via an Ayres T-piece. The T-piece used has 3 mm diameter fresh gas tubing. ⋯ End-tidal CO2 rose, whilst inspired CO2 remained at zero. This experiment demonstrates that the Clare ventilator's low pressure alarm detects common gas outlet disconnection poorly when used with an Ayres T-piece with narrow fresh gas tubing. Graphical representation of airway oxygen content has merit as an alerting monitor for common gas outlet disconnection.
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Anaesth Intensive Care · Dec 1998
Management and outcomes of patients with brain trauma in a tertiary referral trauma hospital without neurosurgeons on site.
Waikato Hospital is a tertiary hospital of over 700 beds receiving large numbers of trauma patients, but has no neurosurgeon closer than 130 kilometres. Over the 10 years ending July 1997, 831 cases of brain trauma were admitted to the Intensive Care Unit. Of these, 191 died before leaving hospital (overall mortality 23%). ⋯ These mortality rates are acceptable when compared with other reports (average 37%, over 12 adult series). Using brain AIS scores, our mortality figures also compared favorably with those in the literature, and suggest that the quality of brain trauma care is adequate in this non-neurosurgical centre with intensive care, backed by CT scanning and general surgeons able to do urgent burr holes. Six percent of the brain trauma patients (approximately five per year), required interhospital transfer for definitive neurosurgical care.