Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2008
Attitudes towards and evaluation of medical emergency teams: a survey of trainees in intensive care medicine.
A survey was conducted to explore the perception of intensive care registrars on the impact of activities outside the intensive care unit (ICU), particularly in medical emergency teams, on their training and the care of patients. An anonymous mail-out survey was sent to 356 trainees registered with the Joint Faculty of Intensive Care Medicine, half of whom were determined to be involved in ICU duties. No patients were involved and respondents participated voluntarily. ⋯ Sixty-six percent of respondents reported that medical emergency team involvement had a positive effect on training but 77% reported little or no supervision of team duties. While trainees did not believe they spent too much time performing medical emergency team duties, the time spent on medical emergency teams at night, when ICU staffing levels are at their lowest, was the same as during the day. Serious concern was expressed about the negative impact of medical emergency team activities on their ability to care for ICU patients and the additional stress on ICU medical and nursing staff Overall, ICU trainees regarded participation in a medical emergency team as positive on training and on patient care in wards, but other results have resource implications for the provision of clinical emergency response systems, care of patients in ICUs and the training of the future intensive care workforce.
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Anaesth Intensive Care · Jan 2008
Case ReportsInsulin infusion via an intraosseous needle in diabetic ketoacidosis.
We report the successful management of a five-year-old child with severe diabetic ketoacidosis with dehydration, who received his initial resuscitative fluids and a continuous infusion of insulin via an intraosseous needle. The patient had presented to a remote community hospital and intravenous access could not be gained. The correction of hyperglycaemia and metabolic acidaemia was achieved at a rate comparable to intravenous therapy. ⋯ Alternatives to intravenous administration of insulin delivery recommended in such guidelines, such as the subcutaneous or intramuscular routes, may be less appropriate than the intraosseous route. This route can also allow resuscitation fluids and other drugs to be reliably administered in children with diabetic ketoacidosis and severe dehydration where intravenous access can not be attained. We suggest that the potential role of intraosseous access, when intravenous access can not be obtained, should be considered when management guidelines for paediatric diabetic ketoacidosis with dehydration are reviewed.
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Anaesth Intensive Care · Jan 2008
Prediction of successful defibrillation in human victims of out-of-hospital cardiac arrest: a retrospective electrocardiographic analysis.
In the present study we sought to examine the efficacy of an electrocardiographic parameter, 'amplitude spectrum area' (AMSA), to predict the likelihood that any one electrical shock would restore a perfusing rhythm during cardiopulmonary resuscitation in human victims of out-of-hospital cardiac arrest. AMSA analysis is not invalidated by artefacts produced by chest compression and thus it can be performed during CPR, avoiding detrimental interruptions of chest compression and ventilation. We hypothesised that a threshold value of AMSA could be identified as an indicator of successful defibrillation in human victims of cardiac arrest. ⋯ An AMSA value of 12 mV-Hz was able to predict the success of each defibrillation attempt with a sensitivity of 0.91 and a specificity of 0.97. In conclusion, AMSA analysis represents a clinically applicable method, which provides a real-time prediction of the success of defibrillation attempts. AMSA may minimise the delivery of futile and detrimental electrical shocks, reducing thereby post-resuscitation myocardial injury.
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Anaesth Intensive Care · Jan 2008
Case ReportsAnaesthesia for excision of an intraoral mass in a neonate: use of a laryngeal mask during removal of congenital epulis.
Congenital epulis is a rare intraoral tumour of the newborn arising from gingival mucosa, most commonly from the alveolar ridge. It may interfere with normal feeding or potentially compromise respiration. ⋯ The lesion was removed one day after delivery, under general anaesthesia using a laryngeal mask airway to control the infant's airway. The rationale for this management plan and alternatives to this strategy are discussed.
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Anaesth Intensive Care · Jan 2008
The influence of passive leg elevation on the cross-sectional area of the internal jugular vein and the subclavian vein in awake adults.
The aim of this study was to evaluate the influence of passive leg elevation and Trendelenburg position on the cross-sectional area (CSA) of the internal jugular (II) and subclavian veins (SCV). Ultrasound imaging was used for the following measurements of both the IJV and SCV baseline in the supine position (control); Trendelenburg position 15 degrees; reverse Trendelenburg position 15 degrees and passive leg elevation 50 degrees. Twenty healthy male volunteers were studied. ⋯ Mean CSA of the SCV was 0.92 +/- 0.23 cm2 in control, 0.98 +/- 0.17 cm2 in the Trendelenburg position, 0.86 +/- 0.21 cm2 in the reverse Trendelenburg position and 0.93 +/- 0.18 cm2 during passive leg elevation. The results indicate that passive leg elevation increases the CSA of the IJV, but has little effect on the SCV. The CSA of the IJV appears to be influenced more by gravitational factors than the SCV.