Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2010
Case ReportsThe use of drotrecogin alfa in severe falciparum malaria.
We report the case of a 55-year-old male European who became septic after he returned from a four-week holiday to Uganda. Soon after; he was diagnosed with severe falciparum malaria and developed multi-organ failure. ⋯ He returned home on day 36 after admission, without neurologic sequelae. Looking at those few cases of severe forms of malaria where drotrecogin alfa (activated) was successfully used, it should at least be considered for administration in patients with severe falciparum malaria with disseminated intravascular coagulation and cerebral involvement who do not respond to or deteriorate during standard treatment.
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Anaesth Intensive Care · Jul 2010
Case ReportsCompression of the common carotid artery following clavicle fracture in a twelve-year-old.
Posterior dislocation of the clavicle in the sternoclavicular joint is rare, but can result in severe complications caused by secondary damage to the adjacent structures on relocation. We present a case of a 12-year-old boy who sustained a dislocated clavicle while playing football. ⋯ Since there was no cardiothoracic standby available in our hospital on that day, the patient was transferred to the nearest centre with cardiothoracic facilities where the relocation of the clavicle was performed uneventfully. However; to avoid the potential for major complications, the risk of secondary damage to the central vessels must be kept in mind in this type of injury and adequate precautions must be in place.
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We investigated whether there was an association between recombinant activated factor VII (rFVIIa) use in cardiac surgery and thromboembolic events by comparing cases in two medical registries. The incidence of thromboembolic events in patients undergoing cardiac surgery (except isolated coronary artery bypass grafts) who had received rFVIIa and were entered into the Australian and New Zealand Haemostasis Registry was compared with the background incidence in patients entered in the Australasian Society for Cardiac and Thoracic Surgeons database. Mortality, length of hospital stay and thromboembolic complications such as stroke, perioperative myocardial infarction and pulmonary embolism data were analysed. ⋯ However multiple regression analyses showed no independent association between rFVIIa and stroke (odds ratio 1.0, P = 0.994) or perioperative myocardial infarction (odds ratio 0.29, P = 0.053), while the use of rFVIIa was associated with fewer pulmonary emboli (odds ratio 0.02, P < 0.001). These findings indicate that patients who received rFVIIa had increased mortality and length of hospital stay, as expected, but that rFVIIa use was not associated with an increased incidence of stroke or perioperative myocardial infarction. In the absence of randomised controlled clinical trials, this analysis suggests that the off-label use of rFVIIa in cardiac surgery does not significantly increase thromboembolic events.
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Anaesth Intensive Care · Jul 2010
Historical ArticleStorage, display and access--innovations at the Harry Daly Museum and the Richard Bailey Library of the Australian Society of Anaesthetists, Sydney.
Open storage with simple access to collection items and books is a well-established form of museum display. It is particularly suited to collections in which many examples of slightly differing artefacts are acquired during the process of research and field work. In the long run, open storage saves curatorial time, relieves storage space problems and increases visitor interest and participation. Simple access procedures are essential when busy professionals require information for their ongoing research or immediate application.
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Anaesth Intensive Care · Jul 2010
Historical ArticleJoseph Clover and the cobra: a tale of snake envenomation and attempted resuscitation with bellows in London, 1852.
The Industrial Revolution saw the creation of many new jobs, but probably none more curious than that of zookeeper. The London Zoological Gardens, established for members in 1828, was opened to the general public in 1847. In 1852 the "Head Keeper in the Serpent Room", Edward Horatio Girling, spent a night farewelling a friend departing for Australia. ⋯ Interestingly, the attempted resuscitation was with bellows, which had been abandoned by the Royal Humane Society twenty years earlier Clover records other cases of resuscitation with bellows at University College Hospital during his time as a resident medical officer there (1848 to 1853). There is a casebook belonging to Joseph Clover in the Geoffrey Kaye Museum, in Melbourne. This story is one of the many interesting stories uncovered during a study of this book and Clover's other personal papers.