Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2010
Comparative StudyA prospective comparison between written examination and either simulation-based or oral viva examination of intensive care trainees' procedural skills.
We compared results of written assessment of intensive care trainees' procedural skills with results obtained from one of two live assessment formats for the purposes of assessing the concurrent validity of the different test methods. Forty-five Australasian senior trainees in intensive care medicine completed a written test relating to a procedural skill, as well as either a simulation format or oral viva assessment on the same procedural skill. We analysed correlation between written exam results and results obtained from simulation format or oral viva assessment. ⋯ The lack of correlation between exam formats supports multi-modal assessment, as currently it is not known which format best represents workplace performance. Correlation between written and oral viva results may indicate redundancy between those test formats, whereas limited correlation between simulation and written exams may support the use of both formats as part of an integrated assessment strategy. We hypothesise that identification of critical candidate errors in a simulation format exam that were not exposed in a written exam may indicate better predictive validity for simulation format examination of procedural skills.
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Anaesth Intensive Care · Sep 2010
Accuracy of weight and height estimation in an intensive care unit.
We report the findings from a prospective study determining the magnitude of errors in the visual estimation of weight and height of critically ill patients. Forty-two consecutive patients were weighed by a physician with a calibrated stretcher scale and length measured with a steel measuring tape. The predicted body weight was calculated using the ARDSnet formulae. ⋯ Our study shows that estimations of patient's weight made by intensive care unit staff are often inaccurate. In contrast, estimations of height made by intensive care unit staff are usually adequate. Estimated body weight of critically ill patients has implications for drug and respiratory therapy and should be used with caution.
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Anaesth Intensive Care · Sep 2010
Risk factors and outcomes of high-dependency patients requiring intensive care unit admission: a nested case-control study.
Intermediate-care or high-dependency units can provide a level of care that lies between the intensive care unit (ICU) and general ward, but the patients who are most likely to benefit from such level of care remains uncertain. This nested case-control study assessed the incidence and risk factors of high-dependency patients requiring ICU admission and whether these admissions were associated with a worse outcome when compared to other emergency ICU admissions. Seventy-seven consecutive high-dependency patients requiring ICU admission (cases) were compared with 77 patients who did not require ICU admission (controls) and also 928 emergency ICU admissions from other areas. ⋯ High-dependency admissions from the ward (odds ratio 4.46, 95% confidence interval 1.55 to 12.78) or emergency department (odds ratio 4.48, 95% confidence interval 1.54 to 13.0) and a need for concurrent non-invasive ventilation, inotrope infusion and acute kidney injury (odds ratio 14.90, 95% confidence interval 3.79 to 58.3) was associated with a higher risk of ICU admission. Hospital mortality of the high-dependency patients requiring ICU admission was not significantly different from other emergency ICU admissions (odds ratio 1.08, 95% confidence interval 0.55 to 2.11). In summary, high-dependency patients requiring ICU admission were uncommon unless they had multi-organ failure and their hospital mortality was not significantly different from other emergency ICU admissions.
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Anaesth Intensive Care · Sep 2010
Case ReportsAcute subdural haematoma in the presence of an intrathecal catheter placed for the prevention of post-dural puncture headache.
A 31-year-old term primigravid woman had an intrathecal catheter placed following a dural puncture during attempted epidural analgesia during labour. After 23 hours she developed sudden loss of consciousness and an urgent brain computed tomography scan demonstrated a large left hyper-acute subdural haematoma. ⋯ Although subdural haematoma is a recognised complication of dural puncture, it has not been reported in the presence of an intrathecal catheter. An intrathecal catheter may not always prevent cerebrospinal fluid efflux, so subdural haematoma remains a potential complication of inadvertent dural puncture.
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Anaesth Intensive Care · Sep 2010
Case ReportsUltrasound-guided bilateral superior laryngeal nerve block to aid awake endotracheal intubation in a patient with cervical spine disease for emergency surgery.
Ultrasound has been widely used to locate nerves for various nerve blocks. The potential advantages of using ultrasound imaging for nerve blocks include reduction in the amount of local anaesthetic required, improved success rate, reduced time to perform the block and reduced complication rate. We describe the successful performance of ultrasound-guided bilateral superior laryngeal nerve block to facilitate awake fibreoptic intubation in a patient presenting for emergency surgery on the cervical spine.