Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2016
Systemic anticoagulation related to heparin locking of non-tunnelled venous dialysis catheters in intensive care patients.
Heparin locking of venous dialysis catheters is routinely performed in intensive care to maintain catheter patency when the catheters are not being used. Leakage of heparin into the circulation can potentially cause systemic anticoagulation and may present a risk to intensive care patients. To assess the effect of 5000 units per millilitre heparin locking of non-tunnelled dialysis catheters on systemic anticoagulation, we performed a prospective observational study of ten intensive care patients receiving heparin locking of dialysis catheters in an adult tertiary intensive care unit between July and September 2015. ⋯ The median rise was by 56 seconds (interquartile range 30-166.5). Following heparin locking, 80% of patients had APTT values within or above the range associated with therapeutic anticoagulation. Heparin locking of non-tunnelled venous dialysis catheters can cause systemic anticoagulation in intensive care patients and therefore poses a potential risk to patient safety.
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Anaesth Intensive Care · Jul 2016
Historical ArticleAnaesthesia on the Western Front-perspectives a century later.
This year, 2016, marks the centenary of some of the worst battles of World War I. It is timely to reflect on the experiences of those who lived through those events, and the significant effects on the development of anaesthesia that occurred as a result. ⋯ The challenges of the Western Front, with its massive numbers of injured, saw progress in the understanding and management of trauma and shock, and significant improvement in the provision of anaesthesia and the training of anaesthesia providers. The result was increased anaesthetic safety for the civilian population after the war and further development of anaesthesia and resuscitation as a specialised area of medicine.
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Anaesth Intensive Care · Jul 2016
Biography Historical ArticleThe introduction of expired air resuscitation into Surf Life Saving Australia.
Surf Life Saving Australia, which began in the early 1900s, initially adopted the indirect resuscitation methods used by the Royal Life Saving Society. As new indirect methods became available, both organisations adapted their resuscitation techniques and followed international developments closely. In the 1950s, accumulating evidence suggested that direct methods of resuscitation, such as mouth-to-mouth ventilation, might be more efficacious. ⋯ Following the convention, Queensland Surf Life Saving conducted training sessions in cooperation with anaesthetists Roger Bennett and Tess Brophy (later Cramond), at St Andrew's Hospital in Brisbane. Two volunteers were anaesthetised and paralysed on two separate weekends to allow over one hundred people to gain experience in expired-air and bag-mask ventilation. One of the volunteers in these training exercises kindly provided much of the material that led to this paper, providing a first hand account of the experiments and an invaluable insight into the cooperation between anaesthetists and volunteer rescue associations.