Anaesthesia and intensive care
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Anaesth Intensive Care · Jun 2007
Stability of the strong ion gap versus the anion gap over extremes of PCO2 and pH.
The strong ion gap (SIG) is under evaluation as a scanning tool for unmeasured ions. SIG is calculated by subtracting [buffer base], which is ([A-]+[HCO3-), from the apparent strong ion difference, which is ([Na+]+[K+]+[Ca++]+[Mg++]-[Cl-]-[L-lactate]). A- is the negative charge on albumin and phosphate. ⋯ AG values were directly correlated with pH (normal: R2 = 0.51, hypoalbuminaemic: R2 = 0.65). Final AG values significantly exceeded initial values (normal blood: 15.9 (1.7) mEq/l versus 8.9 (1.8) mEq/l, P < 0.01; hypoalbuminaemic blood: 16.5 (0.8) mEq/l versus 11.8 (2.0) mEq/l, P < 0.05). We conclude that, unlike the AG, the SIG is not affected by severe respiratory acidosis and alkalosis, enhancing its utility in acid-base disturbances.
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Anaesth Intensive Care · Jun 2007
Biography Historical ArticleThe perils of pointing the finger: a lesson for Dr. Haygarth.
Mr. William Russ Pugh, well known for his anaesthetic activities, and probably the first in Australia to administer ether anaesthesia for a surgical operation in May 1847, was involved in several court cases in Launceston, Tasmania in 1842 and 1843. At that time Tasmania was known as Van Diemen's Land. ⋯ Because of Pugh's standing in Launceston the cases attracted enormous public attention and support for Pugh. The outcome for Dr. Haygarth was very unpleasant and not something which he had anticipated.
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Anaesth Intensive Care · Jun 2007
Case ReportsMyocardial depression associated with pneumococcal septic shock reversed by levosimendan.
Levosimendan is a myocardial calcium sensitiser and potassium-ATP channel opener Levosimendan has been used in critically ill patients in various conditions to support myocardial function as an inotrope, lusitrope and vasodilator. We report the use of levosimendan in a patient with invasive streptococcal septic shock.
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Anaesth Intensive Care · Jun 2007
Case ReportsTranstracheal jet ventilation in management of the difficult airway.
We present the use of transtracheal jet ventilation in two uncooperative patients with a difficult airway. Although transtracheal jet ventilation is considered as a last resort option in the difficult airway algorithm, its use can be a valuable tool in selected difficult airway situations. Transtracheal jet ventilation can effectively maintain arterial oxygenation and provide extra time for attempts to intubate the trachea, either directly or fibreoptically.
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Anaesth Intensive Care · Jun 2007
The diagnostic yield and clinical impact of a chest X-ray after percutaneous dilatational tracheostomy: a prospective cohort study.
A chest X-ray (CXR) is routinely performed after percutaneous dilatational tracheostomy (PDT). The purpose of this study was to evaluate the diagnostic yield of routine CXR following PDT and its impact on patient management and to identify predictors of post-PDT CXR changes. Two-hundred-and-thirty-nine patients who underwent PDT in a 21-bed intensive care unit were included prospectively in the study. ⋯ Routine CXR following PDT has a low diagnostic yield, detecting mainly atelectasis and leading to a change in the management in only a minority ofpatients. Routine CXR after apparently uncomplicated PDT performed by an experienced operator may not be necessary and selective use may improve its diagnostic yield. Further studies are required to validate the safety of selective versus routine post-PDT CXR.