Critical care medicine
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Critical care medicine · Aug 2017
Randomized Controlled TrialChallenging Authority During an Emergency-the Effect of a Teaching Intervention.
Previous research has shown that residents were unable to effectively challenge a superior's wrong decision during a crisis situation, a problem that can contribute to preventable mortality. We aimed to assess whether a teaching intervention enabled residents to effectively challenge clearly wrong clinical decisions made by their staff. ⋯ A short targeted teaching intervention was effective in significantly improving residents' ability to challenge a wrong decision by a superior. This suggests that residents are not given the proper tools to challenge authority during a life-threatening crisis situation. This educational gap can have significant implications for patients' safety.
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Critical care medicine · Aug 2017
Case ReportsLower Cranial Nerves Paralysis Following Prone-Position Mechanical Ventilation.
To communicate a complication of prone-position ventilation. ⋯ This is a very infrequent cause of dysphagia following prone-position ventilation.
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Critical care medicine · Aug 2017
Neurologic Injury in Adults Supported With Veno-Venous Extracorporeal Membrane Oxygenation for Respiratory Failure: Findings From the Extracorporeal Life Support Organization Database.
To assess in-hospital neurologic (CNS) complications in adult patients undergoing veno-venous extracorporeal membrane oxygenation for respiratory failure. ⋯ Approximately 7% of adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure had neurologic injury. Intracranial hemorrhage was the most frequent type, and survival for patients with neurologic injury was poor. Future investigations should evaluate anticoagulation management as well as brain/extracorporeal membrane oxygenation interaction to reduce these life-threatening events.
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Critical care medicine · Aug 2017
Case ReportsAtriobronchial Fistula Complicated by Septic Cerebral Air Emboli After Pulmonary Vein Ablation.
To describe a case of an infected atriobronchial fistula as a late complication after pulmonary vein ablation, leading to septic air emboli and requiring urgent cardiac surgery. ⋯ Clinicians should be aware of the dramatic complications of invasive antiarrhythmic procedures and their atypical and late presentations. Better preprocedural appreciation of cardiac wall thickness, early echocardiographic diagnosis, and swift referral for cardiac surgery might impact outcome dramatically.
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Critical care medicine · Aug 2017
Hyperchloremia Is Associated With Acute Kidney Injury in Patients With Subarachnoid Hemorrhage.
To assess the prevalence of acute kidney injury in patients with subarachnoid hemorrhage patients. ⋯ Critically ill patients with subarachnoid hemorrhage show a strong association between hyperchloremia and acute kidney injury as well as acute kidney injury and mortality.