Current opinion in anaesthesiology
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This review summarizes the knowledge of error and of critical incident reporting systems in general and especially in emergency medicine. ⋯ The first step in avoiding fatalities in emergency medicine is to accept that errors do occur. The next question is how to prevent errors in medicine and not to search for personal mistakes. We need a culture of error and not a culture of blame. Critical incidents occur in all ranges of medical hierarchical structures. We have to accept the presence of mistakes and we need to recognize them every day to protect our patients.
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To assess the current role of selenium supplementation in critically ill patients. ⋯ Despite the low selenium content in the body (20-40 mg), selenoenzymes play an important role in antioxidant defense in humans. Selenium administration may be associated with improved outcomes, but further studies are needed to determine the precise mechanism of action. Studies are also needed to determine optimal dosing regimens, and to identify those patients in whom this approach is likely to be most effective. Currently, doses below the tolerable upper intake level (400 microg) may be used in supplementation. Higher doses (up to the level of no adverse effect, 800 microg) may be of interest and need to be studied further. The pro-oxidant effects of selenocompounds, especially sodium selenite, which vary depending on the compound, dose, and concentration, also need to be assessed further for their toxicity and potential therapeutic use in patients with septic shock.