Current opinion in anaesthesiology
-
Although the overall safety of blood transfusion is high, adverse events do still occur. Much research on transfusion reactions was done in nonperioperative patients. Fortunately, important contributions to the perioperative literature have been made in the last several years, specifically in the areas of transfusion-associated circulatory overload and transfusion-related acute lung injury (TRALI). ⋯ The current article explores new research on the topics of transfusion-associated circulatory overload and transfusion-related lung injury.
-
Curr Opin Anaesthesiol · Apr 2019
ReviewThoracic trauma in military settings: a review of current practices and recommendations.
To examine current literature on thoracic trauma related to military combat and to explore its relevance to the civilian population. ⋯ The Global War on Terror has provided opportunities to better understand and treat thoracic trauma in military settings. Trauma registries and other data sources have contributed to significant advancements in the management of thoracic trauma in military and civilian populations.
-
Tattoos and medallions are examples of nonstandard do-not-resuscitate (DNR) orders that some people use to convey end-of-life wishes. These DNR orders are neither universally accepted nor understood for reasons discussed within this manuscript. ⋯ To improve conveyance of an individual's wishes for end-of-life care, the authors discuss nationwide adoption of Oregon's online registry where a person's account could comprehensively document end-of-life wishes, be universally available in all healthcare institutions, and be searchable by common patient identifiers. Facial recognition software could identify unconscious patients who present without identification.
-
Curr Opin Anaesthesiol · Apr 2019
ReviewWithholding or withdrawing life support versus physician-assisted death: a distinction with a difference?
Withholding or withdrawing life-sustaining therapy is generally differentiated from physician-assisted suicide or euthanasia based on the distinction between intention and foresight. We reviewed the literature surrounding the validity of this distinction. ⋯ Several reasons may be given in favor of the distinction between intention and foresight. Given this distinction, the moral permissibility of withholding or withdrawing life-sustaining therapy does not necessarily entail the moral permissibility of physician-assisted suicide or euthanasia.
-
Curr Opin Anaesthesiol · Apr 2019
ReviewTime-efficient, goal-directed, and evidence-based teaching in the ICU.
Teaching in the stressful, high-acuity environment of the ICU is challenging. The intensivist-educator must use teaching strategies that are both effective and time-efficient, as well as evidence-based approaches to the ICU curriculum. This review provides an overview of pertinent educational theories and their implications on educational practices, a selection of effective teaching techniques, and a review on feedback. ⋯ Direct teaching should be goal-oriented, sequential, and adjusted to the level of the learner. The ICU curriculum should optimize cognitive load, reduce stress that is unrelated to the activity, include resilience training, and help trainees deal with stressful clinical situations better. Simulation is a powerful tool to promote technical and nontechnical skills. Providing feedback is essential and a skill that can be taught and enhanced with structure, prompts, and tools.