Minerva anestesiologica
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This study was conceived to assess a pattern of Italian prehospital critical care team, especially referring to the advanced life support (ALS) rescue team. Function and management of ALS rescue team and its relationship with other members of the emergency medical system (intra hospital physician, basic life support team, general practitioner) are analysed; stress is laidon the knowledge, the background and the complexity of the emergency procedures. The benefit of 2 major prehospital options of the ALS team, composed by 1 physician and 1 nurse staffing or by 2 trained nurse staffing, is discussed; the importance of educational programs for ambulance teams, a comparison of cost-effectiveness and the number of emergency teams availability is underlined. The authors, finally emphasize the advantages of a territorial coverage with an integrated system of ambulances staffed with specially trained rescuers or technicians, ambulances with rescuers and nurses, and ALS teams staffed with emergency physician and 1 nurse (integrated or not with ambulances with 2 trained nurses), being perfectly capable to face up any background in pre-hospital emergency medicine setting.
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Minerva anestesiologica · May 2004
Review[Analgesia, sedation and neuromuscular block in pediatric intensive care units: present procedures and recent progress].
Anxiolysis and pain control are a duty for physicians and must be treated very carefully in the Pediatric Intensive Care Units, although it is very difficult to assess them: in critically ill children sedatives and/or analgesic medications are routinely provided and titrated to obtain a satisfactory level of sedation, but different evaluation scores are needed to discriminate between light or inadequate and deep or excessive sedation, especially when the clinical examination is unavailable. It is usual to associate a benzodiazepin with an opioid, more often Midazolam and Morphine or Fentanyl; other drugs as Propofol, Clonidine and Ketamine have specific indications, brief painful procedures and weaning from long periods of sedation to avoid withdrawal. Sometimes it can be useful to add a neuromuscular blocking agent to help mechanical ventilation. Adverse sedation events are relatively frequent, associated with drug overdoses and drug interactions, particularly when 3 or more drugs are used: all class of medications and all routes of administration are involved.
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Minerva anestesiologica · May 2004
Review[Use of protein C concentrate in critical conditions: clinical experience in pediatric patients with sepsis].
The coagulation disturbance, typical of septic conditions, is associated to a reduction of clotting factors in plasma with an "acquired" deficiency (from consumption) of protein C. As observed with "purpura fulminans" in neonates affected by congenital protein C deficiency, administration of protein C concentrate has proved to reduce thrombotic manifestations and to improve morbidity and mortality of children with septic shock. The Protein C concentrate is presently utilized as a therapy for patients with a congenital deficiency of protein C and several papers in the literature support the efficacy of protein C concentrate in the treatment of children with meningococcus septicemia, with the aim of correcting the acquired protein C deficiency often seen in septic conditions and shown to be strongly correlated to a higher morbidity and mortality. ⋯ At our PICU 8 children, with sepsis, septic shock and purpura have been treated with protein C concentrate (Ceprotin); because the plasma protein C level was lower than the normal range (mean value 0.32 IU/ml, range 0.11-0.6 IU/ml). Six children have shown a rapid response to all therapeutic efforts and survived without sequelae and two are died. No adverse reaction was observed during and after Ceprotin administration to all patients.
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During video assisted thoracoscopy (VAT) the lung should be well collapsed. When the separation of the lungs is strictly indicated, use of difficult tube, such as double lumen tube (DLT) or Univent tube cannot be avoided, despite the presence of a difficult airway. If a patient has a recognized difficult airway, awake intubation with fiberoptic bronchoscopy can be attempted with Univent tube, DLT or with single lumen tube (SLT). ⋯ The most important feature of the blocker is its flexible soft tip that allows to direct it in the desired bronchus. The blocker contains a lumen that allows suctioning of the lung to facilitate deflation, suctioning of secretion and insufflation of oxygen. In summary, the clinician should be able to master different methods of lung separation and make him/her self familiar with the available devices.
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Minerva anestesiologica · May 2004
[Use of protein C concentrate in adult patients with severe sepsis and septic shock].
The aim of this study is to describe the first experiences on the use of protein C concentrate (PC) in adult patients with severe sepsis and septic shock and clinical contraindications to activated protein C (APC). On the basis of the effectiveness demonstrated by the activated form in sepsis and of the encouraging results expressed in literature of protein C concentrate (PC) mainly about meningococcus fulminating infections, we carried out an observational study on protein C concentrate (PC) with 28-day follow-up and a daily analysis of the hemato-chemical and clinical parameters. Particular attention was paid to the variations in the PC plasma levels, to the modifications of the coagulation system, to the SOFA score as well as to the safety under bleeding risk conditions. ⋯ In our small number of patients, protein C concentrate has proven to be safe and particularly useful in the control of the coagulopathy triggered and sustained by sepsis.