Crit Care Resusc
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Survival from acute coronary syndromes and major trauma has been shown to depend on timely access to definitive treatment. We sought to identify the significance of intensive care unit (ICU) admission delay (lead-time) on the outcome of critically-ill medical patients with other diagnoses. ⋯ ICU admission delay (lead-time) is associated with a greater mortality-risk in critically ill medical patients requiring MV and/or RRT.
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Sedative drugs are used routinely in critically ill patients to reduce both physical and psychological stresses imposed by the hostile intensive care unit environment. However, drug accumulation, particularly during prolonged administration, often poses difficulties. Sedation scales chart the physiological effect of sedation although many surveys have revealed that few units use them to monitor the effect of sedative agents hence oversedation is common. ⋯ Our study demonstrates that the use of a sedation scale lead to a decrease in sedative, analgesic and inotrope use with a trend to less ventilated hours in critically ill patients.
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We describe two cases of a unilateral fixed dilated pupil secondary to the ocular instillation of nebulised ipratropium bromide. In one patient there was no other neurological abnormality. ⋯ The differential diagnosis of a unilateral dilated pupil includes partial third nerve palsy, tonic pupil, direct trauma to the eye and pharmacological mydriasis. The diagnosis can often be determined using pilocarpine eye drops.
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To review the techniques and long term complications of the various techniques of percutaneous tracheostomy in the critically ill patient. ⋯ In the critically ill patient who requires a tracheostomy, the percutaneous tracheostomy has become the method of choice as it can be performed at the bedside, leaves a smaller scar after decannulation and may be associated with fewer complications compared with the standard surgical technique.