Crit Care Resusc
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Medication errors can be dangerous and are an intensive care unit quality indicator. Few studies have assessed interventions aimed at improving prescription practice. Anecdotal reports in our ICU indicated a high incidence of prescription errors, including illegible handwriting, and lack of prescriber identity and antibiotic indications. Knowledge translation (KT) is an emerging tool that uses collaborative stakeholder participation and focuses on education and inclusiveness rather than punitive audits. ⋯ A systematic KT process of collaborative education can reduce ICU prescription errors.
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To determine functional outcomes 6 months after intensive care unit admission for severe infection due to pandemic (H1N1) 2009 influenza and examine the relationship between nutrition during ICU admission and outcome. ⋯ Patients admitted to this ICU with H1N1 infection were fed successfully during their stay. Critically ill patients surviving H1N1 infection had good functional outcomes at 6 months.
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The Australian and New Zealand Intensive Care Society (ANZICS) guidelines for the determination of brain death involve clinical testing and/or the use of brain blood flow analysis techniques. Recently, there has been professional and lay discussion regarding the role of brain blood flow analysis in the determination of brain death. ⋯ Two sets of clinical testing is the most common method for determining brain death in Australian and New Zealand ICUs. A minority of units used some form of brain blood flow imaging. Based on these findings, all brain death certification is in accordance with ANZICS guidelines.
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Case Reports
Delayed and prolonged elevated serum paracetamol level after an overdose - possible causes and implications.
We report the case of a 29-year-old man who ingested about 50 g of standard-preparation paracetamol plus other medications. The serum paracetamol level remained low in the first 24 hours. It peaked 54 hours after ingestion and remained high for 5 days. ⋯ On Day 3, the patient's liver function deteriorated and a rising serum paracetamol level was noted; hence, an NAC infusion was reinitiated. Despite this, the patient developed fulminant hepatic failure. This case underlines the importance of monitoring paracetamol levels and liver function for at least 72 hours after a suspected large overdose of paracetamol before discontinuing NAC infusion.