Crit Care Resusc
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Case Reports
Cardiac arrest complicating neostigmine use for bowel opening in a critically ill patient.
Absence of bowel opening is common among critically ill patients. Neostigmine can be used to achieve stool passage after other treatments have been ineffective. Here, we report a case of cardiac arrest complicating neostigmine use in a 16-year-old woman with cerebral palsy who was being treated in the intensive care unit after orthopaedic surgery. Bradycardia is a recognised complication of neostigmine administration; however, cardiac arrest has not been reported previously.
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Studies conducted before the conception of medical emergency teams (METs) revealed that cardiac arrests were often preceded by deranged vital signs. METs have been implemented in hospitals to review ward patients whose conditions are deteriorating in order to prevent adverse events, including cardiac arrest. Antecedents to cardiac arrests in a MET-equipped hospital have not been assessed. ⋯ In this 6-month audit, about half the patients with cardiac arrest may have been unsuitable for resuscitation, or had objective warning signs that were not acted on. Further improvements in advanced care planning and optimisation of MET activation may further reduce cardiac arrest calls at our hospital.
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The systemic inflammatory response syndrome (SIRS) concept lacks sensitivity and specificity for guiding clinical practice and sepsis research. ⋯ Both SIRS and weighted SIRS score had low predictive ability for microbiologically confirmed infection. A more robust conceptual framework incorporating clinical, biochemical and immunological markers must be formulated and validated to better guide clinical practice and research. Clinicians' suspicions may be as good as any scoring system at identifying patients with infection and sepsis.
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To measure and describe the extent and consequences of documented medical patient reviews in the 24 hours before a cardiac arrest, medical emergency team (MET) call or an unanticipated intensive care unit admission ("event"), and the use of such reviews as a rapid response system performance measure. ⋯ Medical reviews in the 24 hours before an adverse event are common. The type of medical review may influence patient outcome and thus may be a useful measure of rapid-response systems and critical care performance.