Crit Care Resusc
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Misdiagnosis of the cause of illness in critically ill patients is common, and a major cause of morbidity and mortality. We reflect upon a misdiagnosis that occurred in the intensive care unit of a metropolitan teaching hospital, and highlight the susceptibility of medical decision making to error. ⋯ We discuss the vulnerability of such processes and - with particular reference to our case - why even knowledgeable and diligent clinicians are prone to misdiagnose. Finally, we review potential solutions, both educational and systemic, that may guard against the inevitable failings of the human mind, especially in a busy modern intensive care setting.
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Comparative Study Clinical Trial
Near-infrared spectroscopy of the thenar eminence: comparison of dynamic testing protocols.
Near-infrared spectroscopy of the thenar eminence (NIRSth) is a non-invasive bedside method for assessing tissue oxygenation. The vascular occlusion test (VOT) with a pressure cuff can be used to provide a dynamic assessment of the tissue oxygenation response to ischaemia. VOT has been applied to assess the microcirculation by NIRSth in critically ill patients. The optimal mode of performing such VOT, however, remains controversial. ⋯ The 3-minute VOT and the 40% StO(2) appear equivalent. However, the 3-minute VOT carries a degree of decreased patient discomfort and shorter overall duration of execution.