Crit Care Resusc
-
Fluid resuscitation with saline in severe sepsis is controversial. Hypertonic (3%) saline (HTS) may be superior to normal (0.9%) saline (NS). ⋯ In gram-negative sepsis, bolus resuscitation with HTS and NS have similar and transient systemic and regional haemodynamic effects, but no effects on renal perfusion and only short-lived effects on renal function. These findings challenge the physiological rationale for fluid bolus resuscitation in sepsis.
-
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.
-
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.
-
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.
-
Necrotising fasciitis is a rare, rapidly progressive soft tissue infection associated with extensive necrosis, profound shock and high morbidity and mortality. Incidence worldwide is thought to be increasing. ⋯ There is an higher incidence of necrotising fasciitis at our hospital in South Auckland than reported elsewhere. Maori and Pacific Islander people are at increased risk. In our patient sample APACHE II score, preexisting abnormal renal function and gout were associated with mortality.