Crit Care Resusc
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There is evidence that intensive glycaemic control decreases morbidity and mortality in surgical intensive care unit patients. In traumatic brain injury, hyperglycaemia is a prognostic indicator. ⋯ The intensive insulin protocol was effective in lowering blood glucose in neurosurgical ICU patients.
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The scientific rationale for administering fresh frozen plasma (FFP) rests on the assumptions that patients are at risk of adverse effects from inadequate coagulation factors, and that FFP transfusions can decrease those risks. There is a general but unfounded enthusiasm for FFP use across a range of clinical specialties in hospital practice. Plasma for transfusion is most often used when a patient has abnormal results on coagulation screening tests, either as therapy in the face of bleeding, or in patients who are not bleeding as prophylaxis before invasive procedures or surgery. ⋯ It is also crucial to clearly understand the risks associated with use of FFP, as no studies have taken adequate account of the extent to which adverse effects might negate the clinical benefits of treatment with FFP. New trials are needed to evaluate the efficacy and adverse effects of plasma, both in bleeding and non-bleeding patients, and to determine whether presumed benefits outweigh the real risks. In addition, new haemostatic tests that better define the risk of bleeding and monitor the effectiveness of FFP use should be validated.
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Multicenter Study
Terror Australis 2004: preparedness of Australian hospitals for disasters and incidents involving chemical, biological and radiological agents.
To assess the level of preparedness of Australian hospitals, as perceived by senior emergency department physicians, for chemical, biological and radiological (CBR) incidents, as well as the resources and training available to their departments. ⋯ This survey raises significant questions about the level of preparedness of Australian EDs for dealing with patients from both conventional and CBR incidents. Hospitals need to review their plans and functionality openly and objectively to ensure that their perceived preparedness is consistent with reality. In addition, they urgently require guidance as to reasonable expectations of their capacity. To that end, we recommend further development of national standards in hospital disaster planning and preparedness.
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Comparative Study
Missed opportunities? An observational study of vital sign measurements.
To determine the frequency of monitoring of patient vital signs in two wards of a tertiary hospital. ⋯ Blood pressure, heart rate and temperature were the most diligently recorded vital signs, but documentation of respiratory rate was poor. Failure to perform vital sign measurements may underpin the failure to recognise patients in general wards whose condition is deteriorating.