Crit Care Resusc
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To describe the frequency and hospital mortality of problems (diagnoses) encountered by a rapid response team (RRT), and to identify the most common diagnoses for RRT triggers and for treating units. ⋯ The RRT activation trigger provides only a general indication of the diagnosis. Some problems appear preventable and could provide a focus for unit-based quality initiatives. The mortality of some diagnoses is substantial, and this may help in setting treatment goals, but more work is needed to understand the association of RRT diagnosis and outcome.
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Observational Study
Longitudinal changes in anthropometrics and impact on self-reported physical function after traumatic brain injury.
Patients admitted to the ICU with a traumatic brain injury (TBI) are at risk of muscle wasting but this has not been quantified. Our aims were to describe longitudinal changes in anthropometrical data, compare the accuracy of non-invasive methodologies to the validated dual-energy x-ray absorptiometry (DXA), and assess the relationships between anthropometrical data and self-reported physical function. ⋯ Patients with a TBI lose muscle thickness while in the ICU but the trajectory of loss stabilises after ICU discharge. Ultrasound-derived QMLT is related to total lean mass and physical function after discharge. Further studies are needed to confirm that ultrasound measurement of QMLT is a useful surrogate measure of muscle mass and functional outcomes after trauma and critical illness.
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To investigate the frequency, characteristics and timing of objectively measured clinical instability in adult ward patients in the 24 hours preceding activation of the medical emergency team (MET). We also examined ward clinician responses to documented clinical instability. ⋯ Patients commonly and repeatedly breached objectively measured UCR criteria in the 24 hours preceding MET activation, providing numerous opportunities for clinicians to recognise and respond to early clinical deterioration. The high incidence of pre- MET afferent limb failure requires further exploration.
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To describe the characteristics, pattern of injury and outcome of children admitted to a paediatric intensive care unit (PICU) following an inflicted injury. ⋯ The majority of children admitted to intensive care following an inflicted injury are aged under 12 months. Children most commonly require intensive care for management of a head injury. Many children have radiological findings suggestive of pre-existing inflicted injury. Despite high mortality, the majority of children survive. While most are likely to be independent, many children will have residual disabilities.
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To describe the use of imaging studies (four-vessel angiography or radionuclide scan) for brain death determination in South Australian intensive care units, and to determine the rates of adherence with The ANZICS statement on death and organ donation of the Australian and New Zealand Intensive Care Society (ANZICS). ⋯ Therapeutic hypothermia, terminal serum sodium level ≥ 150 mmol/L and cause of death were independent predictors of brain death determination by imaging study. Documentation of imaging indication was poor, particularly after hypoxic brain injury. This may reflect emerging indications for imaging, poor adherence to ANZICS recommendations, or simple omissions.