Nederlands tijdschrift voor geneeskunde
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Transfusion-related acute lung injury (TRALI) is a major complication of blood transfusions. The pathogenesis of TRALI is thought to occur in 2 phases: the 'double-hit theory'. The first phase is an underlying condition present in the patient, such as a surgical procedure or sepsis, which leads to priming, i.e. the activation of endothelium and subsequent sequestration of neutrophils in the lungs. ⋯ The incidence of TRALI in patients with an underlying condition is high; up to 15% of transfused patients are at risk. Anti-HLA and anti-HNA antibodies are highly prevalent in multiparous female donors. The exclusion of female donors for plasma and thrombocyte products has led to a 33-66% reduction in the incidence of TRALI.
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Ned Tijdschr Geneeskd · Jan 2013
Case Reports[Palliative sedation in a man with oral cancer; the Royal Dutch Medical Association guidelines not always sufficient].
Palliative sedation is an effective treatment option in patients with refractory symptoms in the last phase of life. In 2009 the Royal Dutch Medical Association (KNMG) published revised guidelines. The dosage of propofol recommended in these guidelines is, however, based on one single study. ⋯ In our opinion the advised starting dose of propofol is too low, especially in comparison with sedation in regional anaesthesia described in the literature. Furthermore, we advocate that administration of drugs from step 2, midazolam and levomepromazine, is not discontinued when propofol sedation is commenced in step 3.
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Ned Tijdschr Geneeskd · Jan 2013
Case Reports[Maternal pulmonary oedema due to the use of atosiban in cases of multiple gestation].
Nifedipine is used as a first choice tocolytic agent in many Dutch hospitals, but its use is discouraged in multiple gestations. Atosiban, a selective oxytocin receptor antagonist that rarely causes systemic side effects, is used as an alternative. ⋯ Every patient with multiple gestation is at increased risk of pulmonary oedema. Any tocolytic agent may elicit that response, even the relatively safe atosiban.
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Ned Tijdschr Geneeskd · Jan 2013
Comparative Study[The simulated setting for testing competencies; task shifting in outpatient anaesthesia].
Pre-anaesthesia evaluation is a complex task requiring integration of information obtained from the patient's history, physical examination and the proposed surgery. This task, traditionally performed by physicians, is increasingly being executed by specialised nurses or physician assistants in daily practice. ⋯ Simulation to test competencies requires properly described competencies within an adequate and validated simulation model, a suitable and validated assessment system, and an understanding of the causes of errors in measurement. A simulation study with an adequate sample size to detect a given sensitivity of physician assistants of 80% to identify significant comorbidity during pre-anaesthesia evaluation would require simulation of 1,000 to 1,500 consults.
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Ned Tijdschr Geneeskd · Jan 2013
Case Reports[Unexpected abdominal trauma from a fireworks explosion].
Fireworks injuries are common and often affect children. Such injuries should be considered high energy trauma in the emergency room and taken care of according to the principles of the Advanced Trauma Life Support (ATLS). ⋯ Potentially life threatening injuries may accompany hand injuries after modern illegal fireworks. Hand injuries are serious. Despite prolonged treatment, they often result in permanent disability. The structured approach to trauma according to ATLS was important in detecting an accompanying abdominal trauma in this case.