Singap Med J
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The APACHE II scoring system was applied to 301 surgical intensive care admissions over a 9-month period. The mean age of patients admitted was 52.39 years (SD 19.3) and the mean duration of stay was 5.37 days (SD 8.93). The overall mortality was 17.27%. ⋯ Using a predicted risk criterion of 0.5 to distinguish between those predicted to survive and die, of the 45 patients predicted to die, only 30 actually did so. No patient survived with an APACHE II score of more than 40 and with a predicted risk of death greater than 0.87. We found the APACHE II system useful for evaluating ICU performance and risk stratification for the purpose of therapeutic trials but not as a triage tool.
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From 1989 to 1991, 104 Chinese patients were admitted to the Prince of Wales Hospital with paracetamol poisoning. Only 11 subjects had a plasma paracetamol concentration above the published treatment line. Intravenous N-acetylcysteine (NAC) was completely effective when given within 8 hours (3 patients), while late treatment with NAC at 16 and 26 hours after overdose (2 patients) was ineffective in preventing liver damage as evidenced by elevations in plasma alanine transaminase concentrations. ⋯ Two other subjects who presented late or in whom a plasma paracetamol concentration was not measured also developed liver damage. Fortunately, none of these 6 subjects developed hepatic encephalopathy. We recommend that a standard protocol be readily available for junior hospital staff to use when treating patients with paracetamol overdosage.