Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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Tidsskr. Nor. Laegeforen. · Nov 2008
Case Reports[A 69-year-old man with temporary left-sided hemiparesis].
A 69-year-old man accidentally disconnected his central venous catheter (CVC) while standing at home. Within the same minute he developed left-sided hemiparesis which lasted for 30 minutes. A CT of the brain three hours later was normal. ⋯ The reason can be paradoxical embolism through an intracardial shunt or through physiological pulmonary arteriovenous shunts, or the air can pass retrogradely from the central vein to the cerebral venous system. When cerebral air emboli is suspected, the CVC must be secured, the patient should be placed in a recumbent position and given 100% O2, and hyperbaric oxygen therapy if symptoms persist. While placing and handling a CVC, the patient should be in a recumbent position, and the increased risk for air emboli in walking patients be taken into account.
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Annual reports from Norwegian Intensive Care Units include risk-adjusted mortality data. Annual variation may be difficult to interpret due to random variation and changes in case mix. Several methods have been developed for continuous monitoring of treatment results in clinical practices where it is possible to calculate a risk for a certain outcome, usually risk of death. We have used the cumulative risk adjusted mortality chart Variable Life Adjusted Display (VLAD) to further illustrate our treatment results. ⋯ The VLAD curve is a very useful supplement to traditional methods of evaluating the performance of intensive care units. The method is useful for showing how treatment results vary over time.
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While bacterial infections are one of the most important causes of disease and death in developing countries, the prevalence and consequences of antimicrobial resistance are not well known. ⋯ Developing countries have a much higher overall burden of infectious diseases than the rich western countries and also poor access to newer antibiotics, which can be lifesaving when treating infections caused by resistant bacteria. To combat overuse and misuse of antibiotics, the diagnosis of infectious diseases must be strengthened and antimicrobial resistance must be emphasized in education of health professionals and the general public. There is a need for improved surveillance of antimicrobial resistance and strengthened quality control of antimicrobial drugs. In the long-term perspective, poverty reduction, improved living conditions and hygiene, safe water supplies and access to quality health care (including vaccination and HIV care), may contribute to prevent emerging antimicrobial resistance.