Anaesthesia, critical care & pain medicine
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Anaesth Crit Care Pain Med · Feb 2015
ReviewDiagnosis and management of the postoperative surgical and medical complications of bariatric surgery.
Perioperative complications following bariatric surgery (BS) have been poorly analysed and their management is not clearly assessed. The associated frequency of ICU admission is difficult to estimate. Among surgical complications, digestive perforations are the most frequent. ⋯ Medical management is based on supportive ICU care of organ dysfunctions, curative anticoagulation if required, nutritional support, and appropriate anti-infective therapy. Pharmacological data are limited in morbidly obese patients and the appropriate doses are debated, especially for anti-infective agents. Complicated BS cases have a poor outcome, probably largely related to delayed diagnosis and reoperation.
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Anaesth Crit Care Pain Med · Feb 2015
Observational StudyThe Script Concordance Test in anesthesiology: Validation of a new tool for assessing clinical reasoning.
To evaluate whether the Script Concordance Test (SCT) can discriminate between levels of experience among anesthesiology residents and attending physicians. ⋯ The SCT is a valid and useful tool for discriminating between anesthesia providers with varying levels of experience in anesthesiology. It may be a useful tool for documenting the progression of reasoning during anesthesia residency.
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Anaesth Crit Care Pain Med · Feb 2015
Implementation of lung ultrasound in polyvalent intensive care unit: Impact on irradiation and medical cost.
To determine the effect of implementing a daily lung ultrasound round on the number of chest radiographs and chest computed tomography (CT) scans in a polyvalent intensive care unit (ICU). ⋯ No demographic difference was found between the two groups, with the exception of a higher severity score in the group POST. For each ICU stay, the number of chest radiographs was 10.3 ± 12.4 in the group PRE and 7.7 ± 10.3 in the group POST, respectively (P<0.005) The number of chest CT scans was not reduced in the group POST, as compared with the group PRE (0.5 ± 0.7 CT scan/patient/ICU stay versus 0.4 ± 0.6 CT scan/patient/ICU stay, P=0.01). The ICU mortality was similar in both groups (21% versus 22%, P=0.75) CONCLUSION: The implementation of a daily lung ultrasound round was associated with a reduction in radiation exposure and medical cost without altering patient outcome.
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Anaesth Crit Care Pain Med · Feb 2015
Residents in tutored practice exchange groups have better medical reasoning as measured by the script concordance test: A pilot study.
This pilot study attempted to evaluate the impact of a practice exchange group (PEG) tutored by a senior anaesthesiologist on clinical reasoning performance of anaesthesiology residents for uncertain situations. Changes in clinical reasoning were measured by script concordance tests (SCT). ⋯ Our pilot study suggested that a senior-directed, peer-conducted educational training might improve the clinical reasoning of anaesthesia residents as measured by the SCT.
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Anaesth Crit Care Pain Med · Feb 2015
Case ReportsTreatment of intra-abdominal haemorrhagic shock by Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA).
Haemorrhagic shock is commonly encountered in the emergency room and is associated with high morbidity and mortality. For intra-thoracic and intra-abdominal bleeding, treatment usually requires either surgery or an interventional radiologic procedure. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has already been described for pelvic fractures and intra-abdominal haemorrhages. In this case report, we present the use of REBOA in a patient admitted for haemorrhagic shock due to a ruptured splenic artery aneurysm. ⋯ This case underlines the feasibility of REBOA and discusses its role in uncontrollable intra-abdominal haemorrhagic shock.