Emergency Care

The use of a remifentanil infusion and elective tracheostomy to avoid ventilation in a patient with tetanus (2014)

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Type of publication:
Journal article

Author(s):
*Redshaw C., *Slater R.

Citation:
Journal of the Intensive Care Society, April 2014, vol./is. 15/2(161-163), 1751-1437

Abstract:
Tetanus is very rare in developed countries but the mortality is still high in the elderly population despite access to intensive care medicine. Death can frequently occur from secondary complications due to the need to sedate, paralyse and ventilate patients in an effort to control spasms. We describe the case of a 77-year-old man with tetanus in whom we successfully controlled tetanic spasms with a remifentanil infusion where conventional treatment failed, thus preventing the need for mechanical ventilation. We also describe the use of an elective percutaneous tracheostomy which was performed for airway protection. This prevented him from developing pneumonia from aspirating the excess secretions caused by the autonomic features of tetanus.

 

Rapid sequence induction in urgent care settings. (2014)

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Type of publication:
Journal article

Author(s):
*Fenwick R

Citation:
Emergency Nurse, 03 2014, vol./is. 21/10(16-24), 1354-5752;1354-5752 (2014 Mar)

Abstract:
In the management of critically ill patients in emergency departments, rapid sequence induction (RSI) of anaesthesia is often required. This article examines the elements of RSI that are necessary before before endotracheal tube placement and reviews the findings of a national audit project, conducted by Royal College of Anaesthetists and Difficult Airway Society. It also considers the role of nurses in RSI procedures.

Link to more details or full-text: http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=2012497882&authtype=athens&site=ehost-live

 

Achieving standards for unscheduled surgical care (2014)

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Type of publication:
Journal article

Author(s):
McArdle, Kirsten, *Leung, Edmund, Cruickshank, Neil, Laloe, Veronique

Citation:
Clinical Governance: An International Journal, 01 March 2014, vol./is. 19/1(21-29), 14777274

Abstract:
Purpose — The Royal College of Surgeons published Standards for Unscheduled Surgical Care in response to variable clinical outcomes for emergency surgery. The purpose of this study is to assess for feasibility of a district hospital providing care in accordance to the recommendations. Design/methodology/approach — A total of 100 consecutive patient unscheduled episodes of care were prospectively included. Information regarding demographics, timeliness of investigations, operations, consultant input and clinical outcomes was collated. All patients were risk-adjusted for mortality. The data were compared to the guidelines. Findings — A total of 91 patients were included; 80 patients underwent surgery. There were 18 deaths (22.5 per cent), eight (10 per cent) post-operative within 30 days. There was no statistical difference between deaths and day of admission or surgery. There were 39 critically-ill patients, none were reviewed by a consultant within the recommended 30 minutes. Of the critically-ill patients, 23 underwent CT scanning, none within the recommended 30 minutes. All patients were operated within the recommended timeframe by urgency grading. For those predicted mortality rate .5 per cent, a consultant was present in theatre for 97 per cent of cases. All patients had a consultant review within 24 hours of admission. Originality/value — To the authors’ knowledge this is the first evaluation of the practical difficulties in achieving consultant delivered care in surgery in a district general hospital. These results are interesting to clinicians and service planners involved in developing emergency services. Adhering to these guidelines would require significant re-allocation of resources in most hospitals and may require centralisation of services.