274 research outputs found
sj-docx-1-jic-10.1177_08850666231192371 - Supplemental material for Accuracy of International Classification of Disease Coding Methods to Estimate Sepsis Epidemiology: A Scoping Review
No full textSupplemental material, sj-docx-1-jic-10.1177_08850666231192371 for Accuracy of International Classification of Disease Coding Methods to Estimate Sepsis Epidemiology: A Scoping Review by Ashwani Kumar, Naomi Hammond, Sarah Grattan, Simon Finfer and Anthony Delaney in Journal of Intensive Care Medicine</p
Managing Patients Who Refuse Blood Transfusions: An Ethical Dilemma
No full textPatients who refuse blood transfusions after severe blood loss have a
poor prognosis but survival is possible. Below Simon Finfer and colleagues
describe how they managed two patients who presented after a car crash. We
asked an ethical expert, a former pathologist who is a Jehovah's Witness, and
a lawyer to comment on the issues that these cases raised
Pulmonary mechanical dysfunction in the critically ill
No full textModern ventilators employed in intensive care units (ICUs) display in real time and breath by breath flow (V̇), volume (V), and pressure (Paw) curves, both as a function of time and as a loop. Data obtained from curve analysis can help the physician to understand the interactions between the patient and the ventilator. The right interpretation of information provided from modern ventilators allows real time monitoring of the actual needs of the patient, ensuring a custom ventilatory support and reducing the risk of complications that can increase the mortality and prolong the ICU length of stay. In patients undergoing mechanical ventilation, measurements of respiratory mechanics can be performed at the bedside in dynamic (no flow interruption) or static (occlusion techniques) conditions. From these, it’s also possible to derive the values of pulmonary compliance and airway resistance
Management of tricyclic antidepressant poisoning
No full textAlthough a number of more recent substances with fewer side effects have become available for the treatment of depression, tricyclic antidepressants (TCA) are still commonly used. In addition, they are used for the treatment of neuropathic pain. The common basic mechanism of action is inhibition of reuptake of different neuromediators at the presynaptic terminal in both the central nervous system (CNS) and peripheral tissues, with the subsequent prolongation of their effect on the post-synaptic membrane. The earliest drug of this class was imipramine. Despite a phenothiazine-like structure it was not effective for the treatment of schizophrenia; quite unexpectedly, it improved depressive symptoms. Consequently, these substances and the derived TCAs became the first line of treatment for depression until the development of the selective serotonin reuptake inhibitors (SSRI). Although all TCAs share the same mechanisms of action, there are some differences in terms of the mediator involved. Whereas imipramine and some of its derivates, including amitriptyline and doxepin, block the reuptake of noradrenaline and serotonin at the presynaptic terminals, clomipramine has a more selective action on serotonin. After oral administration, TCAs are promptly absorbed and achieve peak blood concentrations in 2–6 hours; their absorption is reduced by antacids and drugs with anticholinergic effects. Being highly lipophilic, TCAs are rapidly taken up by the CNS. They are metabolized in the liver through oxidation and glucoronization. Although they undergo a relevant enterohepatic circulation, they are primarily eliminated through the kidney, with a half-life of 12–24 hours depending on the specific drug
Respiratory rate: the neglected vital sign
No full textThe level of documentation of vital signs in many hospitals is extremely poor, and respiratory rate, in particular, is often not recorded. There is substantial evidence that an abnormal respiratory rate is a predictor of potentially serious clinical events. Nurses and doctors need to be more aware of the importance of an abnormal respiratory rate as a marker of serious illness. Hospital systems that encourage appropriate responses to an elevated respiratory rate and other abnormal vital signs can be rapidly implemented. Such systems help to raise and sustain awareness of the importance of vital signs.Michelle A. Cretikos, Rinaldo Bellomo, Ken Hillman, Jack Chen, Simon Finfer and Arthas Flabouri
Cetacean acoustics in bubbly water (Invited Paper)
No full textMarine mammal signals often propagate through bubbly water, be they generated under breaking waves, wakes, or even by the mammals themselves. Two circumstances are of particular interest: the possible use of acoustic signals to trap prey in bubble nets; and the ability of dolphin sonar to operate in bubbly water (such as the surf zone) that would confound the best human sonar, despite the fact that the dolphins possess ‘hardware’ which is comparatively mediocre. This paper examines these circumstances
- …
