Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2021
Intensive care digital health response to emerging infectious disease outbreaks such as COVID-19.
The COVID-19 pandemic has required intensive care units to rapidly adjust and adapt their existing practices. Although there has a focus on expanding critical care infrastructure, equipment and workforce, plans have not emphasised the need to increase digital capabilities. ⋯ We identified and explored six focus areas relevant to intensive care, including using digital solutions to increase critical care capacity, developing surge capacity within an electronic health record, maintenance and downtime planning, training considerations and the role of data analytics. This article forms the basis of a framework for the intensive care digital health response to COVID-19 and other emerging infectious disease outbreaks.
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Anaesth Intensive Care · Jan 2021
Allergic contact dermatitis to a dye or alcohol in a chlorhexidine-based skin preparation: A case report.
This case report describes a patient who developed allergic contact dermatitis to a chlorhexidine skin preparation applied for a transversus abdominis plane block, but not to a different chlorhexidine solution applied to the surgical field. The patient had presented for an elective inguinal hernia repair. He had a known history of anaphylaxis to non-steroidal anti-inflammatory medication but was otherwise well. ⋯ The skin preparations differed in the dyes and alcohols that they contained. The dyes or alcohol in the preparation for the transversus abdominis plane block were therefore considered the likely cause of this patient's allergic reaction. Dyes and alcohols should be considered as a cause of skin allergy in the perioperative setting.
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Anaesth Intensive Care · Jan 2021
The effect of alcohol policy on intensive care unit admission patterns in Central Australia: A before-after cross-sectional study.
Alcohol misuse is a disproportionately large contributor to morbidity and mortality in the Northern Territory. A number of alcohol harm minimisation policies have been implemented in recent years. The effect of these on intensive care unit (ICU) admissions has not been fully explored. ⋯ Admissions with a primary diagnosis of trauma were lower (10.5% versus 4.7%, P < 0.01). This study demonstrated a reduction in ICU admissions associated with alcohol misuse following the implementation of new alcohol harm minimisation policies. This apparent reduction in alcohol-related harm is suggestive of the effectiveness of the Northern Territory's integrated alcohol harm reduction framework.
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Anaesth Intensive Care · Jan 2021
A survey of self-reported use of cricoid pressure amongst Australian and New Zealand anaesthetists: Attitudes and practice.
We conducted a survey of Australian and New Zealand anaesthetists designed to quantify self-reported use of cricoid pressure (CP) in patients presumed to be at risk of gastric regurgitation, and to ascertain the underlying justifications used to support individual practice. We aimed to identify the perceived benefits and harms associated with the use of CP and to explore the potential impact of medicolegal concerns on clinical decision-making. We also sought to ascertain the views of Australian and New Zealand anaesthetists on whether recommendations relating to CP should be included in airway management guidelines. ⋯ When asked whether participants believed the use of CP reduces the risk of gastric regurgitation, 39.8% indicated yes, 23.8% believed no and 36.3% were unsure. Of the respondents who indicated that they routinely performed CP, 159/267 (60%) indicated that concerns over the potential medicolegal consequences of omitting CP in a patient who subsequently aspirates was one of the main reasons for using CP. The majority (224/337; 66%) of respondents believed that recommendations about the use of CP in airway management guidelines should include individual practitioner judgement, while only 55/337 (16%) respondents believed that routine CP should be advocated in contemporary emergency airway management guidelines.