Anaesthesia and intensive care
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Early excision of deep burn eschar and the expeditious closure of the resultant wounds have become established as gold standard burn care. However, early burn excision has been accepted as up to four days post injury based on a series of misconceptions, not least that the patient is too unwell to undergo surgery and tolerate anaesthesia too soon after injury. ⋯ The systemic pathophysiology following major burn injury, especially when complicated by the respiratory pathophysiology accompanying smoke inhalation, evolves. The hours immediately after burn injury offer several windows of surgical opportunity, windows closed by the pathophysiological events that peak 24 hours later and make surgery and anaesthesia at that time both dangerous and ill-advised.
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Because the median dose of one vial 'clears the blood of circulating venom', the authors of the Australian Snakebite Project recommend restriction of antivenom to one vial for all envenomated victims. This is neither scientific nor safe. ⋯ The recommendation fails to consider larger doses of venom than that neutralised by one vial of antivenom. Although one vial may be adequate for minor envenomation, the initial dose should be two vials with more on a clinical basis.
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Anaesth Intensive Care · Mar 2020
ReviewChallenges in anaesthesia and pain management for burn injuries.
Burn-injured patients provide unique challenges to those providing anaesthesia and pain management. This review aims to update both the regular burn anaesthetist and the anaesthetist only occasionally involved with burn patients in emergency settings. It addresses some aspects of care that are perhaps contentious in terms of airway management, fluid resuscitation, transfusion practices and pharmacology. Recognition of pain management failures and the lack of mechanism-specific analgesics are discussed along with the opioid crisis as it relates to burns and nonpharmacological methods in the management of distressed patients.
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Anaesth Intensive Care · Mar 2020
ReviewThere is no fire without smoke! Pathophysiology and treatment of inhalational injury in burns: A narrative review.
Smoke inhalation resulting in acute lung injury is a common challenge facing critical care practitioners caring for patients with severe burns, contributing significantly to morbidity and mortality. The intention of this review is to critically evaluate the published literature and trends in the diagnosis, management, implications and novel therapies in caring for patients with inhalation injury.
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Anaesth Intensive Care · Mar 2020
Burnout syndrome and its association with anxiety and fear of medical errors among intensive care unit physicians: A cross-sectional study.
Burnout is a work-specific syndrome with high incidence among intensive care unit personnel. Although several risk factors have been proposed, data regarding the association of anxiety and burnout among intensive care unit physicians are scarce. The aim of this study is to investigate the incidence of burnout and its association with state and trait anxiety and other sociodemographic, behavioural and occupational-related parameters, among intensivists. ⋯ From the 98 intensive care physicians addressed, 80 returned fully completed questionnaires; 26.9% of them presented with high emotional exhaustion, 37.5% with high depersonalisation and 41.5% with low personal accomplishment scores. Trait anxiety, fear of having committed a medical error and self-reporting difficulty when having to act accurately were independently associated with high burnout. In conclusion, burnout is common among intensivists and is associated with specific behavioural characteristics and personality traits, but not with work-related factors.