Anaesthesia
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Drug related incidents are a common form of reported medical errors. This paper reviews the critical incidents related to drug errors reported from the main operating theatre suite in a teaching hospital in a developing country from January 1997 to December 2002. Each report was evaluated individually by two reviewers using a structured process. ⋯ A total of 76% were classified as preventable; 56% due to human error and 19% due to system error. High risk incidents accounted for 10% of all drug errors and most of these were related to the use of neuromuscular blocking drugs. This analysis has been found useful in addressing some issues about priorities.
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The impact of cricoid pressure on laryngoscopy is unknown. We have developed a quantitative method of recording the laryngoscopic view using a rigid, zero-degree endoscope. We found that an image matching the laryngoscopist's view could be obtained by positioning the endoscope along the laryngoscopist's 'line of sight'. ⋯ We identified five subjects with a good initial view (anteroposterior length of the rima glottidis > 5 mm) who showed a marked deterioration in laryngoscopic view as cricoid pressure increased; in three of these subjects this progressed to obscure the larynx completely at a force of 30 N, 40 N and 60 N, respectively. We conclude that the effect of cricoid pressure on laryngoscopy is complex. However, in some individuals, a force close to that currently recommended (30 N) may cause a complete loss of the glottic view.
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Case Reports
Interaction between infusion equipment resulting in drug overdose in a critically ill patient.
A critically ill septic patient on haemofiltration for acute renal failure suffered sudden circulatory and respiratory collapse. The cause of the collapse was traced to an interaction between mechanical devices (syringe driver infusion pumps and haemofiltration equipment) connected to two central venous catheters.