Crit Care Resusc
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To investigate the resources and infrastructure available for collecting intensive care unit data in New South Wales for submission to the Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database (APD). ⋯ It appears that NSW ICUs are generally not adequately resourced or organised for collecting data, which could significantly affect the quality of data submitted to the ANZICS APD. Further investigation of data quality is warranted, and a follow-up survey of ICU directors is planned. Until the issue of data quality is adequately addressed, outcomes measurement based on these data should be treated with caution.
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To examine practice patterns and workload of practising Australian intensivists and to investigate the risk and prevalence of "burnout syndrome". ⋯ Intensivists are at high risk of burnout syndrome. Recognising the drivers and early signs of burnout and identifying a preventive strategy is a professional priority for ANZICS and the intensive care community.
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A 14-year-old boy with catecholamine-induced polymorphic ventricular tachycardia was treated for hypoxic brain injury after a 25-minute ventricular tachycardia arrest. He had been treated by the local paediatric cardiology service with ?-blockers for syncopal events related to episodes of ventricular tachycardia. ⋯ PtO2 is a reliable and effective clinical assessment tool that can aid in the management of patients with significant cerebral injury. Vasopressin proved a valuable adjunct in treatment of hypoxic brain injury when inotropic agents were contraindicated.
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Case Reports
Paradoxical and severe hypotension in response to adrenaline infusions in massive quetiapine overdose.
Atypical antipsychotics (quetiapine, olanzapine, risperidone and clozapine) are increasingly prescribed in Australia, and emergency departments report growing rates of overdose of these agents. As these drugs are comparatively new, the spectrum of toxicity may be unfamiliar to critical care physicians. Severe hypotension is a recognised consequence of quetiapine poisoning. ⋯ The pharmacodynamics of quetiapine and the literature on overdose are reviewed. We present these cases to broaden the knowledge of physicians treating quetiapine overdose and to publicise the potential deleterious interaction with adrenaline. We recommend use of noradrenaline in preference to adrenaline in pharmacological management of shock in these patients.