Ann Acad Med Singap
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Ann Acad Med Singap · May 1998
Case ReportsFive paediatric case reports of the use of adenosine in supraventricular tachycardia.
The efficacy, safety and diagnostic usefulness of adenosine in the treatment of supraventricular tachycardia in children were prospectively studied over a 2-year period. Only patients who were stable and without hypotension were included. Adenosine was given at a dose of 0.1 mg/kg and increased to 0.2 mg/kg for the second and third doses if there was no response. ⋯ One out of 3 patients who were old enough to report side-effects, experienced chest discomfort and dizziness lasting 5 seconds. All side-effects were transient and mild. We concluded that adenosine is effective and safe in terminating supraventricular tachycardia in children after vagal manoeuvres have failed.
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Ann Acad Med Singap · May 1998
APACHE II and SAPS II are poorly calibrated in a Hong Kong intensive care unit.
This study seeks to determine if the Acute Physiology and Chronic Health Evaluation II (APACHE II) and the new Simplified Acute Physiology Score (SAPS II) model predictions are well calibrated in our adult Intensive Care Unit (ICU) patient population. 1064 successive ICU discharges were enrolled with 222 deaths at hospital discharge. APACHE II predicted 287.44 deaths, thus giving an APACHE II standardised mortality ratio (SMR) of 0.77 (95% confidence interval +/- 0.07). ⋯ The area under the Receiver Operating Characteristic plot for SAPS II risk of death was 0.87 (95% confidence interval +/- 0.028) while that for APACHE II risk of death was 0.88 (95% confidence interval +/- 0.026). Although the APACHE II and SAPS II models provide good discriminatory performance this study finds the APACHE II and SAPS II models to be poorly calibrated in that they over-predict mortality in our ICU population.
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Ann Acad Med Singap · May 1998
Comparative StudyA retrospective study of near-drowning victims admitted to the intensive care unit.
A retrospective study was conducted to evaluate the outcome of near-drowning patients admitted to the intensive care unit (ICU) comparing seawater and freshwater drownings. A chart review was used to identify near-drowning patients admitted to ICU from 1 April 1989 to 1 May 1996 for biodata, physiological data and outcome. Seventeen near-drowning patients were admitted to ICU over a period of nearly 7 years. ⋯ Patients that survived to hospital discharge had full neurological recovery and stayed an average of 4.5 days. We concluded that near-drowning victims that survive to be admitted to ICU have significant oxygenation defect with nearly half requiring ventilatory support. Mortality is appreciable, but those that survive to hospital discharge had full neurological recovery.
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Ann Acad Med Singap · Mar 1998
ReviewInterventional electrophysiology and its role in the treatment of cardiac arrhythmia.
Cardiac arrhythmias can present as benign ectopics or as life-threatening arrhythmias and sudden cardiac death. Clinical cardiac electrophysiology is the study of the electrophysiology of the heart and all aspects of management of cardiac arrhythmias. The invasive electrophysiological study was initially purely diagnostic, but recent advances in technology has allowed us to intervene and hence the term interventional electrophysiology. ⋯ In conclusion, interventional electrophysiology represents a tremendous leap forward in the management of cardiac arrhythmias. With catheter ablation, it offers a safe curative therapy for patients with recurrent SVTs and VTs and with the ICD, prevents sudden cardiac death in patients who have been resuscitated from it or who are at risk for it. The future will see us improving our success in ablating patients with monomorphic ischaemic VT and even atrial fibrillation, and the role of prophylactic ICDs in high risk patients will be better defined.
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An ideal analgesic for labour would preferably be non-invasive, as effective as spinals and epidurals without their attendant complications and is safe to mother and child and should not complicate the labour process. Analgesia for labouring women ranges from the use of opioid injections to invasive methods, chiefly epidural injections. Each has its advantages and drawbacks. ⋯ They are known to improve maternal satisfaction because of preservation of motor power. Ambulation may help with cervical dilatation and engagement, and abolition of backpain, among other advantages. This article describes the methods of establishing mobile epidurals and offers guidelines on safe ambulation and contraindications to its use.