Best practice & research. Clinical anaesthesiology
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It is often unclear whether or not a patient's stroke volume will increase following a fluid bolus. Volume responsiveness is defined by an increase in stroke volume following a fluid bolus. ⋯ However, lung-protective ventilation is increasingly being used to avoid the adverse outcomes of higher tidal volume ventilation, and pulse pressure and stroke volume variation do not effectively predict volume responsiveness in the setting of lung-protective ventilation without using special techniques. Dynamic preload assessment is more effective at determining whether a patient will be fluid responsive than static measures of preload, but further studies are needed to more conclusively show that outcomes are improved with this approach to fluid management.
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The haemodynamic state refers to the integration of myocardial and vascular systems, and involves both left and right hearts, and systolic and diastolic phases. The assessment of the haemodynamic state can be performed with echocardiography, and provides a higher level of diagnosis than conventional pressure- and flow-based monitoring. Whilst hypotension alerts the practitioner about the existence of haemodynamic abnormality, it does not provide sufficient information to identify the cause or the underlying haemodynamic state. ⋯ Patients may have an abnormal haemodynamic state (such a systolic failure), but may not need active treatment if they are haemodynamically stable. However, if treatment is required, it can be directed according to the underlying haemodynamic state. For example, a patient with systolic failure may benefit from inotrope support, whereas an empty state acquires volume infusion and vasodilation requires vasopressor support.
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Feedback is an integral part of the educational process. It provides learners with a comparison of their performance to educational goals with the aim of helping them achieve or exceed their goals. Effective feedback is delivered in an appropriate setting, focusses on performance and not the individual, is specific, is based on direct observation or objective date, is delivered using neutral, non-judgemental language and identifies actions or plans for improvement. ⋯ Reflection can help learners process negative feedback and allow them to develop and implement improvement plans. Both delivering and receiving feedback are skills that can be improved with training. Teachers have a duty to provide meaningful feedback to learners; learners should expect feedback and seek it.
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Best Pract Res Clin Anaesthesiol · Sep 2013
European Resuscitation Council (ERC) - the Network to fight against cardiac arrest in Europe.
The ideas of collaboration and formation of scientific societies and registries for cardiac arrest were developed in the 18th century. The European Resuscitation Council (ERC) was formed in 1990. ⋯ NRCs should emphasize and actively participate in acute care training of healthcare professionals and of lay rescuers. Implementation of current resuscitation guidelines should be a priority of each NRC and identification of the weakest link in the chain of survival should be a priority.