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- Southern African Journal of Critical Care
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- Volume 24, Issue 1, 2008
Southern African Journal of Critical Care - Volume 24, Issue 1, 2008
Volume 24, Issue 1, 2008
Source: Southern African Journal of Critical Care 24, pp 4 –6 (2008)More Less
Source: Southern African Journal of Critical Care 24, pp 8 –12 (2008)More Less
Summary. Pressure sores are a predictable consequence of poorly managed spinal cord-injured patients. Not only do pressure sores contribute to the morbidity, but also add significantly to the medical / nursing management, cost and admission stay, limiting optimal bed utilisation. This intervention study assesses the impact of active intervention in terms of pressure-relief mattresses, establishment of a 'turning team' and medical / nursing staff education on pressure sore incidence, extended stay and associated costs.
Results. The de novo incidence reduced from 16% to nil once the interventions were in place, with an annualised estimated saving of R738 239, or R4 732 per cervical spine-injured patient admitted.
Conclusion. Active intervention costs are well justified by the cost saving in terms of reduced extended stay days. The routine use of pressure-relieving mattresses and a turning team in the management of spinal cord injuries is recommended.
Author Timothy HardcastleSource: Southern African Journal of Critical Care 24, pp 13 –25 (2008)More Less
Introduction. Recent literature questions the suitability of etomidate as a rapid-sequence intubation (RSI) drug, owing to induced relative adrenal insufficiency (AI) and possible increased mortality.
Aim. This paper examines the evidence for and against etomidate in the shocked emergency patient and whether or not its use should be cautiously considered or abandoned in this patient cohort, given the AI effect. The issue is examined from the perspective of the septic shock patient, the child and the trauma patient.
Method. A literature review focusing on the risk-benefit ratio and whether there are mortality differences in the outcome of patients in whom etomidate is used, that are attributable to the relative adrenal suppression with even a single bolus dose.
Discussion. The evidence of relative AI is clear, but the cause-effect relationship of increased mortality is not as clear. Currently, most evidence is in the context of septic shock, with only retrospective studies in the trauma subgroup, with a small or moderate sample size.
Conclusion. Etomidate should preferably be avoided as an RSI drug in the septic patient, and cautiously considered in the trauma patient, provided that steroid supplementation is provided in the event that vasopressor-resistant shock occurs.
Improving the quality of care of the critically ill patient : implementing the central venous line care bundle in the ICUAuthor Rencia GillespieSource: Southern African Journal of Critical Care 24, pp 26 –31 (2008)More Less
Intravascular (IV) access in the care of the critically ill patient is an intervention that is both life-saving and life-threatening under certain circumstances. Critically ill patients frequently require the administration of intravenous fluids, blood products, medication, nutritional replacement therapy as well as monitoring of the intravascular volume.
Such invasive interventions, together with the critically ill patient's impaired immune system as a result of multiple and complex medications, co-morbid illnesses, prolonged intensive care unit (ICU) admission and multiple intravascular line insertions, make such patients at risk of developing catheter-related bloodstream infections (CRBSIs). According to the Centers for Disease Control (CDC) in the USA, 80 000 central venous catheter (CVC)-associated bloodstream infections (BSIs) occur in American ICUs each year based on an average rate of 5.3 CVC-associated BSIs per 1 000 catheter days in ICU.
South African Critical Care and Thoracic Societies Congress : Cape Town, 5-8 August 2008 : abstractsSource: Southern African Journal of Critical Care 24, pp 32 –40 (2008)More Less