Pub Date : 2015-04-01DOI: 10.1093/bjaceaccp/mku023
Ward Patrick MB ChB BSc FRCA, Hartle Andrew MB ChB FRCA FFICM
{"title":"UK healthcare workers infected with blood-borne viruses: guidance on risk, transmission, surveillance, and management","authors":"Ward Patrick MB ChB BSc FRCA, Hartle Andrew MB ChB FRCA FFICM","doi":"10.1093/bjaceaccp/mku023","DOIUrl":"https://doi.org/10.1093/bjaceaccp/mku023","url":null,"abstract":"","PeriodicalId":100332,"journal":{"name":"Continuing Education in Anaesthesia Critical Care & Pain","volume":"15 2","pages":"Pages 103-108"},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/bjaceaccp/mku023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91717380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-04-01DOI: 10.1093/BJACEACCP/MKU018
A. Stewart, K. Greaves, J. Bromilow
This review will provide an overview of supraventricular tachycardias (SVTs), their classification, diagnostic features, and management in the perioperative period of adult non-cardiac surgery. The term ‘SVT’ refers to paroxysmal tachyarrythmias that require atrial or atrioventricular (AV) nodal tissue, or both, for their initiation and maintenance. The incidence of persistent SVT is 2% before operation and 6% in the postoperative period. In non-cardiac surgery, perioperative arrhythmias are more likely to be supraventricular than ventricular in origin. Atrial arrhythmias occur most frequently 2–3 days post-surgery similar to perioperative acute coronary syndromes and are likely related to sympathetic stimulation associated with an inflammatory response. Other precipitants of SVT often associated with high sympathetic tone are summarized in Table 1. Such arrhythmias are important for the anaesthetist; in particular, atrial fibrillation (AF) is associated with haemodynamic derangement, postoperative stroke, perioperative myocardial infarction, ventricular arrhythmia, heart failure, and longer hospital stay.
{"title":"Supraventricular tachyarrhythmias and their management in the perioperative period","authors":"A. Stewart, K. Greaves, J. Bromilow","doi":"10.1093/BJACEACCP/MKU018","DOIUrl":"https://doi.org/10.1093/BJACEACCP/MKU018","url":null,"abstract":"This review will provide an overview of supraventricular tachycardias (SVTs), their classification, diagnostic features, and management in the perioperative period of adult non-cardiac surgery. The term ‘SVT’ refers to paroxysmal tachyarrythmias that require atrial or atrioventricular (AV) nodal tissue, or both, for their initiation and maintenance. The incidence of persistent SVT is 2% before operation and 6% in the postoperative period. In non-cardiac surgery, perioperative arrhythmias are more likely to be supraventricular than ventricular in origin. Atrial arrhythmias occur most frequently 2–3 days post-surgery similar to perioperative acute coronary syndromes and are likely related to sympathetic stimulation associated with an inflammatory response. Other precipitants of SVT often associated with high sympathetic tone are summarized in Table 1. Such arrhythmias are important for the anaesthetist; in particular, atrial fibrillation (AF) is associated with haemodynamic derangement, postoperative stroke, perioperative myocardial infarction, ventricular arrhythmia, heart failure, and longer hospital stay.","PeriodicalId":100332,"journal":{"name":"Continuing Education in Anaesthesia Critical Care & Pain","volume":"55 1","pages":"90-97"},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87470331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-04-01DOI: 10.1093/bjaceaccp/mku011
Lachlan F Miles MBBS (Hons) PGCertCU, Carlos D Scheinkestel MBBS FRACP FCICM DipDHM, Glenn O Downey MBBS FANZCA
{"title":"Environmental emergencies in theatre and critical care areas: power failure, fire, and explosion","authors":"Lachlan F Miles MBBS (Hons) PGCertCU, Carlos D Scheinkestel MBBS FRACP FCICM DipDHM, Glenn O Downey MBBS FANZCA","doi":"10.1093/bjaceaccp/mku011","DOIUrl":"https://doi.org/10.1093/bjaceaccp/mku011","url":null,"abstract":"","PeriodicalId":100332,"journal":{"name":"Continuing Education in Anaesthesia Critical Care & Pain","volume":"15 2","pages":"Pages 78-83"},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/bjaceaccp/mku011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91759238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-04-01DOI: 10.1093/BJACEACCP/MKU023
Patrick S. Ward, A. Hartle
Occupational exposure of healthcare workers to blood-borne viruses (HIV, Hepatitis B and C) in the healthcare setting is a growing concern that has prompted the Department of Health and Health Protection Agency to instruct a nationwide surveillance scheme, develop a national policy, and implement guidelines. Apportioned equal consideration, although far less common, is the risk of blood-borne viral transmission from infected healthcare workers to patients, which has also warranted Department of Health guidance, to assist infected healthcare workers, and to minimize the risk to patients.
{"title":"UK healthcare workers infected with blood-borne viruses: guidance on risk, transmission, surveillance, and management","authors":"Patrick S. Ward, A. Hartle","doi":"10.1093/BJACEACCP/MKU023","DOIUrl":"https://doi.org/10.1093/BJACEACCP/MKU023","url":null,"abstract":"Occupational exposure of healthcare workers to blood-borne viruses (HIV, Hepatitis B and C) in the healthcare setting is a growing concern that has prompted the Department of Health and Health Protection Agency to instruct a nationwide surveillance scheme, develop a national policy, and implement guidelines. Apportioned equal consideration, although far less common, is the risk of blood-borne viral transmission from infected healthcare workers to patients, which has also warranted Department of Health guidance, to assist infected healthcare workers, and to minimize the risk to patients.","PeriodicalId":100332,"journal":{"name":"Continuing Education in Anaesthesia Critical Care & Pain","volume":"11 1","pages":"103-108"},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81694630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-04-01DOI: 10.1093/BJACEACCP/MKU011
L. Miles, C. Scheinkestel, G. Downey
In 2012, a fire broke out in the intensive care unit (ICU) of the Royal United Hospital, Bath, when a faulty oxygen cylinder placed on a patient bed ignited. The patient sustained burns to the lower limbs, the cubicle sustained substantial structural damage, and the ICU rapidly filled with smoke, necessitating evacuation. Recent studies have highlighted weaknesses in a number of London ICUs due to failures of unit design, equipment, escape routes, drills, and evacuation planning. In the 11 yr between 1994/5 and 2004/5, some 10 662 fires were reported in National Health Service (NHS) facilities costing an estimated £14.6 million. Roughly 500 per annum involved acute care facilities and resulted in 651 injuries and 17 fatalities. In addition to burns and smoke inhalation, a number of other traumatic injuries were sustained during evacuations. These incidents show that environmental emergencies such as power failure, fire, and explosion have the potential to lead to substantial patient morbidity and mortality, and also endangering staff and facilities. Key to the successful management of these environmental emergencies are comprehensive and regular staff training and credentialing, inspections and auditing for environmental risks and evacuation obstacles, and simulations and exercises designed to reveal shortcomings in institutional protocols.
2012年，巴斯皇家联合医院(Royal United Hospital, Bath)的重症监护室(ICU)发生火灾，原因是放在病床上的一个有问题的氧气瓶着火了。患者下肢持续烧伤，隔间持续严重的结构性损伤，ICU迅速充满烟雾，需要疏散。最近的研究强调了由于单元设计、设备、逃生路线、演习和疏散计划的失败，伦敦icu的一些弱点。在1994/5年至2004/5年的11年期间，据报告，国家保健服务设施发生了大约10 662起火灾，损失估计为1 460万英镑。每年大约有500起涉及急性护理设施，造成651人受伤，17人死亡。除了烧伤和吸入烟雾外，在撤离期间还有一些其他创伤。这些事件表明，停电、火灾和爆炸等环境紧急情况有可能导致大量患者发病和死亡，并危及工作人员和设施。成功管理这些环境紧急情况的关键是对工作人员进行全面和定期的培训和颁发证书，对环境风险和疏散障碍进行检查和审计，以及旨在揭示机构规程缺点的模拟和演习。
{"title":"Environmental emergencies in theatre and critical care areas: power failure, fire, and explosion","authors":"L. Miles, C. Scheinkestel, G. Downey","doi":"10.1093/BJACEACCP/MKU011","DOIUrl":"https://doi.org/10.1093/BJACEACCP/MKU011","url":null,"abstract":"In 2012, a fire broke out in the intensive care unit (ICU) of the Royal United Hospital, Bath, when a faulty oxygen cylinder placed on a patient bed ignited. The patient sustained burns to the lower limbs, the cubicle sustained substantial structural damage, and the ICU rapidly filled with smoke, necessitating evacuation. Recent studies have highlighted weaknesses in a number of London ICUs due to failures of unit design, equipment, escape routes, drills, and evacuation planning. In the 11 yr between 1994/5 and 2004/5, some 10 662 fires were reported in National Health Service (NHS) facilities costing an estimated £14.6 million. Roughly 500 per annum involved acute care facilities and resulted in 651 injuries and 17 fatalities. In addition to burns and smoke inhalation, a number of other traumatic injuries were sustained during evacuations. These incidents show that environmental emergencies such as power failure, fire, and explosion have the potential to lead to substantial patient morbidity and mortality, and also endangering staff and facilities. Key to the successful management of these environmental emergencies are comprehensive and regular staff training and credentialing, inspections and auditing for environmental risks and evacuation obstacles, and simulations and exercises designed to reveal shortcomings in institutional protocols.","PeriodicalId":100332,"journal":{"name":"Continuing Education in Anaesthesia Critical Care & Pain","volume":"6 1","pages":"78-83"},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76088566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-04-01DOI: 10.1093/BJACEACCP/MKU016
S. Clarke, S. Kanakarajan
Chronic abdominal pain is a frequently presenting condition in the pain clinics. Patients have often undergone a plethora of investigations, including diagnostic surgery and psychiatric review, before referral to Pain Management Services. Ongoing pain leads to development of central sensitization, which is heightened sensitivity to pain and touch, because of the effect of persistent pain on the neuroplasticity of the central nervous system. It can result in significant anxiety, distress, and loss of work days for the patient. Up to 30% of patients with chronic abdominal pain have pain originating in the abdominal wall 1,2 and abdominal cutaneous nerve entrapment syndrome (ACNES) is the most frequent cause of pain in these cases. 3 This diagnosis can be established from the patient’s history, physical examination, and positive response to local anaesthetic injection. 4 More awareness among clinicians of the abdominal cutaneous nerve entrapment syndrome could lead to earlier diagnosis and prevent the consequences of prolonged investigation and pain.
{"title":"Abdominal cutaneous nerve entrapment syndrome","authors":"S. Clarke, S. Kanakarajan","doi":"10.1093/BJACEACCP/MKU016","DOIUrl":"https://doi.org/10.1093/BJACEACCP/MKU016","url":null,"abstract":"Chronic abdominal pain is a frequently presenting condition in the pain clinics. Patients have often undergone a plethora of investigations, including diagnostic surgery and psychiatric review, before referral to Pain Management Services. Ongoing pain leads to development of central sensitization, which is heightened sensitivity to pain and touch, because of the effect of persistent pain on the neuroplasticity of the central nervous system. It can result in significant anxiety, distress, and loss of work days for the patient. Up to 30% of patients with chronic abdominal pain have pain originating in the abdominal wall 1,2 and abdominal cutaneous nerve entrapment syndrome (ACNES) is the most frequent cause of pain in these cases. 3 This diagnosis can be established from the patient’s history, physical examination, and positive response to local anaesthetic injection. 4 More awareness among clinicians of the abdominal cutaneous nerve entrapment syndrome could lead to earlier diagnosis and prevent the consequences of prolonged investigation and pain.","PeriodicalId":100332,"journal":{"name":"Continuing Education in Anaesthesia Critical Care & Pain","volume":"43 1","pages":"60-63"},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77719157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-04-01DOI: 10.1093/bjaceaccp/mku038
Scott Nick B
{"title":"Reply from the authors","authors":"Scott Nick B","doi":"10.1093/bjaceaccp/mku038","DOIUrl":"https://doi.org/10.1093/bjaceaccp/mku038","url":null,"abstract":"","PeriodicalId":100332,"journal":{"name":"Continuing Education in Anaesthesia Critical Care & Pain","volume":"15 2","pages":"Pages 109-110"},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/bjaceaccp/mku038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91717377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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