Aims: A systematized review aimed to identify the impact of basic electrocardiogram (ECG) training courses on qualified nurses. Background: ECG plays a crucial role in helping to diagnose, follow-up, and detect any abnormalities in patients' conditions. Nurses often work on the frontline in hospitals and are the ones who initially assess patients' conditions. According to the British Heart Foundation (n. d), 26% of all mortality in the UK is attributable to heart and circulatory diseases. Methodology: A comprehensive, systematized review was undertaken using the AMED, EMBASE, CINAHL, and MEDLINE databases. Thematic analysis was then used to synthesis the findings from the studies selected. Ten papers were selected following the application of inclusion and exclusion criteria. Conclusion: Basic ECG training courses were found to improve nurses' knowledge, compared to those who did not possess ECG training, the quality of care was seen better among nurses who had received ECG courses, and even patient outcomes were improved in the total number of myocardial infarction events in hospital which was decreased compared to before the intervention. Cardiac care nurses had better ECG interpretation skills than other nurses regardless if they took ECG courses or not.
{"title":"A systematized review aimed to identify the impact of basic electrocardiogram training courses on qualified nurses","authors":"F. Alanezi","doi":"10.4103/SCCJ.SCCJ_2_19","DOIUrl":"https://doi.org/10.4103/SCCJ.SCCJ_2_19","url":null,"abstract":"Aims: A systematized review aimed to identify the impact of basic electrocardiogram (ECG) training courses on qualified nurses. Background: ECG plays a crucial role in helping to diagnose, follow-up, and detect any abnormalities in patients' conditions. Nurses often work on the frontline in hospitals and are the ones who initially assess patients' conditions. According to the British Heart Foundation (n. d), 26% of all mortality in the UK is attributable to heart and circulatory diseases. Methodology: A comprehensive, systematized review was undertaken using the AMED, EMBASE, CINAHL, and MEDLINE databases. Thematic analysis was then used to synthesis the findings from the studies selected. Ten papers were selected following the application of inclusion and exclusion criteria. Conclusion: Basic ECG training courses were found to improve nurses' knowledge, compared to those who did not possess ECG training, the quality of care was seen better among nurses who had received ECG courses, and even patient outcomes were improved in the total number of myocardial infarction events in hospital which was decreased compared to before the intervention. Cardiac care nurses had better ECG interpretation skills than other nurses regardless if they took ECG courses or not.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125991521","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}
Background: In recent years, patients' safety has become high priority for health-care organizations. It has been documented that poor knowledge and compliance of health-care providers toward hand hygiene have contributed to poor patient safety outcomes. College students of health sciences may not receive adequate education and training on hand hygiene best practices. Objectives: To assess the health profession students' knowledge, attitude, and practice toward hand hygiene and to investigate the factors associated with poor hand hygiene knowledge and practice. Methods: This cross-sectional, correlational, descriptive study was conducted at King Saud Bin Abdulaziz University for Health Sciences performing clinical rotations at King Abdulaziz Medical City in Riyadh, Saudi Arabia. A proportional sampling was used to calculate the required proportions that reflect the size of student population form each of the three colleges. A total of 270 students including 140 medical, 83 nursing, and 47 respiratory therapy students who were selected using a simple random sampling method were included in the study. An adapted and validated knowledge, attitude, and practice (KAP) questionnaire was used to assess four domains: general information, knowledge, self-reported compliance to the WHO 5 Moments of Hand Hygiene, and general satisfaction on received education. Results: The overall average of knowledge score was 81.13 points out of 100. The results revealed that the knowledge score of hand hygiene was higher for nursing school (84.22 ± 12.98), followed by medical school (81.71 ± 11.31) and then respiratory therapy program (75.53 ± 11.76). The results also showed that students who took courses covering hand hygiene scored higher in knowledge score (83.28 ± 11.3) as compared to students who did not take such courses (75.16 ± 12.89). In the compliance domain, the results showed that there were no significant differences in compliance of hand hygiene between students in all categories. In terms of overall student satisfaction with hand hygiene education and training, the results showed that nursing students have higher satisfaction score (72.7%) than their counterparts in medical school (48.3%) and respiratory therapy program (49.7%). Conclusion: Hand hygiene knowledge among students was generally good, and the highest was among nursing students and the lowest among respiratory therapy students. The compliance of students toward the WHO 5 Moments of Hand Hygiene did not vary across different colleges. Improved knowledge was found to be associated with improved compliance with hand hygiene best practices. Recommendations: Increasing the academic focus on hand hygiene in both the curriculum and clinical rotations with periodic standardized educational courses and focusing on hands-on workshops could have a positive impact on the knowledge and practice of hand hygiene for current health sciences students and future health-care providers. Future studies are needed t
{"title":"Assessment of knowledge, attitude, and practice of hand hygiene among medical and health profession students at King Saud Bin Abdulaziz University for Health Sciences in Saudi Arabia","authors":"Mohammed Humran, Khalid A Alahmary","doi":"10.4103/SCCJ.SCCJ_6_19","DOIUrl":"https://doi.org/10.4103/SCCJ.SCCJ_6_19","url":null,"abstract":"Background: In recent years, patients' safety has become high priority for health-care organizations. It has been documented that poor knowledge and compliance of health-care providers toward hand hygiene have contributed to poor patient safety outcomes. College students of health sciences may not receive adequate education and training on hand hygiene best practices. Objectives: To assess the health profession students' knowledge, attitude, and practice toward hand hygiene and to investigate the factors associated with poor hand hygiene knowledge and practice. Methods: This cross-sectional, correlational, descriptive study was conducted at King Saud Bin Abdulaziz University for Health Sciences performing clinical rotations at King Abdulaziz Medical City in Riyadh, Saudi Arabia. A proportional sampling was used to calculate the required proportions that reflect the size of student population form each of the three colleges. A total of 270 students including 140 medical, 83 nursing, and 47 respiratory therapy students who were selected using a simple random sampling method were included in the study. An adapted and validated knowledge, attitude, and practice (KAP) questionnaire was used to assess four domains: general information, knowledge, self-reported compliance to the WHO 5 Moments of Hand Hygiene, and general satisfaction on received education. Results: The overall average of knowledge score was 81.13 points out of 100. The results revealed that the knowledge score of hand hygiene was higher for nursing school (84.22 ± 12.98), followed by medical school (81.71 ± 11.31) and then respiratory therapy program (75.53 ± 11.76). The results also showed that students who took courses covering hand hygiene scored higher in knowledge score (83.28 ± 11.3) as compared to students who did not take such courses (75.16 ± 12.89). In the compliance domain, the results showed that there were no significant differences in compliance of hand hygiene between students in all categories. In terms of overall student satisfaction with hand hygiene education and training, the results showed that nursing students have higher satisfaction score (72.7%) than their counterparts in medical school (48.3%) and respiratory therapy program (49.7%). Conclusion: Hand hygiene knowledge among students was generally good, and the highest was among nursing students and the lowest among respiratory therapy students. The compliance of students toward the WHO 5 Moments of Hand Hygiene did not vary across different colleges. Improved knowledge was found to be associated with improved compliance with hand hygiene best practices. Recommendations: Increasing the academic focus on hand hygiene in both the curriculum and clinical rotations with periodic standardized educational courses and focusing on hands-on workshops could have a positive impact on the knowledge and practice of hand hygiene for current health sciences students and future health-care providers. Future studies are needed t","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130302109","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}
Urethral strictures are fairly common in elderly males getting admitted to the intensive care unit. Urethral catheterization is mostly done as a blind procedure and often leads to urethral trauma and, sometimes, false channelization in a patient who is many a time sedated, intubated, and is unable to tell about extreme of pain occurring which could warn the handler. Fluoroscopy is utilized in difficult situations to aid insertion, but this is not always an option for patients in intensive care units. The scope of ultrasonography is expanding in the practice of critical care. We used point-of-care ultrasound to confirm the position of guidewire before dilatation, in order to prevent dilatation of false passage.
{"title":"Role of point-of-care ultrasound to prevent dilatation of false passage in a critically ill patient with urethral stricture","authors":"D. Midha, A. Kumar, A. Mandal","doi":"10.4103/SCCJ.SCCJ_29_18","DOIUrl":"https://doi.org/10.4103/SCCJ.SCCJ_29_18","url":null,"abstract":"Urethral strictures are fairly common in elderly males getting admitted to the intensive care unit. Urethral catheterization is mostly done as a blind procedure and often leads to urethral trauma and, sometimes, false channelization in a patient who is many a time sedated, intubated, and is unable to tell about extreme of pain occurring which could warn the handler. Fluoroscopy is utilized in difficult situations to aid insertion, but this is not always an option for patients in intensive care units. The scope of ultrasonography is expanding in the practice of critical care. We used point-of-care ultrasound to confirm the position of guidewire before dilatation, in order to prevent dilatation of false passage.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"109 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129273303","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}
Axillary pseudoaneurysm (PSA) is a rare condition that mainly presents with traumatic injury. In this case report, we show an iatrogenic axillary PSA, following an intra-arterial line (A-line) removal. A 75-year-old with an extensive past medical history including diabetes hypertension, peripheral vascular disease, and atrial fibrillation on Warfarin came to the hospital for an elective abdominal aortic aneurism repair. During her postsurgical stay, she had multiple A-line placements due to recurrent malfunctions and ended up having an axillary A-line. The development of a PSA complicated the removal of the line; an infrequent complication. This was treated with thrombin injection a couple of times after which homeostasis was achieved. Although axillary PSAs are rare, especially iatrogenic ones, individual attention and care should be taken while handling axillary A-lines. Furthermore, one should have a low level of suspicion, especially in patients with multiple predisposing risk factors such as ours.
{"title":"Rare case of axillary pseudoaneurysm subsequent to an intra-arterial percutaneous cannulation","authors":"A. Badeeb, Abdullah Taiyeb, J. Hudcova","doi":"10.4103/SCCJ.SCCJ_26_18","DOIUrl":"https://doi.org/10.4103/SCCJ.SCCJ_26_18","url":null,"abstract":"Axillary pseudoaneurysm (PSA) is a rare condition that mainly presents with traumatic injury. In this case report, we show an iatrogenic axillary PSA, following an intra-arterial line (A-line) removal. A 75-year-old with an extensive past medical history including diabetes hypertension, peripheral vascular disease, and atrial fibrillation on Warfarin came to the hospital for an elective abdominal aortic aneurism repair. During her postsurgical stay, she had multiple A-line placements due to recurrent malfunctions and ended up having an axillary A-line. The development of a PSA complicated the removal of the line; an infrequent complication. This was treated with thrombin injection a couple of times after which homeostasis was achieved. Although axillary PSAs are rare, especially iatrogenic ones, individual attention and care should be taken while handling axillary A-lines. Furthermore, one should have a low level of suspicion, especially in patients with multiple predisposing risk factors such as ours.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"93 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116265646","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}
High-altitude sickness can present with numerous symptoms ranging from headache, blurring of vision, dyspnea on exertion to more critical events such as pulmonary edema and cerebral edema. Rapid ascent, high altitudes of >2500 m, and previous lung disorders are the predisposing factors. Rapid and aggressive management forms the core treatment. Mechanical ventilation should be instituted at the earliest to prevent fatal consequences. Most of the cases are managed at medical centers at high altitudes only. Utmost coordination is required between centers for rapid management. Here, we report a case which was referred to our institute located at foothills with high-altitude pulmonary edema for intensive management.
{"title":"Essence of time in high altitude pulmonary edema – A case report","authors":"U. Rathi, R. Gill, R. Saroa, Puja Saxena","doi":"10.4103/SCCJ.SCCJ_31_18","DOIUrl":"https://doi.org/10.4103/SCCJ.SCCJ_31_18","url":null,"abstract":"High-altitude sickness can present with numerous symptoms ranging from headache, blurring of vision, dyspnea on exertion to more critical events such as pulmonary edema and cerebral edema. Rapid ascent, high altitudes of >2500 m, and previous lung disorders are the predisposing factors. Rapid and aggressive management forms the core treatment. Mechanical ventilation should be instituted at the earliest to prevent fatal consequences. Most of the cases are managed at medical centers at high altitudes only. Utmost coordination is required between centers for rapid management. Here, we report a case which was referred to our institute located at foothills with high-altitude pulmonary edema for intensive management.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131318204","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}
Introduction: Hand hygiene (HH) has been characterized as the keystone and starting point in all infection control programs, with the hands of health-care faculty being the handler and advocates of infection in critically ill patients. Materials and Methods: This was a cross-sectional observational study using direct observation technique. A single observer collected all HH data. This single-observer study was conducted in the 45-bedded intensive care unit (ICU) of Mahatma Gandhi Hospital. HH compliance was monitored using the hand hygiene observation form developed by the World Health Organization. A nonidentified observer was used for monitoring compliance with HH. Results and Discussion: A total of 900 observations were recorded from health-care personnel in ICU. With respect to the personnel, the nursing department had the highest number of observations as 400 circulating nurses were sampled. There were also 110 senior consultants, 250 resident doctors, and 140 paramedical staffs. Of the total opportunities, nurses had the highest number of contacts (67%), followed by allied health-care workers (82.94%). The average compliance was about 75%, which differed significantly among health-care workers, with higher compliance among the nursing staff (82.9%) followed by allied staff (67%). Of the average overall compliance of 75%, maximum compliance was seen for moment 3, that is, the staffs were very careful after body fluid contact as it was perceived important for self-protection. The HH instances after patient contact (86.29%) also suggested similarly. The nurses' compliance was 64.40% before patient contact and 68.35% after touching surroundings. Conclusion: The observance of HH is still low in our local environment. Handwashing practices in our study show that health-care workers pay attention to HH, when it appears, there is a direct observable threat to their well-being. Educational programs need to be developed to address the issue of poor HH.
{"title":"A study of hand hygiene technique in intensive care unit of a tertiary care hospital","authors":"S. Vaya, J. Jeswani","doi":"10.4103/SCCJ.SCCJ_28_18","DOIUrl":"https://doi.org/10.4103/SCCJ.SCCJ_28_18","url":null,"abstract":"Introduction: Hand hygiene (HH) has been characterized as the keystone and starting point in all infection control programs, with the hands of health-care faculty being the handler and advocates of infection in critically ill patients. Materials and Methods: This was a cross-sectional observational study using direct observation technique. A single observer collected all HH data. This single-observer study was conducted in the 45-bedded intensive care unit (ICU) of Mahatma Gandhi Hospital. HH compliance was monitored using the hand hygiene observation form developed by the World Health Organization. A nonidentified observer was used for monitoring compliance with HH. Results and Discussion: A total of 900 observations were recorded from health-care personnel in ICU. With respect to the personnel, the nursing department had the highest number of observations as 400 circulating nurses were sampled. There were also 110 senior consultants, 250 resident doctors, and 140 paramedical staffs. Of the total opportunities, nurses had the highest number of contacts (67%), followed by allied health-care workers (82.94%). The average compliance was about 75%, which differed significantly among health-care workers, with higher compliance among the nursing staff (82.9%) followed by allied staff (67%). Of the average overall compliance of 75%, maximum compliance was seen for moment 3, that is, the staffs were very careful after body fluid contact as it was perceived important for self-protection. The HH instances after patient contact (86.29%) also suggested similarly. The nurses' compliance was 64.40% before patient contact and 68.35% after touching surroundings. Conclusion: The observance of HH is still low in our local environment. Handwashing practices in our study show that health-care workers pay attention to HH, when it appears, there is a direct observable threat to their well-being. Educational programs need to be developed to address the issue of poor HH.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"506 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124463042","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}
A. Deeb, E. Al Qasim, Lara Y. Afesh, S. Abdukahil, M. Sadat, Y. Arabi
Critical care research is growing around the world including Saudi Arabia. The objective of this review is to discuss the building capacity in critical care research coordination in Saudi Arabia as a part of the research strategy of the Saudi Critical Care Trials Group (SCCTG). The SCCTG was developed to promote high impact critical care research in Saudi Arabia and to facilitate collaboration in national and international clinical research. Well-organized coordination between all parties is necessary by the presence of qualified clinical research coordinator (CRC). Critical care has unique features that make clinical research conduct more complex and demanding. It is a high-risk area with increased potentiality of error or adverse events occurrence. Critical care providers such as critical care nurses, critical care pharmacists, respiratory therapists, critical care physiotherapists, or intensive care unit physicians with added skills may be appropriate candidates to handle CRC roles in critical care setting. These skills include but not limited to data collection, obtaining consent, patient assessment, patient screening for the study eligibility, data entry, ethics submissions, providing teaching regarding the study protocol and research topics to clinical staff, attending to regulatory requirements, and designing data collection tools. The SCCTG shall focus on training the clinical research coordination skills through providing specialized courses and workshops that enable different hospitals to conduct and participate in clinical research. It will also help developing network group to connect critical care CRCs in Saudi Arabia and worldwide.
{"title":"Building capacity in critical care research coordination in Saudi Arabia: The role of the Saudi critical care trials group","authors":"A. Deeb, E. Al Qasim, Lara Y. Afesh, S. Abdukahil, M. Sadat, Y. Arabi","doi":"10.4103/SCCJ.SCCJ_30_18","DOIUrl":"https://doi.org/10.4103/SCCJ.SCCJ_30_18","url":null,"abstract":"Critical care research is growing around the world including Saudi Arabia. The objective of this review is to discuss the building capacity in critical care research coordination in Saudi Arabia as a part of the research strategy of the Saudi Critical Care Trials Group (SCCTG). The SCCTG was developed to promote high impact critical care research in Saudi Arabia and to facilitate collaboration in national and international clinical research. Well-organized coordination between all parties is necessary by the presence of qualified clinical research coordinator (CRC). Critical care has unique features that make clinical research conduct more complex and demanding. It is a high-risk area with increased potentiality of error or adverse events occurrence. Critical care providers such as critical care nurses, critical care pharmacists, respiratory therapists, critical care physiotherapists, or intensive care unit physicians with added skills may be appropriate candidates to handle CRC roles in critical care setting. These skills include but not limited to data collection, obtaining consent, patient assessment, patient screening for the study eligibility, data entry, ethics submissions, providing teaching regarding the study protocol and research topics to clinical staff, attending to regulatory requirements, and designing data collection tools. The SCCTG shall focus on training the clinical research coordination skills through providing specialized courses and workshops that enable different hospitals to conduct and participate in clinical research. It will also help developing network group to connect critical care CRCs in Saudi Arabia and worldwide.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121456647","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}
Rupali Lahoria, S. Pandove, D. Bhasin, Harpal Singh, Surinder Singh, Rajit Jhingan
Drugs are one of the rare precipitating factors for diabetic ketoacidosis (DKA) in diabetes mellitus. Medications causing DKA are corticosteroids, pentamidine, clozapine, etc. Even rare is for an oral hypoglycemic agent to cause DKA, but since the approval of the first-in-class drug in 2013, data have emerged suggesting that sodium glucose transporter-2 inhibitors, including canagliflozin, may lead to DKA. This is a case of a 46-year-old male patient who was admitted to the intensive care unit with signs and symptoms suggestive of DKA. He was recently started on canagliflozin. He had a blood glucose level of 243 mg/dl, urine was positive for ketones, and his arterial blood gas was suggestive of high anion gap metabolic acidosis. All the precipitating causes of DKA were ruled out. Based on the above findings and laboratory results, the possibility of canagliflozin-induced ketoacidosis was kept and managed on the lines of DKA.
{"title":"Euglycemic diabetic ketoacidosis caused by canagliflozin: A rare case report","authors":"Rupali Lahoria, S. Pandove, D. Bhasin, Harpal Singh, Surinder Singh, Rajit Jhingan","doi":"10.4103/SCCJ.SCCJ_20_18","DOIUrl":"https://doi.org/10.4103/SCCJ.SCCJ_20_18","url":null,"abstract":"Drugs are one of the rare precipitating factors for diabetic ketoacidosis (DKA) in diabetes mellitus. Medications causing DKA are corticosteroids, pentamidine, clozapine, etc. Even rare is for an oral hypoglycemic agent to cause DKA, but since the approval of the first-in-class drug in 2013, data have emerged suggesting that sodium glucose transporter-2 inhibitors, including canagliflozin, may lead to DKA. This is a case of a 46-year-old male patient who was admitted to the intensive care unit with signs and symptoms suggestive of DKA. He was recently started on canagliflozin. He had a blood glucose level of 243 mg/dl, urine was positive for ketones, and his arterial blood gas was suggestive of high anion gap metabolic acidosis. All the precipitating causes of DKA were ruled out. Based on the above findings and laboratory results, the possibility of canagliflozin-induced ketoacidosis was kept and managed on the lines of DKA.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116715679","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}
Raghu Kondle, D. Madhusudana, P. Shreevani, G. Reddy
Aim: India is predominantly an agricultural country; pesticides and insecticides are abundantly used during cultivation. The adult mortality rate due to mixed drug poisoning in rural south India is 0.97/1000 persons/year. Only 70%–80% of patients admitted to hospitals survive. The present study is undertaken to identifying the association of laboratory parameters with different poisoning etiologies which may help in predicting the need for ventilator support to reduce the mortality by timely entry into emergency department (ED). Materials and Methods: A prospective study on the mixed poisoning of 964 cases was done in the ED at Narayana Medical College Hospital, Nellore, Andhra Pradesh, for 8 years (from 2009 to Jan 2016). Clinical and laboratory data were recorded for all patients on admission (time 0) and 24 h later (time 24). The severity of patients graded according to the Glasgow Coma Scale (GCS) classification. Results: Among 964 patients, in the present study, the majority of the patients in the study group were males, and higher age group affected was 40–50 years. Agricultural farmers and rural residents were highly consumed pesticides. In the study, ingestion poisoning 95% had common occurrences than inhalation poisoning 5%. In severity categorization, we observed that 28.4% of patients were in mild condition, 55.6% in moderate, and 16% in severe. Mean, GCS scoring system was statistically significant between time 0 and time 24 in the survivors. Low GCS at admission was vulnerable for ventilator support. Cholinesterase activity was measured significantly depressed in the Grade 1, 2, and 3. Conclusions: The present study concludes that the need for ventilatory support in organophosphoros poisoning was significantly more in patients who consumed chlorpyrifos methyl parathion compounds, airway edema secondary to hair dye poisoning, presence of cholinergic crisis, GCS score of <6, and cardiovascular collapse secondary to aluminum poisoning.
{"title":"Analysis of emergency laboratory parameters of various poisonings in tertiary care teaching hospital","authors":"Raghu Kondle, D. Madhusudana, P. Shreevani, G. Reddy","doi":"10.4103/SCCJ.SCCJ_13_18","DOIUrl":"https://doi.org/10.4103/SCCJ.SCCJ_13_18","url":null,"abstract":"Aim: India is predominantly an agricultural country; pesticides and insecticides are abundantly used during cultivation. The adult mortality rate due to mixed drug poisoning in rural south India is 0.97/1000 persons/year. Only 70%–80% of patients admitted to hospitals survive. The present study is undertaken to identifying the association of laboratory parameters with different poisoning etiologies which may help in predicting the need for ventilator support to reduce the mortality by timely entry into emergency department (ED). Materials and Methods: A prospective study on the mixed poisoning of 964 cases was done in the ED at Narayana Medical College Hospital, Nellore, Andhra Pradesh, for 8 years (from 2009 to Jan 2016). Clinical and laboratory data were recorded for all patients on admission (time 0) and 24 h later (time 24). The severity of patients graded according to the Glasgow Coma Scale (GCS) classification. Results: Among 964 patients, in the present study, the majority of the patients in the study group were males, and higher age group affected was 40–50 years. Agricultural farmers and rural residents were highly consumed pesticides. In the study, ingestion poisoning 95% had common occurrences than inhalation poisoning 5%. In severity categorization, we observed that 28.4% of patients were in mild condition, 55.6% in moderate, and 16% in severe. Mean, GCS scoring system was statistically significant between time 0 and time 24 in the survivors. Low GCS at admission was vulnerable for ventilator support. Cholinesterase activity was measured significantly depressed in the Grade 1, 2, and 3. Conclusions: The present study concludes that the need for ventilatory support in organophosphoros poisoning was significantly more in patients who consumed chlorpyrifos methyl parathion compounds, airway edema secondary to hair dye poisoning, presence of cholinergic crisis, GCS score of <6, and cardiovascular collapse secondary to aluminum poisoning.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"219 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117000456","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}
Chronic subdural hematoma (SDH) is associated with trauma, antiplatelet therapy, anticoagulant medications, long-term alcohol abuse, arteriovenous malformations, and even postcraniotomy. However, SDH associated with imatinib mesylate (IM) treatment for chronic myeloid leukemia (CML) is rare that too in the remission phase of CML is even rarer. Among the cases of CML in remission phase, the literature review of those with SDH revealed that IM was taken in a dose of 800 mg per day. We report a case of SDH in a 70-year-old gentleman who was in the chronic remission phase of CML and was treated with IM 400 mg per day by hematologist.
{"title":"Low-dose imatinib mesylate causing subdural hematoma in remission phase of chronic myeloid leukemia: A rare phenomenon","authors":"V. Mishra, R. Singh, Souvik Chaudhuri, M. Sinha","doi":"10.4103/SCCJ.SCCJ_19_18","DOIUrl":"https://doi.org/10.4103/SCCJ.SCCJ_19_18","url":null,"abstract":"Chronic subdural hematoma (SDH) is associated with trauma, antiplatelet therapy, anticoagulant medications, long-term alcohol abuse, arteriovenous malformations, and even postcraniotomy. However, SDH associated with imatinib mesylate (IM) treatment for chronic myeloid leukemia (CML) is rare that too in the remission phase of CML is even rarer. Among the cases of CML in remission phase, the literature review of those with SDH revealed that IM was taken in a dose of 800 mg per day. We report a case of SDH in a 70-year-old gentleman who was in the chronic remission phase of CML and was treated with IM 400 mg per day by hematologist.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116049216","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}
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