Reported mortality of severe COVID-19 pneumonia-associated ARDS is high. This mortality rate increases further in obstetric patients who develop COVID-19 ARDS. We report a case of a postpartum mother who developed life-threatening events while being on respiratory support for severe COVID-19 pneumonia-associated ARDS and made a complete recovery due to the timely diagnosis and efficient interventions.
{"title":"Successful management of a postpartum mother with severe COVID-19 associated ARDS complicated by life-threatening respiratory events","authors":"Kavisha P. Dissanayake, P. T. R. Makuloluwa","doi":"10.4038/slja.v31i2.9277","DOIUrl":"https://doi.org/10.4038/slja.v31i2.9277","url":null,"abstract":"Reported mortality of severe COVID-19 pneumonia-associated ARDS is high. This mortality rate increases further in obstetric patients who develop COVID-19 ARDS. We report a case of a postpartum mother who developed life-threatening events while being on respiratory support for severe COVID-19 pneumonia-associated ARDS and made a complete recovery due to the timely diagnosis and efficient interventions.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135645558","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}
Bhavish Reddy, Leena H. Parate, Suresh Govindswamy
Introduction: Optimal strategy for smooth, cough less extubation is still not well established. We aimed to study the effect of single dose of dexmedetomidine (0.5ug/kg) given prior to extubation on cough response during extubation.Methods: 220 patients undergoing laparoscopic cholecystectomy under general anaesthesia were included in the study. Group D (n=110) received IV dexmedetomidine 0.5ug/kg diluted in 100 ml saline and Group S (n=110) received 100ml saline 15 minutes before extubation. Primary outcome was incidence and severity of cough at the time of extubation. Secondary outcome was haemodynamic parameters and sedation. The severity of cough was graded on a four-point scale. Statistical analysis was performed using chi square test and independent t test.Results: The incidence of coughing was significantly lower in Group D than Group S (49.1% vs.70.9%, p = 0.002). Lower grades of cough was observed more in Group D than Group S (17.2% vs. 30.9% p = 0.018). The mean heart rate and blood pressure were lower in Group D. (p <0.001) Sedation score was similar in both groups. (p=0.07)Conclusion: Use of single bolus dose of dexmedetomidine prior to extubation reduces the incidence and severity of cough grade. In addition, it also attenuated haemodynamic response to tracheal extubation without affecting recovery.
顺畅，少咳嗽拔管的最佳策略仍然没有很好地建立。我们的目的是研究拔管前给予单剂量右美托咪定(0.5ug/kg)对拔管时咳嗽反应的影响。方法:选取全麻下行腹腔镜胆囊切除术的220例患者作为研究对象。D组(n=110)静脉滴注右美托咪定0.5ug/kg，稀释于100ml生理盐水中;S组(n=110)拔管前15分钟静脉滴注生理盐水100ml。主要结局是拔管时咳嗽的发生率和严重程度。次要结果是血流动力学参数和镇静。咳嗽的严重程度按四分制进行分级。统计学分析采用卡方检验和独立t检验。结果:D组咳嗽发生率明显低于S组(49.1% vs.70.9%， p = 0.002)。D组咳嗽程度较低者多于S组(17.2% vs. 30.9% p = 0.018)。d组平均心率和血压较低(p <0.001)，镇静评分两组相似。(p=0.07)结论:拔管前单次给药右美托咪定可降低咳嗽等级的发生率和严重程度。此外，它还能在不影响康复的情况下减弱对气管拔管的血流动力学反应。
{"title":"The Effect of Single-Dose Dexmedetomidine on Cough Response During Tracheal Extubation","authors":"Bhavish Reddy, Leena H. Parate, Suresh Govindswamy","doi":"10.4038/slja.v31i2.9148","DOIUrl":"https://doi.org/10.4038/slja.v31i2.9148","url":null,"abstract":"Introduction: Optimal strategy for smooth, cough less extubation is still not well established. We aimed to study the effect of single dose of dexmedetomidine (0.5ug/kg) given prior to extubation on cough response during extubation.Methods: 220 patients undergoing laparoscopic cholecystectomy under general anaesthesia were included in the study. Group D (n=110) received IV dexmedetomidine 0.5ug/kg diluted in 100 ml saline and Group S (n=110) received 100ml saline 15 minutes before extubation. Primary outcome was incidence and severity of cough at the time of extubation. Secondary outcome was haemodynamic parameters and sedation. The severity of cough was graded on a four-point scale. Statistical analysis was performed using chi square test and independent t test.Results: The incidence of coughing was significantly lower in Group D than Group S (49.1% vs.70.9%, p = 0.002). Lower grades of cough was observed more in Group D than Group S (17.2% vs. 30.9% p = 0.018). The mean heart rate and blood pressure were lower in Group D. (p <0.001) Sedation score was similar in both groups. (p=0.07)Conclusion: Use of single bolus dose of dexmedetomidine prior to extubation reduces the incidence and severity of cough grade. In addition, it also attenuated haemodynamic response to tracheal extubation without affecting recovery.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135645273","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}
Serotonin syndrome or serotonin toxicity is defined as an iatrogenic drug-induced toxidrome associated with increased intrasynaptic serotonin concentration in the central nervous system. Most cases are provoked by therapeutic doses of a combination of two or more serotonergic agents. The incidence of serotonin syndrome is on the rise, because of increased use of serotonergic medications in current clinical practice. However, the actual incidence of perioperative serotonin syndrome and its morbidity are likely unknown. The diagnosis is difficult in the perioperative period, as clinical features may mimic other conditions commonly seen in the perioperative period or may be masked by the use of anaesthetic medications. Therefore, anaesthetists must be proactive in preventing, identifying and managing serotonin syndrome in the perioperative period.
{"title":"Serotonin syndrome: A case report","authors":"Sasika Wijayasinghe, Roshana Mallawaarachchi, Ruwani Dharmabandu","doi":"10.4038/slja.v31i2.9108","DOIUrl":"https://doi.org/10.4038/slja.v31i2.9108","url":null,"abstract":"Serotonin syndrome or serotonin toxicity is defined as an iatrogenic drug-induced toxidrome associated with increased intrasynaptic serotonin concentration in the central nervous system. Most cases are provoked by therapeutic doses of a combination of two or more serotonergic agents. The incidence of serotonin syndrome is on the rise, because of increased use of serotonergic medications in current clinical practice. However, the actual incidence of perioperative serotonin syndrome and its morbidity are likely unknown. The diagnosis is difficult in the perioperative period, as clinical features may mimic other conditions commonly seen in the perioperative period or may be masked by the use of anaesthetic medications. Therefore, anaesthetists must be proactive in preventing, identifying and managing serotonin syndrome in the perioperative period.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135645848","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: Vasopressors are administrated peripherally in hemodynamically unstable patients with sepsis in the initial period. International guidelines are available for peripheral administration of vasopressors, including Surviving Sepsis guidelines 2021.Objective: Assess the ward-based practice regarding peripheral administration of vasopressors in patients with sepsis, in NHSL.Methods: A prospective cross-sectional study, during a period of six weeks in 2022, setting of Medical and surgical wards in NHSL, in a group of 52 patients.Results: Noradrenaline was the vasopressor used for all patients with septic shock. 93% of patients had peripheral noradrenaline infusions for a medium duration of 77.7 hours. Peripheral cannula for noradrenaline was sited in the forearm at 46% and in the dorsum of the hand at 34%. Only 7% had a central line for vasopressors. Other infusions along with noradrenaline in the same cannula were given in 75%. Approximately 90% were monitored hourly during the infusion of vasopressors. ICU referral was done only in 5.7% of patients. Adverse reactions were noted in 38% of patients, all minor complications.Conclusion: Peripheral administration of vasopressors was prolonged compared to standard. Adverse reactions were identified, but all were minor complications.
{"title":"Study on Ward-Based Practice of Vasopressor Administration for Patients with Sepsis, in National Hospital of Sri Lanka (NHSL)","authors":"H. S. Vitharana, Ramya Amarasena","doi":"10.4038/slja.v31i2.9144","DOIUrl":"https://doi.org/10.4038/slja.v31i2.9144","url":null,"abstract":"Background: Vasopressors are administrated peripherally in hemodynamically unstable patients with sepsis in the initial period. International guidelines are available for peripheral administration of vasopressors, including Surviving Sepsis guidelines 2021.Objective: Assess the ward-based practice regarding peripheral administration of vasopressors in patients with sepsis, in NHSL.Methods: A prospective cross-sectional study, during a period of six weeks in 2022, setting of Medical and surgical wards in NHSL, in a group of 52 patients.Results: Noradrenaline was the vasopressor used for all patients with septic shock. 93% of patients had peripheral noradrenaline infusions for a medium duration of 77.7 hours. Peripheral cannula for noradrenaline was sited in the forearm at 46% and in the dorsum of the hand at 34%. Only 7% had a central line for vasopressors. Other infusions along with noradrenaline in the same cannula were given in 75%. Approximately 90% were monitored hourly during the infusion of vasopressors. ICU referral was done only in 5.7% of patients. Adverse reactions were noted in 38% of patients, all minor complications.Conclusion: Peripheral administration of vasopressors was prolonged compared to standard. Adverse reactions were identified, but all were minor complications.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135645415","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}
Intrathecal morphine provides excellent postoperative pain relief but results in pruritus in 30-60% of patients. Nalbuphine, an opioid agonist-antagonist prevents intrathecal morphine-induced itch when given by intravenous route. In this study, we compared efficacy of intrathecal and intravenous nalbuphine for the prevention of intrathecal morphine-induced pruritus. 90 patients were randomly divided into two groups. IT group received 100 mcg of morphine with 400 mcg of nalbuphine intrathecally. IV group received 100 mcg of morphine intrathecally and 400 mcg of nalbuphine intravenously. Incidence of itching, respiratory depression, hypotension, nausea, vomiting, sedation and analgesia were compared between the groups every 4th hourly for 24 hours. Data were analyzed with Chi-square test and Mann-Whitney test. Incidence of itching in 24 hours period was 11.6% (5 patients) in IV group and 4.8% (2 patients) in IT group which was comparable. (P= 0.250) Two patients in IV group had intractable itching requiring naloxone. Incidence of itching at all time intervals was comparable between the groups. Analgesia was prolonged in IV group (P=0.03) Incidence of nausea, vomiting, sedation and respiratory depression was comparable. We conclude that intrathecal nalbuphine and intravenous nalbuphine were equally effective in preventing intrathecal morphine induced pruritus. The duration of analgesia was more when nalbuphine was given by IV route as compared to IT route.
鞘内注射吗啡能很好地缓解术后疼痛，但30-60%的患者会出现瘙痒。纳布啡，一种阿片激动剂-拮抗剂，通过静脉给药可预防鞘内吗啡引起的瘙痒。在这项研究中，我们比较了鞘内注射和静脉注射纳布啡预防鞘内吗啡引起的瘙痒的疗效。90例患者随机分为两组。IT组给予吗啡100 mcg +纳布啡400 mcg的鞘内注射。静脉注射组给予鞘内吗啡100 mcg，静脉注射纳布啡400 mcg。比较各组瘙痒、呼吸抑制、低血压、恶心、呕吐、镇静、镇痛的发生率，每4 h进行一次，持续24 h。资料分析采用卡方检验和Mann-Whitney检验。静脉注射组24 h内瘙痒发生率为11.6%(5例)，静脉注射组为4.8%(2例)，两组比较具有可比性。(P= 0.250)静脉注射组有2例难治性瘙痒需要纳洛酮治疗。各组间瘙痒发生率在所有时间间隔均具有可比性。静脉注射组镇痛时间延长(P=0.03)，恶心、呕吐、镇静、呼吸抑制发生率无明显差异。我们得出结论，鞘内注射纳布啡和静脉注射纳布啡在预防鞘内吗啡引起的瘙痒方面同样有效。静脉给药比IT给药镇痛时间更长。
{"title":"Randomized Double-Blind Trial Comparing Efficacy of Intravenous Nalbuphine vs Intrathecal Nalbuphine for Prevention of Intrathecal Morphine Induced Pruritus in Orthopaedic Surgeries","authors":"Pranjali Kurhekar, J. Shesha dhiviya Krishna","doi":"10.4038/slja.v31i2.9031","DOIUrl":"https://doi.org/10.4038/slja.v31i2.9031","url":null,"abstract":"Intrathecal morphine provides excellent postoperative pain relief but results in pruritus in 30-60% of patients. Nalbuphine, an opioid agonist-antagonist prevents intrathecal morphine-induced itch when given by intravenous route. In this study, we compared efficacy of intrathecal and intravenous nalbuphine for the prevention of intrathecal morphine-induced pruritus. 90 patients were randomly divided into two groups. IT group received 100 mcg of morphine with 400 mcg of nalbuphine intrathecally. IV group received 100 mcg of morphine intrathecally and 400 mcg of nalbuphine intravenously. Incidence of itching, respiratory depression, hypotension, nausea, vomiting, sedation and analgesia were compared between the groups every 4th hourly for 24 hours. Data were analyzed with Chi-square test and Mann-Whitney test. Incidence of itching in 24 hours period was 11.6% (5 patients) in IV group and 4.8% (2 patients) in IT group which was comparable. (P= 0.250) Two patients in IV group had intractable itching requiring naloxone. Incidence of itching at all time intervals was comparable between the groups. Analgesia was prolonged in IV group (P=0.03) Incidence of nausea, vomiting, sedation and respiratory depression was comparable. We conclude that intrathecal nalbuphine and intravenous nalbuphine were equally effective in preventing intrathecal morphine induced pruritus. The duration of analgesia was more when nalbuphine was given by IV route as compared to IT route.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":"221 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135646266","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}
B. Chandana, Prapti Rath, Akshita Niranjan, Sharmila Narayana, C. A. Tejesh
Involuntary movements/myoclonus are brief, short-lived jerky movements and a complication in the post-operative period are seen following central neuraxial blockade causing distress to the patient but is usually self-limiting. We wish to bring cognizance among fellow anesthesiologists regarding this possible, extremely rare complication and also review the available work for its cause and management.Post-spinal myoclonus was witnessed in a young adult patient in their twenties who underwent closed reduction and internal fixation for a right femur shaft fracture under combined spinal-epidural anaesthesia. The patient developed involuntary jerky movements of the right foot 8 hours after the subarachnoid block gradually reduced in the next 24 hours. After ruling out other possible causes of myoclonus, the case was followed up and discharged on postoperative day 5. Post spinal myoclonus though a rare complication can be distressing to the patient and the doctor. It is a self-limiting complication with no residual effects.
{"title":"Myoclonus in the Post-Operative Period: A Case Report","authors":"B. Chandana, Prapti Rath, Akshita Niranjan, Sharmila Narayana, C. A. Tejesh","doi":"10.4038/slja.v31i2.9153","DOIUrl":"https://doi.org/10.4038/slja.v31i2.9153","url":null,"abstract":"Involuntary movements/myoclonus are brief, short-lived jerky movements and a complication in the post-operative period are seen following central neuraxial blockade causing distress to the patient but is usually self-limiting. We wish to bring cognizance among fellow anesthesiologists regarding this possible, extremely rare complication and also review the available work for its cause and management.Post-spinal myoclonus was witnessed in a young adult patient in their twenties who underwent closed reduction and internal fixation for a right femur shaft fracture under combined spinal-epidural anaesthesia. The patient developed involuntary jerky movements of the right foot 8 hours after the subarachnoid block gradually reduced in the next 24 hours. After ruling out other possible causes of myoclonus, the case was followed up and discharged on postoperative day 5. Post spinal myoclonus though a rare complication can be distressing to the patient and the doctor. It is a self-limiting complication with no residual effects.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135646264","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}
An accepted model for predicting the need for postoperative organ support and intensive care, in patients undergoing elective surgery, is lacking worldwide. A reliable tool that could predict the need for postoperative organ support would facilitate the efficient utilisation of ICU beds while ensuring patient safety. The American College of Surgeons - National Quality Improvement Project (ACS-NSQIP) surgical risk calculator is validated for the prediction of the risk of serious complications in the postoperative period. We aimed to validate this calculator to predict the need for post-operative organ support. We obtained perioperative data from 126 patients who underwent elective major general surgery. We calculated the percentage risk of serious complications for each patient using the ACS-NSQIP calculator and correlated it with the level of postoperative organ support needed. The mean predicted percentage risk of serious complications, for the group that did not require any organ support was 10.5% and the group requiring 1 or more organ support was 18.1%. The standard error was 0.49 (p= 0.001). A receiver-operating characteristic (ROC) curve gave an area under the curve of 0.71. We chose a cutoff for the percentage risk of serious complications for needing postoperative organ support and 10.8% was chosen as a fair value as it had a sensitivity of 71.4% and a specificity of 66%. The percentage risk of serious complications calculated by the ACS-NSQIP surgical risk calculator has a strong positive correlation with the need for postoperative organ support. Multi-center data is needed to determine definite cut-offs.
{"title":"Prediction model for the need of postoperative organ support in an adult population undergoing elective major general surgery - Utilizing the American College of Surgeons - National quality improvement project (ACS-NSQIP) surgical risk calculator","authors":"Kavya Galle Kankanamge Botejue, Aloka Pathirana, Shamini Prathapan","doi":"10.4038/slja.v31i2.9243","DOIUrl":"https://doi.org/10.4038/slja.v31i2.9243","url":null,"abstract":"An accepted model for predicting the need for postoperative organ support and intensive care, in patients undergoing elective surgery, is lacking worldwide. A reliable tool that could predict the need for postoperative organ support would facilitate the efficient utilisation of ICU beds while ensuring patient safety. The American College of Surgeons - National Quality Improvement Project (ACS-NSQIP) surgical risk calculator is validated for the prediction of the risk of serious complications in the postoperative period. We aimed to validate this calculator to predict the need for post-operative organ support. We obtained perioperative data from 126 patients who underwent elective major general surgery. We calculated the percentage risk of serious complications for each patient using the ACS-NSQIP calculator and correlated it with the level of postoperative organ support needed. The mean predicted percentage risk of serious complications, for the group that did not require any organ support was 10.5% and the group requiring 1 or more organ support was 18.1%. The standard error was 0.49 (p= 0.001). A receiver-operating characteristic (ROC) curve gave an area under the curve of 0.71. We chose a cutoff for the percentage risk of serious complications for needing postoperative organ support and 10.8% was chosen as a fair value as it had a sensitivity of 71.4% and a specificity of 66%. The percentage risk of serious complications calculated by the ACS-NSQIP surgical risk calculator has a strong positive correlation with the need for postoperative organ support. Multi-center data is needed to determine definite cut-offs.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135645563","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}
Airway management in infants can become more challenging in the presence of congenital anomalies such as hydrocephalus. In this case, we present the extreme airway challenges faced during the intubation of a 7-month-old child with massive hydrocephalus presenting for ventriculoperitoneal (VP) shunt surgery. The C-MAC video laryngoscope (VL) turned out to be the ultimate saviour after the failure of direct laryngoscopy and Airtraq. Paediatric airway management can sometimes be a nightmare for the anaesthesiologist in such scenarios. Early use of rescue devices such as the C-MAC VL can help tide over the crisis.
{"title":"C-MAC VL as Saviour Following Failed Intubation Attempts in an Infant with Huge Hydrocephalous","authors":"Farah Nasreen, Atif Khalid, Sobia Manaal Siddiqui","doi":"10.4038/slja.v31i2.9081","DOIUrl":"https://doi.org/10.4038/slja.v31i2.9081","url":null,"abstract":"Airway management in infants can become more challenging in the presence of congenital anomalies such as hydrocephalus. In this case, we present the extreme airway challenges faced during the intubation of a 7-month-old child with massive hydrocephalus presenting for ventriculoperitoneal (VP) shunt surgery. The C-MAC video laryngoscope (VL) turned out to be the ultimate saviour after the failure of direct laryngoscopy and Airtraq. Paediatric airway management can sometimes be a nightmare for the anaesthesiologist in such scenarios. Early use of rescue devices such as the C-MAC VL can help tide over the crisis.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135645287","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}
Failure or delay in recognition of acutely deteriorating patients in acute care ward setting leads to preventable morbidity, cardiac arrest, and death. Assessment and responding to Early Warning Score (EWS) adapted from National Early Warning Score 2 is implemented at Asiri Surgical Hospital to capture these patients early and escalate their care appropriately. Though a colour-coded EWS chart and a hospital policy are available, gaps in accurate recording, monitoring, and triggering were reported. Thus, a quality improvement project was conducted with the aim of establishing more than 80% accuracy in completing the EWS chart and appropriate clinical response to EWS score in acute care wards at Asiri Surgical Hospital by August 2022.A multidisciplinary team performed a series of Plan-Do-Study-Act cycles focusing on correct documentation and calculation of EWS score and appropriate monitoring and escalation of care. Key drivers for hindering the pathway were identified and addressed. Over the course of the project, correct recording improved from 81.25% to 99.4%, accurate calculation of total EWS score had improved from 79% to 88%, patients who received recommended monitoring as triggered by EWS score improved from 78.8% to 84.6% and escalation of care when EWS score is 5 or more improved from 70.9% to 91.7%.A step improvement in the clinical response to a deteriorating patient in the acute care ward setting at Asiri Surgical Hospital was attained by the successful quality improvement project involving the frontline care providers.
{"title":"A quality improvement project to establish accuracy in completing Early Warning Score chart and appropriate clinical response depending on the score in acute care wards at Asiri Surgical Hospital","authors":"Nimali Lochanie, Kalsara Haresh Abeyasekara, Gayani Senanayaka","doi":"10.4038/slja.v31i2.9132","DOIUrl":"https://doi.org/10.4038/slja.v31i2.9132","url":null,"abstract":"Failure or delay in recognition of acutely deteriorating patients in acute care ward setting leads to preventable morbidity, cardiac arrest, and death. Assessment and responding to Early Warning Score (EWS) adapted from National Early Warning Score 2 is implemented at Asiri Surgical Hospital to capture these patients early and escalate their care appropriately. Though a colour-coded EWS chart and a hospital policy are available, gaps in accurate recording, monitoring, and triggering were reported. Thus, a quality improvement project was conducted with the aim of establishing more than 80% accuracy in completing the EWS chart and appropriate clinical response to EWS score in acute care wards at Asiri Surgical Hospital by August 2022.A multidisciplinary team performed a series of Plan-Do-Study-Act cycles focusing on correct documentation and calculation of EWS score and appropriate monitoring and escalation of care. Key drivers for hindering the pathway were identified and addressed. Over the course of the project, correct recording improved from 81.25% to 99.4%, accurate calculation of total EWS score had improved from 79% to 88%, patients who received recommended monitoring as triggered by EWS score improved from 78.8% to 84.6% and escalation of care when EWS score is 5 or more improved from 70.9% to 91.7%.A step improvement in the clinical response to a deteriorating patient in the acute care ward setting at Asiri Surgical Hospital was attained by the successful quality improvement project involving the frontline care providers.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":"19U 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135645838","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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