ABSTRACT
The purpose of intensive care is to provide monitoring and organ support for patients with critical illness from which recovery is possible. Despite increasing technological and pharmacological sophistication, mortality in intensive care units remains high, with significant disability in those who survive. Methods of predicting outcome from intensive care have been developed. These enable patients to be placed in risk groups, but do not accurately predict the outcome of individual patients. That prediction is a clinical judgement based on the underlying disease, the number of body systems failing and the length of time for which intensive care support has been necessary. Once a decision has been made to withhold or withdraw intensive care, the principles of good palliative medicine should be employed during what will then be the inevitable terminal phase of the illness.
Subject(s)
Critical Care , Euthanasia, Passive , APACHE , Critical Care/economics , Critical Illness , Humans , Terminal Care , Treatment OutcomeABSTRACT
We describe the successful use of a guide wire and ureteral dilator to pass a tracheal tube into the trachea through the mouth in an awake, sedated patient when attempts to pass a larger tube over an Olympus LF1 fibreoptic bronchoscope were unsuccessful. Since the ureteral and renal dilators are available in a variety of sizes, if too large a tube is inadvertently mounted on the instrument this technique allows an appropriate sized tube to be inserted without the need to re-endoscope the patient.
Subject(s)
Intubation, Intratracheal/instrumentation , Adult , Bronchoscopy , Consciousness , Dilatation/instrumentation , Female , Fiber Optic Technology , Humans , Intubation, Intratracheal/methods , Nasopharyngeal Neoplasms/diagnosis , UreterABSTRACT
Within a single district health authority all the general practitioners and community registered general nurses were asked to complete a questionnaire regarding awareness and perceptions of a domiciliary hospice service. Responses were received from 127 doctors (71%) and 58 nurses (80%). Awareness of resources offered by the domiciliary hospice service was high, especially among the 102 respondents with access to the service. Eighty per cent or more of general practitioners and community nurses were satisfied with the amount of information received concerning changes in the patient's condition and who was involved in the care process. However, 33% of nurses agreed that it was difficult to know who had overall responsibility for the patient's care and 28% of nurses felt that their own contribution was under-rated. These findings were reinforced by a number of written statements submitted by the nurses. There was a desire expressed by both general practitioners and community nurses for more educational input from the domiciliary service. Overall, assistance from the service was welcomed and its special skills acknowledged. In the future planning of a comprehensive hospice service the differing needs expressed by doctors and nurses should be taken into account.
Subject(s)
Attitude of Health Personnel , Community Health Nursing/statistics & numerical data , Home Care Services/statistics & numerical data , Hospice Care/statistics & numerical data , Physicians, Family/psychology , Clinical Competence , England , Humans , Physicians, Family/statistics & numerical data , Surveys and QuestionnairesSubject(s)
Anesthesiology/education , Critical Care , Education, Medical, Continuing , England , HumansABSTRACT
In the five years 1979-1983, 486 patients were treated by mechanical ventilation in the Intensive Care Unit of a District General Hospital. Of these 43.6% died in the Unit and a further 8.9% died after discharge to the general wards. Sepsis was a major complication in 28% of patients. Renal failure was almost always a fatal complication. Of patients who had a cardiac arrest 80% died. At the end of one year 17.2% of patients had returned to their previously normal life.
Subject(s)
Critical Care , Respiration, Artificial/mortality , Adolescent , Adult , Aged , Child , Child, Preschool , England , Evaluation Studies as Topic , Humans , Infant , Infant, Newborn , Intensive Care Units , Middle Aged , Respiration, Artificial/adverse effectsSubject(s)
Intensive Care Units , Kidney Transplantation , Kidney , Tissue Donors , Tissue and Organ Procurement , Humans , United KingdomSubject(s)
Brain Death , Tissue Donors , Tissue and Organ Procurement , Withholding Treatment , Death , Family , Humans , Nurses , Persistent Vegetative State , Physicians , Reference Standards , United KingdomABSTRACT
It is well recognized that patients presenting for cataract surgery are usually old, with a high incidence of medical disease. This combination is said greatly to increase the risk of general anaesthesia. In an unselected series of patients undergoing cataract surgery, 53.5% had a significant medical problem and 50% were receiving some form of medical treatment. All but three of the patients were given a general anaesthetic. The series is discussed against the background of anaesthetic morbidity. The authors recommend that routine electrocardiograms should be carried out on all patients over 60 years of age.
