Emergency pharmacology for the CT technologist.

The scope of practice of the medical radiation practitioner demands knowledge and understanding of the indications, contraindications, warnings, precautions, proper use, drug interactions and adverse reactions of a variety of medications. The risk of patient deterioration or acute emergent event, particularly following contrast administration, makes the command of crash cart medications particularly important. This article explores the pharmacological principles of medications most likely to be required in a medical emergency in the medical radiation department and in particular by the computed tomography (CT) technologist. The article also outlines early warning signs to assist in identifying the emergent or deteriorating patient. The learning outlined is designed to equip medical radiation practitioners with the capacity to identify and respond to a medical emergency typical of the medical radiation department, and to respond to that situation with the appropriate use of emergency medications where appropriate. The ability of medical radiation practitioners to recognise and respond to (including the use of medicines) the deteriorating patient or circumstances of a medically urgent nature are key capabilities required to meet minimum standards for Medical Radiation Practice Board of Australia registration and National Safety and Quality Health Service standards.

A "Neurological Emergency Trolley" reduces turnaround time for high-risk medications in a general intensive care unit.

OBJECTIVES: To reduce medication turnaround times during neurological emergencies, a multidisciplinary team developed a neurological emergency crash trolley in our intensive care unit. This trolley includes phenytoin, hypertonic saline and mannitol, as well as other equipment. The aim of this study was to assess whether the cart reduced turnaround times for these medications. RESEARCH METHODOLOGY/DESIGN: In this retrospective cohort study, medication delivery times for two year epochs before and after its implementation were compared. Eligible patients were identified from our intensive care unit screening log. Adults who required emergent use of phenytoin, hypertonic saline or mannitol while in the intensive care unit were included. Groups were compared with nonparametric analyses. SETTING: 33-bed general medical-surgical intensive care unit in an academic teaching hospital. MAIN OUTCOME MEASURES: Time to medication administration. RESULTS: In the pre-intervention group, there were 43 patients with 66 events. In the post-intervention group, there were 45 patients with 80 events. The median medication turnaround time was significantly reduced after implementation of the neurological emergency trolley (25 vs. 10minutes, p=0.003). There was no statistically significant difference in intensive care or 30-day survival between the two cohorts. CONCLUSION: The implementation of a novel neurological emergency crash trolley in our intensive care unit reduced medication turnaround times.

[Real-time safety audits in a neonatal unit]. / Auditorías de seguridad en tiempo real en una unidad neonatal.

BACKGROUND: Random audits are a safety tool to help in the prevention of adverse events, but they have not been widely used in hospitals. The aim of the study was to determine, through random safety audits, whether the information and material required for resuscitation were available for each patient in a neonatal intensive care unit and determine if factors related to the patient, time or location affect the implementation of the recommendations. MATERIAL AND METHODS: Prospective observational study conducted in a level III-C neonatal intensive care unit during the year 2012. The evaluation of written information on the endotracheal tube, mask and ambu bag prepared of each patient and laryngoscopes of the emergency trolley were included within a broader audit of technological resources and study procedures. The technological resources and procedures were randomly selected twice a week for audit. Appropriate overall use was defined when all evaluated variables were correctly programmed in the same procedure. RESULTS: A total of 296 audits were performed. The kappa coefficient of inter-observer agreement was 0.93. The rate of appropriate overall use of written information and material required for resuscitation was 62.50% (185/296). Mask and ambu bag prepared for each patient was the variable with better compliance (97.3%, P=.001). Significant differences were found with improved usage during weekends versus working-day (73.97 vs. 58.74%, P=.01), and the rest of the year versus 3rd quarter (66.06 vs. 52%, P=.02). CONCLUSIONS: Only in 62.5% of cases was the information and the material necessary to attend to a critical situation urgently easily available. Opportunities for improvement were identified through the audits.

Os carros de emergência e o suporte avançado de vida / Emergency trolleys and advanced life support

JUSTIFICATIVA E OBJETIVOS: O sucesso no atendimento a pacientes com parada cardiorrespiratória (PCR) depende, em parte, da disponibilidade e funcionalidade do equipamento de reanimação. Com o objetivo de normatizar os materiais dos carros de emergência (CE) e assim agilizar o atendimento foi publicada a Diretriz de Apoio ao Suporte Avançado de Vida (SAV). O objetivo deste estudo foi analisar a adequação dos CE à diretriz brasileira. MÉTODO: Estudo de corte transversal. Foram avaliados os CE de dois hospitais universitários. Foram considerados adequados aqueles que possuíam todos os itens nas quatro categorias especificadas na referida diretriz. RESULTADOS: Nenhum CE avaliado dispunha do conjunto de materiais especificados na normatização brasileira. Aspirina, material para acesso de via aérea alternativa, dispositivo para confirmação secundária do tubo orotraqueal (TOT), entre outros, não estavam disponíveis em nenhum dos CE. Apenas 29,2% dos CE localizados em enfermarias para adultos possuíam monitor / desfibrilador com a função de monitorização nas pás e 45,9% deles dispunham de desfibrilador externo automático (DEA). Em nenhum CE avaliado foram encontrados TOT de todos os tamanhos recomendados. Foram detectadas deficiências em relação às agulhas de punção venosa periférica recomendadas pela diretriz. Em um dos hospitais pesquisados, nenhum CE era equipado com máscara com reservatório de oxigênio. Os CE das unidades de pediatria apresentavam as maiores defasagens de materiais e equipamentos. Em três setores pesquisados, os CE não estavam localizados em pontos adequados na unidade. CONCLUSÃO: Os CE dos hospitais pesquisados não obedecem à normatização brasileira.

BACKGROUND AND OBJECTIVES: The success in attending to patients of cardiorespiratory arrest depends partially on the availability and functioning of resuscitation equipment. With the aim of standardizing materials of the emergency trolleys (ET) and thus improve care was published guidelines for ET. The objective of this study was analyzing the degree of adaptation of ET to the guidelines. METHOD: This cross-sectional study evaluated ET at two university hospitals. ET was considered adequate if they presented all the items in the four categories specified in that guideline. RESULTS: None of the ET contained the entire set of materials specified in the Brazilian standard. Aspirin, material accessing alternative airways, devices for secondary confirmation of orotracheal tube positioning, among others, were not available in any of the ET. Only 29.2% of ET located in adult wards contained a monitor / defibrillator with monitoring function in the pads and 45.9% of them had AED. In no ET evaluated TOT were found in all recommended sizes. Deficiencies were found regarding the venous puncture needles recommended by the guideline. In one of the hospitals, no CE was equipped with masks with oxygen reservoir. The ET in pediatrics units contained the greatest deficiencies of materials and equipment. In three of the sectors investigated, the ETs were not located at appropriate points in the unit. CONCLUSION: The ET in the hospitals investigated did not comply with the Brazilian standard.