Sepsis

Sepsis, which may be defined as the systemic illness caused by the suspected invasion of normally sterile parts of the body by microbial organisms, is a major healthcare problem, ranking among the top ten causes of death. This article reviews the evidence behind the general and specific measures in the management of sepsis, based on the Surviving Sepsis Campaign Guidelines.peer-reviewe

Cardiopulmonary resuscitation : the history and evidence behind modern management

Resuscitation following cardiac arrest involves a life-saving set of skills which are practised by healthcare workers and trained laypersons throughout the world. Various associations and groups, such as the European Resuscitation Council (ERC) and the American Heart Association have training programmes on resuscitation techniques using standardized algorithms. There are different protocols for different situations, using various pieces of equipment and with a range of complexity, however the key aspects of modern resuscitation remain the same; these are summarized by the ERC guidelines as the “Chain of Survival” : • Early recognition and call for help • Early Cardiopulmonary resuscitation (CPR) • Early defibrillation • Post-resuscitation care This article focuses on the history and development of the evidence behind some of the key aspects of modern resuscitation: airway maintenance and breathing, circulation and chest compressions, and defibrillatinpeer-reviewe

Communicating about cardiopulmonary resuscitation and do not attempt resuscitation decisions

As the boundaries of medicine are pushed, and life prolonged further, it is increasingly evident that healthcare and modern medicine no longer simply equate to a prolongation of life at all costs; actually, decisions not to attempt cardiopulmonary resuscitation (CPR) may be in a patient’s best interests. This article discusses how we discuss these complex decisions with those affected by them: our patients.peer-reviewe

Management practices for postdural puncture headache in obstetrics: a prospective, international, cohort study

© 2020 British Journal of AnaesthesiaBackground: Accidental dural puncture is an uncommon complication of epidural analgesia and can cause postdural puncture headache (PDPH). We aimed to describe management practices and outcomes after PDPH treated by epidural blood patch (EBP) or no EBP. Methods: Following ethics committee approval, patients who developed PDPH after accidental dural puncture were recruited from participating countries and divided into two groups, those receiving EBP or no EBP. Data registered included patient and procedure characteristics, headache symptoms and intensity, management practices, and complications. Follow-up was at 3 months. Results: A total of 1001 patients from 24 countries were included, of which 647 (64.6%) received an EBP and 354 (35.4%) did not receive an EBP (no-EBP). Higher initial headache intensity was associated with greater use of EBP, odds ratio 1.29 (95% confidence interval 1.19–1.41) per pain intensity unit increase. Headache intensity declined sharply at 4 h after EBP and 127 (19.3%) patients received a second EBP. On average, no or mild headache (numeric rating score≤3) was observed 7 days after diagnosis. Intracranial bleeding was diagnosed in three patients (0.46%), and backache, headache, and analgesic use were more common at 3 months in the EBP group. Conclusions: Management practices vary between countries, but EBP was more often used in patients with greater initial headache intensity. EBP reduced headache intensity quickly, but about 20% of patients needed a second EBP. After 7 days, most patients had no or mild headache. Backache, headache, and analgesic use were more common at 3 months in patients receiving an EBP

Management practices for postdural puncture headache in obstetrics : a prospective, international, cohort study

Background: Accidental dural puncture is an uncommon complication of epidural analgesia and can cause postdural puncture headache (PDPH). We aimed to describe management practices and outcomes after PDPH treated by epidural blood patch (EBP) or no EBP. Methods: Following ethics committee approval, patients who developed PDPH after accidental dural puncture were recruited from participating countries and divided into two groups, those receiving EBP or no EBP. Data registered included patient and procedure characteristics, headache symptoms and intensity, management practices, and complications. Follow-up was at 3 months. Results: A total of 1001 patients from 24 countries were included, of which 647 (64.6%) received an EBP and 354 (35.4%) did not receive an EBP (no-EBP). Higher initial headache intensity was associated with greater use of EBP, odds ratio 1.29 (95% confidence interval 1.19-1.41) per pain intensity unit increase. Headache intensity declined sharply at 4 h after EBP and 127 (19.3%) patients received a second EBP. On average, no or mild headache (numeric rating score <= 3) was observed 7 days after diagnosis. Intracranial bleeding was diagnosed in three patients (0.46%), and backache, headache, and analgesic use were more common at 3 months in the EBP group. Conclusions: Management practices vary between countries, but EBP was more often used in patients with greater initial headache intensity. EBP reduced headache intensity quickly, but about 20% of patients needed a second EBP. After 7 days, most patients had no or mild headache. Backache, headache, and analgesic use were more common at 3 months in patients receiving an EBP