Effective use of defibrillators in the Emergency Centre

Includes bibliographical references (leaves 68-73)

Emergency centres lack defibrillator knowledge

The original publication is available at http://www.samj.org.zaIn the emergency centre (EC), a number of essential items of equipment are needed to manage a wide variety of acute life-threatening emergencies. Their correct use depends heavily on the training and experience of personnel. The defibrillator is part of this essential equipment and should be available in all ECs. Although defibrillators are widely available in Western Cape ECs, it is not known whether public sector EC personnel have the knowledge and skills necessary to use them safely and effectively. Most cardiac arrests in adult patients are due to ventricular fibrillation (VF) or cardiac-related causes, and early defibrillation improves survival of such patients1,2 and is therefore an important part of their immediate treatment (combined with the other links of the chain of survival for both in- and out-of-hospital cardiac arrest).Publishers' Versio

Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU)

Purpose Thrombocytopenia (platelet count < 150 × 109/L) is common in intensive care unit (ICU) patients and is likely associated with worse outcomes. In this study we present international contemporary data on thrombocytopenia in ICU patients. Methods We conducted a prospective cohort study in adult ICU patients in 52 ICUs across 10 countries. We assessed frequencies of thrombocytopenia, use of platelet transfusions and clinical outcomes including mortality. We evaluated pre-selected potential risk factors for the development of thrombocytopenia during ICU stay and associations between thrombocytopenia at ICU admission and 90-day mortality using pre-specified logistic regression analyses. Results We analysed 1166 ICU patients; the median age was 63 years and 39.5% were female. Overall, 43.2% (95% confidence interval (CI) 40.4–46.1) had thrombocytopenia; 23.4% (20–26) had thrombocytopenia at ICU admission, and 19.8% (17.6–22.2) developed thrombocytopenia during their ICU stay. Non-AIDS-, non-cancer-related immune deficiency, liver failure, male sex, septic shock, and bleeding at ICU admission were associated with the development of thrombocytopenia during ICU stay. Among patients with thrombocytopenia, 22.6% received platelet transfusion(s), and 64.3% of in-ICU transfusions were prophylactic. Patients with thrombocytopenia had higher occurrences of bleeding and death, fewer days alive without the use of life-support, and fewer days alive and out of hospital. Thrombocytopenia at ICU admission was associated with 90-day mortality (adjusted odds ratio 1.7; 95% CI 1.19–2.42). Conclusion Thrombocytopenia occurred in 43% of critically ill patients and was associated with worse outcomes including increased mortality. Platelet transfusions were given to 23% of patients with thrombocytopenia and most were prophylactic.publishedVersio