Post-market modification of valves from AMBU bags (AMBU Inc, Columbia, MD, USA) may be more susceptible to failure during use compared with our use of commercial pressure regulators (produced under ISO standards). Our data do not cover the full range of clinical parameters. For our studies, inspiratory times were kept fixed, although in actual patients, inspiratory times may be intermittently adjusted. Furthermore, this scheme is not intended as a permanent solution for ventilating multiple patients, and should be used only with hospital administration approval and acknowledgement of the unique ethical considerations during a crisis (such as the COVID-19 pandemic). 11,12 Although the COVID-19 pandemic inspired our designs, it may have utility in other mass casualty scenarios such as natural disasters, terrorist attacks, and battlefield medicine. Future versions should aim to extend to more than two patients per ventilator. Declarations of interest GWF is a consultant for and on the speaker's bureau of Edwards LifeSciences. All other authors have no conflicts to declare. 4. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirusinfected pneumonia in Wuhan, China. JAMA 2020; 323: 1061e9 5. Neyman G, Irvin CB. A single ventilator for multiple simulated patients to meet disaster surge.

The World Health Organization produced the Surgical Safety Checklist to improve patient safety. This review examines the supporting evidence, the results of a study of its worldwide trial and discusses the possible mechanisms of its effects.

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SummaryA 32-year-old man, with a long history of chronic pain and bipolar disorder, was admitted to our emergency department 2 h after a mixed overdose, predominately consisting of carbamazepine. Following no clinical improvement after four days of ventilation on our intensive care unit (ICU), high-volume continuous veno-venous haemofiltration with dialysis was instituted to enhance the elimination of the carbamazepine. It had no significant effect on the patient's clinical status or serum carbamazepine level. It was discontinued after 48 h. He spontaneously recovered and was discharged uneventfully from ICU after 7 days. BACKGROUND

Background Trauma in the elderly (≥ 65 years) population is increasing. This study compares the performance of trauma scoring systems in predicting 30-day mortality among the traumatised elderly patients admitted to the intensive care unit in a major trauma centre. Methods We collected retrospective data for all elderly trauma patients admitted to our intensive care units between January 2012 and December 2017. We assessed Injury Severity Score (ISS), Geriatric Trauma Outcome Score (GTOS) and the Trauma Audit and Research Network’s (TARN) Probability of Survival (Ps17) between survivors and non-survivors. Receiver operator characteristic (ROC) curves were used to assess the performance of these scoring systems. Results There were 255 elderly trauma patients with overall 30-day survival of 76%. There was a statistically significant difference in ISS, GTOS and Ps17 scores between survivors and non-survivors (p < 0.001). The area under the ROC curve (AUROC) was statistically significant for all 3, with AUROC of 0.66 (95% CI 0.59–0.74) for the ISS, 0.68 (95% CI 0.61–0.76) for the GTOS and 0.79 (95% CI 0.72–0.85) for the Ps17. The optimal cut-off points were ≥ 28, ≥ 142, ≤ 76.73 for ISS, GTOS and Ps17, respectively. Conclusion Both ISS and GTOS scoring systems preformed equally in predicting 30-day mortality in traumatised elderly patients admitted to the intensive care unit, however neither were robust enough to utilise in clinical practise. The Ps17 performed more robustly, although was not developed for prognosticating on individual patients. Larger prospective studies are needed to validate these scoring systems in critically-ill elderly traumatised patients, which may help to facilitate early prognostication.

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