We describe a protocol for etomidate infusion for the emergency management of hypercortisolemia. Etomidate is commenced at 2.5 mg/h and titrated subsequently according to cortisol levels. It is well tolerated without any sedative effects and can be administered safely via peripheral access for use in the general ward setting.
The aim of the study was to investigate in a qualitative study the thoughts and feelings of women's experiences of asthma in pregnancy. Methods NHS IRAS ethical approval and trust research governance were obtained; women gave written informed consent subject to the usual ethical guarantees. Twenty-two women with asthma and a pregnancy within two years were invited to participate. Seven women were interviewed when data saturation was achieved. Data collection took place between March 2012 and September 2012. Interviews were transcribed and analysed using a phenomenological 'Framework' Method involving familiarisation; identifying a thematic framework; indexing; charting; mapping; interpretation. Data were independently analysed by two researchers and consensus reached concerning themes. Results• Asthma and pregnancy • Self-management including fears; lack of recognition of symptoms; poor knowledge of inhaled therapy• Risk factors • Anxieties including drugs, procedures, risks versus benefits • General understanding of asthma • Concealing symptoms
Pregnancy and post-natal experiences• Impact of exacerbations on baby; breastfeeding benefits; changes to asthma, post-natal experience
Health professionals• Lack of regular contact; midwife support; interaction with healthcare professionals, educationConclusions These findings are globally relevant because maternal asthma is so prevalent. They illustrate participants' experiences of their asthma care and their views on its improvement. Similar to the international literature (Lim et al 2012), pregnant asthmatic women have concerns about their care and treatment, which might be alleviated by outreach, joint working between respiratory nurse specialists, midwives and GP practice nurses.
Asthma and chronic obstructive pulmonary disease (COPD) account direct costs of £1 billion each per year in the United Kingdom (UK). A national review of asthma deaths found that a significant proportion of patients die without seeking medical assistance or before emergency medical care could be provided. This study aims to establish the pathway that patients undertake to access care in the lead up to an accident and emergency (A&E) attendance and/or inpatient admission. Patients attending A&E and/or following an inpatient admission due to an exacerbation of asthma or COPD were reviewed by a specialist respiratory pharmacist during weekday working hours. Over a one-year period, 920 (224 asthma and 696 COPD) presentations for exacerbation of asthma and COPD were reviewed. Although the majority of the patients were registered with a general practitioner (GP), less than 50% received medical attention from their GP and/or had an active intervention prior to presenting to hospital. These findings correlate with those found in the national review of asthma deaths. At a time of increasing demands on healthcare resources, these results pose the question of how we can better triage patients to appropriate care settings to minimise unscheduled care and improve patient outcomes.
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