Background and Aims:Pregnancy is a state of physiological stress to a woman's health. Concomitant complications and infections during pregnancy may necessitate intensive monitoring and management of such patients in critical care settings. This study aims to determine the perceptions about the requirement of obstetric critical care based on the experience of obstetricians.Material and Methods:An observational, questionnaire-based study was conducted in 200 obstetricians working in various settings, who were approached during obstetric conferences. The questionnaire consisted of twenty items and was designed to determine the views of obstetricians, based on their clinical experience, regarding problems at the time of medical or surgical crisis in obstetric patients due to nonavailability of the intensive care services.Results:Seventeen percent of the participating obstetricians had a facility of dedicated obstetric Intensive Care Unit (ICU) at their institution. In the opinion of 62% of the respondents, ICU bed was made available in cases of crisis. Forty-two percent of the obstetricians reported that it took <10 min for the intensivist to reach the critically ill parturient. According to 32% of respondents, the intensivist could not reach within 20 min. There was a delay of more than 30 min in providing critical care services according to almost half (49%) of the respondents. Postpartum hemorrhage (24%) was the leading cause of ICU admission, followed by pregnancy-induced hypertension (14%) and acute respiratory distress syndrome (12%). A majority (87%) of the obstetricians were strongly in favor of a dedicated obstetric ICU.Conclusions:Need for a dedicated obstetric ICU is felt by most of the obstetricians to improve patient care.
Acute intermittent porphyria (AIP) presents with diverse group of symptoms making its early diagnosis difficult. Delaying diagnosis and treatment of AIP can be fatal or can cause long term or permanent neurological damage. We present here a case report of AIP where the diagnosis was missed. The diversity of symptoms and details concerning the treatment options for AIP are discussed.
Background:Critical care outreach services (CCOS) is a relatively a new concept in India and is not as developed as in Western countries. Efficient utilization of limited intensive care service requires comprehensive CCOS. Appropriate activation of such services will limit excess burden on already scarce human resources.Aim:To evaluate the functioning of CCOS in a tertiary care hospital and also to identify factors leading to its overactivation.Materials and Methods:Data of 400 calls received in resuscitation room (RR) of the Trauma Center during January 2011-June 2011 was analyzed. Categorical variables were summarized by calculating the frequency and percentage. Records of the department sending the call, purpose of the calls, and designation of the person sending the calls were noted. Calls were grouped into appropriate or inappropriate.Results:Maximum calls were received from medicine wards (65.8%) followed by neurosurgery ward (12.5%). Of all, 26% of the calls were sent by senior doctors (senior resident), whereas 69.4% of the calls were sent by junior doctors. 66.2% of the calls were indicated for assessment and intensive care unit (ICU) transfer, whereas central venous/intravenous access constituted 14.8% of the calls. Intubation and ventilator settings constituted 7.3 and 7.8% calls, respectively. About one-third (36.2%) of all calls were inappropriate.Conclusion:There is inefficient use of human resources in CCOS in our hospital. Lack of objective activation criteria and inefficient training in basic lifesaving skills and ventilator know-how were identified as primary factors for the same.
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