In a study of 59 elderly medically ill in-patients, 35% were found to have significant depressive symptomatology, as detected by the Geriatric Mental Status Schedule (GMSS). Of two screening methods, the Geriatric Depression Scale (GDS) performed satisfactorily but detection by nurses was poor. Acknowledgement of depression in medical casenotes was low. Training of nurses might improve detection; otherwise a mood-rating scale such as the GDS should be incorporated into routine practice.
We conducted a prospective study to determine the relationship between central (CVP) and peripheral (PVP) venous pressures in critically ill patients. CVP and PVP were measured on five different occasions in 20 critically ill patients in the intensive care unit. Results showed that the mean difference between PVP and CVP was 4.4 mmHg (95% CI= 3.7 to 5.0). However, PVP might be 1.9 mmHg below (95% CI=0.7 to 3.1) or 10.6 mmHg above (95% CI=9.4 to 11.8) the CVP. The mean difference between changes in PVP and corresponding changes in CVP was 0.3 mmHg (95%CI=-0.1 to 0.7). The actual change in PVP could be 3.0 mmHg below (95% CI=2.3 to 3.7) or 3.6 mmHg above (95% CI=2.9 to 4.3) the change in CVP. Overall, the direction of change in PVP (rise or drop) predicted a same direction of change in CVP with an accuracy of 78%. Changes in PVP ≥2 mmHg predicted a change in same direction of CVP with an accuracy of 90%. The direction of changes in CVP ≥2 mmHg were predicted by the direction of change in PVP with an accuracy of 91%. We conclude that PVP measurement does not give an accurate estimate of the absolute value of CVP in individual patients. However, as changes in PVP parallel, in direction, changes in CVP, serial measurements of PVP may have a value in determining volume status and guiding fluid therapy in critically ill patients.
A single abdominal radiograph is insufficiently sensitive to rule out abdominal drug carriage. However, specificivity is high and a positive finding is diagnostic. Cochrane: 'heliox'
Search outcomeAltogether 207 papers were found, of which six were considered to be original research of high quality (randomised controlled trials) suitable for inclusion. Secondary citations from these papers were also scanned. These six papers have since been subject to meta-analysis by the Cochrane Review Group. The review was first published in 2000 with the most recent substantive amendment made in November 2002 (see table 2).
Comment(s)The individual trials examined in the Cochrane review vary widely in the type of patients recruited (age, severity of asthma), delivery of heliox and outcome measures. Outcomes vary between heliox having a beneficial effect and having no effect. There are very few side effects of heliox reported.c CLINICAL BOTTOM LINE At the moment the evidence does not support the use of heliox in the emergency department treatment of acute asthma exacerbations. Abstract A short cut review was carried out to establish whether cardiopulmonary bypass improves survival and function after cardiac arrest resistant to ACLS. Altogether 387 papers were found using the reported search, of which nine presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
Clinical scenarioYou are the arrest team leader for a 56 year old patient that has just been brought in by emergency ambulance. He collapsed suddenly in the town centre, but had early, effective bystander CPR. Fourteen minutes have elapsed since and he remains in VF despite three prehospital DC
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