Two patients suffered barotrauma whilst undergoing transtracheal jet ventilation (TTJV). In the first, TTJV was provided by a Sanders injector and in the second it was given by a high frequency jet ventilator. Barotrauma was a consequence of the expiratory pathway becoming blocked. The mechanism of barotrauma and a method of airway pressure monitoring during TTJV are discussed. It is recommended that meticulous care is taken to ensure an adequate path for expiration when jet ventilation is used.
In 2011, a fire broke out on our intensive care unit. An oxygen cylinder caught fire as it was turned on and spread to the mattress of the bed on which it was laid, the bedding, the patient on the bed, the curtains around the bed, the flooring beneath it and the ceiling above. The patient was dragged to safety and the fire put out by two doctors using five fire extinguishers. The unit was filled with smoke within seconds. Ten other patients on the ICU at the time were evacuated within seven minutes, and a patient in a side room (who was not immediately affected) 30 minutes later. We discuss the event, the evacuation, how the aftermath of the fire was managed by the hospital staff, and the changes put in place to improve fire safety locally and nationally.
1 Six healthy volunteers took part in a 2-week haemodynamic safety study of astemizole. 2 They were given 30 mg daily (3 x 10 mg tablets) for the first 3 days and 10 mg daily for the next 12 consecutive days. 3 Heart rate, blood pressure, ECG and systolic time intervals at rest were measured before the start and five times during the day. 4 No changes were observed in any of the parameters measured. The configuration of the ECG was not influenced. 5 Serum concentrations of astemizole plus hydroxylated metabolites measured at the end of the study were 16 times lower than those detected in a patient overdosing on 200 mg astemizole.
Klebsiella
species occupy a wide range of environmental and animal niches, and occasionally cause opportunistic infections that are resistant to multiple antibiotics. In particular,
Klebsiella pneumoniae
(Kpne) has gained notoriety as a major nosocomial pathogen, due principally to the rise in non-susceptibility to carbapenems and other beta-lactam antibiotics. Whilst it has been proposed that the urban water cycle facilitates transmission of pathogens between clinical settings and the environment, the level of risk posed by resistant
Klebsiella
strains in hospital wastewater remains unclear. We used whole genome sequencing (WGS) to compare
Klebsiella
species in contemporaneous samples of wastewater from an English hospital and influent to the associated wastewater treatment plant (WWTP). As we aimed to characterize representative samples of
Klebsiella
communities, we did not actively select for antibiotic resistance (other than for ampicillin), nor for specific
Klebsiella
species. Two species, Kpne and K. (
Raoultella
) ornithinolytica (Korn), were of equal dominance in the hospital wastewater, and four other
Klebsiella
species were present in low abundance in this sample. In contrast, despite being the species most closely associated with healthcare settings, Kpne was the dominant species within the WWTP influent. In total, 29 % of all isolates harboured the bla
OXA-48 gene on a pOXA-48-like plasmid, and these isolates were almost exclusively recovered from the hospital wastewater. This gene was far more common in Korn (68 % of isolates) than in Kpne (3.4 % of isolates). In general plasmid-borne, but not chromosomal, resistance genes were significantly enriched in the hospital wastewater sample. These data implicate hospital wastewater as an important reservoir for antibiotic-resistant
Klebsiella
, and point to an unsuspected role of species within the
Raoultella
group in the maintenance and dissemination of plasmid-borne bla
OXA-48. This article contains data hosted by Microreact.
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