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.
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