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Biomedical subjects

M Currie

Publications and source records attributed to M Currie.

At least 19 recordsLinked to original sources
PubMed2005

Crisis management during anaesthesia: hypertension.

BACKGROUND: Hypertension occurs commonly during anaesthesia and is usually promptly and appropriately treated by anaesthetists. However, its recognition is dependent on correctly functioning and calibrated monitors. If it is not diagnosed and/or promptly corrected, it has the potential to cause significant morbidity and even mortality. OBJECTIVES: To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK" supplemented by a specific sub-algorithm for the management of hypertension occurring in association with anaesthesia. METHODS: The potential performance of this approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved. RESULTS: There were 70 reports of intraoperative hypertension among the first 4000 incidents reported to AIMS. Drug related causes accounted for 59% of all incidents. It was considered that, properly applied, this structured approach would have led to a quicker and/or better resolution of the problem in 21% of the cases. CONCLUSION: Once hypertension is identified and confirmed, its rapid control by the careful use of a volatile anaesthetic agent, intravenous opioids, or rapidly acting antihypertensives will usually avoid serious morbidity. If hypertension is unresponsive to the treatment recommended in the relevant sub-algorithm, an unusual cause such as phaeochromocytoma, carcinoid syndrome, or thyroid storm should be considered.

Algorithms↗
PubMed2005

Crisis management during anaesthesia: recovering from a crisis.

Preventing harm to the patient is the priority during a crisis. After a major incident, and especially when a patient has been harmed, there are a number of matters to be addressed: the ongoing care of the patient; documentation of the incident; investigation of the root causes; completion of reports; interviews with the patient and/or the next of kin, together with apologies and expression of regret; updates and ongoing support for friends and relatives; a word of thanks to the staff involved for their assistance; formal debriefing of staff for quality assurance and possibly ongoing support and a separate debriefing for psychological purposes; ensuring that the recommendations of the root cause analysis are carried out; or, failing that, that the issues are logged on a risk register. The extent and depth of the follow up protocol depends on what, if any, harm may have been done. This may constitute completion of an incident report; notification of an equipment failure to a federal regulatory authority; arranging consultations with a mental health professional to manage psychological sequelae (especially following an awareness episode); follow up during weeks of intensive care treatment; or, when a death has occurred, a full medico-legal and/or coronial set of procedures. A precis is appended in an action card format.

Algorithms↗
PubMed2005

Crisis management during anaesthesia: myocardial ischaemia and infarction.

BACKGROUND: Myocardial ischaemia and infarction are significant perioperative complications which are associated with poor patient outcome. Anaesthetic practice should therefore focus, particularly in the at risk patient, on their prevention, their accurate detection, on the identification of precipitating factors, and on rapid effective management. OBJECTIVES: To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK" supplemented by a specific sub-algorithm for myocardial ischaemia and infarction in the management of myocardial ischaemia and/or infarction occurring in association with anaesthesia. METHODS: The potential performance of this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved. RESULTS: Of the 125 incidents retrieved from the 4000 reports, 40 (1%) were considered to demonstrate myocardial infarction or ischaemia. The use of the structured approach described in this paper would have led to appropriate management in 90% of cases, with the remaining 10% requiring other sub-algorithms. It was considered that the application of this structured approach would have led to earlier recognition and/or better management of the problem in 45% of cases. CONCLUSION: Close and continuous monitoring of patients at risk of myocardial ischaemia during anaesthesia is necessary, using optimal ECG lead configurations, but sensitivity of this monitoring is not 100%. Coronary vasodilatation with glyceryl trinitrate (GTN) should not be withheld when indicated and the early use of beta blocking drugs should be considered even with normal blood pressures and heart rates.

Algorithms↗
PubMed2005

Crisis management during anaesthesia: anaphylaxis and allergy.

BACKGROUND: Anaphylactic and anaphylactoid reactions during anaesthesia are a major cause for concern for anaesthetists. However, as individual practitioners encounter such events so rarely, the rapidity with which the diagnosis is made and appropriate management instituted varies considerably. OBJECTIVES: To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK", supplemented by a specific sub-algorithm for anaphylaxis, in the management of severe allergic reactions occurring in association with anaesthesia. METHODS: The potential performance of this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual performance as reported by the anaesthetists involved. RESULTS: There were 148 allergic reactions among the first 4000 incidents reported to AIMS. It was considered that, properly applied, the structured approach would have led to a quicker and/or better resolution of the problem in 30% of cases, and would not have caused harm had it been applied in all of them. CONCLUSION: An increased awareness of the diverse clinical manifestations of allergy seen in anaesthetic practice, together with the adoption of a structured approach to management should improve and standardise the treatment and improve follow up of patients suspected of having suffered a significant allergic reaction under anaesthesia.

Algorithms↗
PubMed2005

Crisis management during anaesthesia: vascular access problems.

BACKGROUND: In confronting an evolving crisis, the anaesthetist should consider the vascular catheter as a potential cause, abandoning assumptions that the device has been satisfactorily placed and is functioning correctly. OBJECTIVES: To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK", supplemented by a specific sub-algorithm for vascular access problems, in the management of crises occurring in association with anaesthesia. METHODS: The potential performance of a structured approach was evaluated for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS). RESULTS: There were 128 incidents involving problems related to vascular access. The structured approach begins distally, checking the infusion device or fluid (12 incidents), moving proximally by way of the fluid giving line (10), the line deadspace (8), then the catheter/skin interface (65), and on to the peripheral vascular tree (3) and central venous space (23), and finally, the interface of the vascular access system and the attending staff (7). The approach was able to accommodate all the vascular access problems among the first 4000 incidents reported to AIMS. CONCLUSION: The approach has potential as an easily remembered and applied clinical tool to lead to early resolution of vascular access problems occurring during anaesthesia.

Algorithms↗
PubMed2003

Physician knowledge of the diagnosis and management of Rocky Mountain spotted fever: Mississippi, 2002.

Rocky Mountain spotted fever (RMSF), a tick-borne illness that has its highest incidence in the south central and southeastern United States, is often a diagnostic challenge, as patients frequently present with nonspecific symptoms during the early stages of illness. RMSF has a high case fatality rate among untreated individuals, and the median time from onset of symptoms to death is only eight days, making early recognition and treatment of RMSF crucial. In two Mississippi public health districts, 148 primary care physicians were randomly selected and mailed surveys regarding RMSF diagnosis, treatment, and prevention. Eighty-four of the 148 (57%) physicians responded. Responses from different specialties and different health districts were compared using chi square statistics. Almost all (99%) physicians correctly identified doxycycline as the antibiotic agent of choice for treating adults and adolescents. However, only 21% of family practice physicians, and 25% of emergency medicine physicians correctly identified the antibiotic of choice for treating children with RMSF. Twenty-three percent of physicians responded that waiting for the development of a rash before prescribing antibiotics is an appropriate treatment strategy. The current standard of care-doxycycline as the agent of choice among children 8 years of age or younger with suspected RMSF-has not been effectively communicated to all physicians caring for children. Also, many physicians are not familiar with the rationale underlying initiation of antibiotic therapy prior to the development of rash in patients with suspected RMSF. Continuing education efforts should focus on antibiotic selection in pediatric patients and initiation of therapy prior to the onset of rash in appropriate patients.

Animals↗
PubMed2001

Smallpox nursing in Britain, Part II: Nursing care and nurse training.

Part I of this paper attempted to justify the need for this research for historical purposes, that is, to fill a gap in the history of nursing, and sought to raise awareness of possible bioterrorist activity with the smallpox virus. The disease process, now unfamiliar to most nurses, was briefly described, and reference was made to the change from a predominantly childhood to adult disease. The gradual removal of patients from home to hospital or other institutions was considered and the diverse nature of their attendants was discussed. Smallpox was then explained from two nursing perspectives: firstly, the concept of smallpox as a nurses' disease. In this, it was universally acknowledged that only nurses could make some difference to a patient's survival and minimal disfigurement, but secondly, in so doing, they put their own lives at risk. Examples were given of nurses who succumbed. Finally, some central and local government measures which endeavoured to prevent the spread of the disease were outlined. Part II focuses specifically on nursing care and training as it is through this medium that knowledge may be passed from earlier to present day nurses.

Disease Outbreaks↗
PubMed1998

A new short practical quality of life questionnaire for use in head and neck oncology outpatient clinics.

A new short questionnaire to assess the quality of life of head and neck patients has been designed at the University of Liverpool Head and Neck Oncology Department. The questionnaire is short, simple and can be easily completed by a patient whilst in the waiting room before consultation. It is filled in 6 months after completion of treatment and shows very good correlation with the standard long exhaustive questionnaires that are difficult to complete on every patient in a busy National Health Service clinic. The University of Liverpool questionnaire provides a simple score from 0%-100% which should prove valuable in the assessment of quality of care and help with decisions regarding treatment options in head and neck cancer patients.

Head and Neck Neoplasms↗
PubMed1993

The Australian Incident Monitoring Study. Errors, incidents and accidents in anaesthetic practice.

Human error is a pervasive and normal part of everyday life and is of interest to the anaesthetist because errors may lead to accidents. Definitions of, and the relationships between, errors, incidents and accidents are provided as the basis to this introduction to the psychology of human error in the context of the work of the anaesthetist. Examples are drawn from the Australian Incident Monitoring Study (AIMS). An argument is put forward for the use of contemporaneous incident reporting (eliciting relevant contextual information as well as details of use to cognitive psychologists), rather than the use of accident investigation after the event (with the inherent problems of scant information, altered perception and outcome bias). A classification of errors is provided. "Active" errors may be classified into knowledge-based, rule-based, skill-based and technical errors. Different strategies are required for the prevention of each type and it may now be useful to place more emphasis in anaesthetic practice on categories to which little attention has been directed in the past. "Latent" errors make an enormous contribution to problems in anaesthesia and several categories are discussed (e.g. environment, physiological state, equipment, work practices, personnel training, social and cultural factors). An approach is provided for the prevention and management of errors, incidents and accidents which allows clinical problems to be categorized, the relative importance of various contributing factors to be established, and appropriate preventative strategies to be devised and implemented on the basis of priorities determined from the AIMS data. Accidents cannot be abolished; however, an understanding of the factors underlying them can lead to the rational direction of resources and effort to prevent them and minimise their effects.

Accident Prevention↗
PubMed1993

The Australian Incident Monitoring Study: an analysis of 2000 incident reports.

The Australian Patient Safety Foundation was formed in 1987; it was decided to set up and co-ordinate the Australian Incident Monitoring Study as a function of this Foundation; 90 hospitals and practices joined the study. Participating anaesthetists were invited to report, on an anonymous and voluntary basis, any unintended incident which reduced, or could have reduced, the safety margin for a patient. Any incident could be reported, not only those which were deemed "preventable" or were thought to involve human error. The Mark I AIMS form was developed which incorporated features and concepts from several other studies. All the incidents in this symposium were reported using this form, which contains general instructions to the reporter, key words and space for a narrative of the incident, structured sections for what happened (with subsections for circuitry incidents, circuitry involved, equipment involved, pharmacological incidents and airway incidents), why it happened (with subsections for factors contributing to the incident, factors minimising the incident and suggested corrective strategies), the type of anaesthesia and procedure, monitors in use, when and where the incident happened, the experience of the personnel involved, patient age and a classification of patient outcome. Enrollment, reporting and data-handling procedures are described. Data on patient outcome are presented; this is correlated with the stages at which the incident occurred and with the ASA status of the patients. The locations at which the incidents occurred and the types of procedures, the sets of incidents analysed in detail and a breakdown of the incidents due to drugs are also presented.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents↗
PubMed1993

The Australian Incident Monitoring Study. The pulse oximeter: applications and limitations--an analysis of 2000 incident reports.

The first 2000 incidents reported to the Australian Incident Monitoring Study were analysed with respect to the role of the pulse oximeter. Of these 184 (9%) were first detected by a pulse oximeter and there were a further 177 (9%) in which desaturation was recorded. Of the 1256 incidents which occurred in association with general anaesthesia 48% were "human detected" and 52% "monitor detected". The pulse oximeter was ranked first and detected 27% of these monitor detected incidents; this figure would have been over 40% if an oximeter had always been used and its more informative modulated pulse tone relied upon instead of that of the "bleep" of the ECG. The pulse oximeter is the "front-line" monitor for endobronchial intubation, the fourth most common incident in association with general anaesthesia (it detected 87% of the 76 cases in which it was in use). It also played an invaluable role as a "back-up" monitor in 40 life-threatening situations in which "front-line" monitors (e.g. oxygen analyser, low pressure alarm, capnograph) were either not in use, were being used incorrectly or failed. Other situations detected, in order of frequency of detection, were: circuit disconnection, circuit leak, desaturation (severe shunt), oesophageal intubation, aspiration and/or regurgitation, pulmonary oedema, endotracheal tube obstruction, severe hypotension, failure of oxygen delivery, hypoxic gas mixture, hypoventilation, anaphylaxis, air embolism, bronchospasm, malignant hyperthermia, and tension pneumothorax.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents↗
PubMed1993

The Australian Incident Monitoring Study. The electrocardiograph: applications and limitations--an analysis of 2000 incident reports.

The first 2000 incidents reported to the Australian Incident Monitoring Study (AIMS) were analysed with respect to the role of the electrocardiograph (ECG). Of these, 138 (7%) were first detected by the ECG. Of the 1256 incidents which occurred in association with general anaesthesia (GA incidents) 48% were "human detected" and 52% "monitor detected", the ECG was ranked third and detected 121 (19%) of these monitor detected GA incidents. However over 98% of incidents first detected by the ECG were heart rate changes; they would also have been detected by a pulse meter or pulse oximeter which would have supplied additional information about the adequacy of peripheral perfusion. The ECG is a "first-line" monitor in situations with the potential for myocardial ischaemia, complex dysrhythmias or altered myocardial conduction and should be used in all critically ill patients as well as those at significant risk of these problems. The ECG frequently detects incidents involving minor physiological trespass, such as simple heart rate and rhythm changes associated with anaesthetic agents. These incidents are generally detected relatively early in their evolution. AIMS data has confirmed, however, that the ECG has such poor sensitivity for serious physiological changes such as hypoxia, hypercarbia and hypotension that it cannot even be regarded as a useful "back-up" monitor for these problems. Indeed a "normal" ECG in a dangerous situation may lead to a degree of complacency.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents↗
PubMed1993

The Australian Incident Monitoring Study. Blood pressure monitoring--applications and limitations: an analysis of 2000 incident reports.

Of the first 2000 incidents reported to the Australian Incident Monitoring Study, 1256 occurred in relation to general anaesthesia and 81 of the latter were first detected by blood pressure (BP) monitoring. A further 25 incidents not associated with general anaesthesia were first detected by blood pressure monitoring, giving a total of 106. In the monitor detection of incidents in relation to general anaesthesia, BP monitoring ranked fourth after oximetry, capnography and low pressure alarms. On the other hand, 38 incidents in which the problem was primarily one of significant change in BP were first detected by means other than the BP monitor (20 clinically, 12 by pulse oximetry and 6 by ECG). Early detection rates of hypotension were 60% for invasive methods, 40% for automated non-invasive (NIBP) devices and 30% for manual sphygmomanometry. There were 21 reports of BP monitor "failure"; the 11 of these which occurred with NIBPs involved unexplained false "low" or "high" readings and failure to detect profound hypotension, and led to considerable morbidity and at least one death. The 10 cases of invasive monitoring failure were predominantly due to mains power loss, hardware breakage or operator error. In a theoretical analysis of the 1256 GA incidents, it was considered that on its own, BP monitoring would have detected 919 (73%), but in the vast majority, by the time this detection has occurred, potential organ damage could not be excluded. It is recommended that BP be measured at regular intervals dictated by clinical requirements (usually at least every five minutes).(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents↗
PubMed1993

The Australian Incident Monitoring Study. The "wrong drug" problem in anaesthesia: an analysis of 2000 incident reports.

Amongst the first 2000 incidents reported to the Australian Incident Monitoring Study, there were 144 incidents in which the "wrong drug" was nearly or actually administered to a patient. Thirty-three percent of the incidents involved ampoules and just over 40% syringes; in over half of the latter the syringes were of the same size, and also, in over half, they were correctly labelled. In 81% of the 144 incidents the "wrong drug" was actually given. This was more common with syringes (93%) than ampoules (58%). Thus the most common error was actually giving the wrong drug from a correctly labelled syringe. The most common drug involved was a muscle relaxant in both ampoule and syringe incidents. In 74% of all reports, there was the potential for serious harm to the patient; however no deaths were reported. Factors which contributed significantly to the incidents were similar appearance, inattention and haste. "Failure of communication" was a significant factor in syringe incidents when two or more staff were involved. The only significant factor which minimised the outcome was rechecking of the syringe or drug ampoule before giving the drug. Strategies suggested to address the "wrong drug" problem include education of staff about the nature of the problem and the mechanisms involved; colour coding of selected drug classes for both ampoules and syringes; the use of standardised drug storage, layout and selection protocols; having a drawing up and labelling convention; and the use of checking protocols.

Anesthesia↗
PubMed1993

The Australian Incident Monitoring Study. Clinical anaphylaxis: an analysis of 2000 incident reports.

There were 57 reports of possible allergic reactions in the perioperative period in the first 2000 incidents reported to the Australian Incident Monitoring Study. These were examined and classified with respect to presentation, clinical course, agents implicated and management strategies employed. Reactions were graded as to probability of allergic aetiology and severity of systemic disturbance. Two deaths were reported. A method of determining an "allergy score" was devised as an indication of which reactions may be most deserving of further investigation.

Anaphylaxis↗
PubMed1989

A prospective survey of anaesthetic critical events in a teaching hospital.

A survey of anaesthetic critical events based on voluntary anonymous reports was undertaken over a two and a half year period within a teaching hospital Department of Anaesthesia. At the end of the survey 167 reports were analysed. Human error was a contributing factor in 82% of events. Inadequate preoperative patient assessment or preparation, problems in the area of human/equipment interface and various stress factors for the anaesthetist featured significantly in the survey. The method enables the collection of objective data on factors contributing to anaesthetic and surgical risk and the formulation and evaluation of potential corrective strategies. It also facilitates harmonious peer review via individual and group feedback activities. The adoption of such a survey on a wider scale is seen as a valuable part of quality assurance in the continuing attempt to increase patient safety.

Anesthesia↗