Severe Hypertriglyceridaemia Leading to Factitious Hypobicarbonataemia

Anion gap metabolic acidosis is a laboratory finding commonly encountered in patients with sepsis, diabetic ketoacidosis, acute kidney injury and toxic alcohol ingestion. Serum blood chemistry assessment detects this abnormality. However, this can be falsely low in situations of high triglyceride levels due to lipid interference with measurement of the bicarbonate levels and through volume displacement by these large molecules. Arterial blood gas analysis and a lipid panel are required to confirm accurate bicarbonate levels. Clinicians handling acid-base disorders in hospitalized patients need to be aware of this spurious laboratory value to avoid unnecessary tests and to determine accurate total bicarbonate levels.

Severe Oleander Poisoning Presenting with Hyperkalaemia and Unusual Electrocardiographic Changes

Background: Hyperkalaemia in oleander (Nerium oleander) poisoning has been associated with a poor prognosis. Different electrocardiographic (ECG) presentations are possible because of vagotonia and hyperkalaemia. Methods/Results: We report a series of three cases of oleander poisoning in which ECG showed unusual hyperkalaemia features, such as bradyarrhythmia, sinoatrial block, atrioventricular block and junctional rhythm. Conclusions: If arterial blood gas analysis or laboratory values indicate hyperkalaemia in oleander poisoning, the hyperkalaemia should be treated immediately, even if the ECG does not show typical hyperkalaemia features.

Incidence of hyperoxia in trauma patients receiving pre-hospital emergency anaesthesia: results of a 5-year retrospective analysis

Background Previous studies have demonstrated an association between hyperoxia and increased mortality in various patient groups. Critically unwell and injured patients are routinely given high concentration oxygen in the pre-hospital phase of care. We aim to investigate the incidence of hyperoxia in major trauma patients receiving pre-hospital emergency anesthesia (PHEA) in the pre-hospital setting and determine factors that may help guide clinicians with pre-hospital oxygen administration in these patients. Methods A retrospective cohort study was performed of all patients who received PHEA by a single helicopter emergency medical service (HEMS) between 1 October 2014 and 1 May 2019 and who were subsequently transferred to one major trauma centre (MTC). Patient and treatment factors were collected from the electronic patient records of the HEMS service and the MTC. Hyperoxia was defined as a PaO2 > 16 kPA on the first arterial blood gas analysis upon arrival in the MTC. Results On arrival in the MTC, the majority of the patients (90/147, 61.2%) had severe hyperoxia, whereas 30 patients (20.4%) had mild hyperoxia and 26 patients (19.7%) had normoxia. Only 1 patient (0.7%) had hypoxia. The median PaO2 on the first arterial blood gas analysis (ABGA) after HEMS handover was 36.7 [IQR 18.5–52.2] kPa, with a range of 7.0–86.0 kPa. SpO2 pulse oximetry readings before handover were independently associated with the presence of hyperoxia. An SpO2 ≥ 97% was associated with a significantly increased odds of hyperoxia (OR 3.99 [1.58–10.08]), and had a sensitivity of 86.7% [79.1–92.4], a specificity of 37.9% [20.7–57.8], a positive predictive value of 84.5% [70.2–87.9] and a negative predictive value of 42.3% [27.4–58.7] for the presence of hyperoxemia. Conclusion Trauma patients who have undergone PHEA often have profound hyperoxemia upon arrival at hospital. In the pre-hospital setting, where arterial blood gas analysis is not readily available a titrated approach to oxygen therapy should be considered to reduce the incidence of potentially harmful tissue hyperoxia.

THE EFFECT OF STRUCTURED TEACHING PROGRAM ON KNOWLEDGE ABOUT ARTERIAL BLOOD GAS ANALYSIS AMONG THE STAFF NURSES WORKING IN CRITICAL CARE UNIT

Statement:A STUDY TO ASSESS THE EFFECT OF STRUCTURED TEACHING PROGRAM ON KNOWLEDGE ABOUT ARTERIAL BLOOD GAS ANALYSIS AMONG THE STAFF NURSES WORKING IN CRITICAL CARE UNIT OF SELECTED HOSPITAL, LUCKNOW Introduction: Arterial blood gas analysis is a basic and useful laboratory test for the critically ill patients. It is an essential investigation for assessing ventilation, oxygenation and acid base status among critically ill patients. These three are closely interrelated physiological parameters which maintain pH homeostasis. Measurement of arterial blood gas involves analysis of components: pH, partial pressure (PP), Base excess (BE), Bicarbonate (HCO3), Electrolytes, Haemoglobin (Hb) and Glucose.Interpreting an arterial blood gas (ABG) is a crucial skill for physicians, nurses, respiratory therapists, and other health care personnel. Any deviation from a normal value will indicate that the client is experiencing an acid base imbalance. Disorders of acid-base balance can lead to severe complications and occasionally the abnormality may be so severe that it can lead to life threatening condition. Objectives Of The Study: 1. Assess the level of knowledge about Arterial Blood Gas analysis among the staff nurses working in the Critical Care Unit at selected Hospital. 2. Evaluate the effect of Structure Teaching Programme on level of knowledge about Arterial Blood Gas Analysis among the staff nurses working in the Critical Care Unit at selected Hospital. 3. Association between level of knowledge about Arterial Blood Gas analysis among the staff nurses working in the Critical Care Unit with selected demographic variables. Research Methodology:This study was conducted using Quantitative approach at Integral Hospital, Lucknow. Pre-experimental one group pre-test-post-test design was used in the study. The conceptual framework used in this study was Modified Kings Goal Attainment theory. The total sample size was 30 selected by convenience sampling technique. The data was collected by administering Structured Knowledge Questionnaire followed by Structured Teaching Programme about Arterial Blood Gas analysis. After 7 days, post-test was done to assess the effectiveness of STP. Reults:The data obtained are tabulated and analysed using descriptive and inferential statistics. The statistical analysis of the data shows that 86.7% of the staff nurses had moderate knowledge and 13.3% of the staff nurses had inadequate knowledge. The mean pretest knowledge score regarding Arterial Blood Gas analysis was 13.96 with a standard deviation of 3.39. After giving STP the mean score was increased to 23.00 with a standard deviation of 2.36. The Structured Teaching Programme was effective in improving the knowledge as the t value is -12.54 which was highly significant with the degree of freedom 29 p< 0.05. Conclusion: The findings revealed that there was a significant improvement in knowledge of staff nurses in post-test after structured teaching programme. It also showed that there was an association with pre-test knowledge and selected demographic variables like age and association of post-test knowledge and selected demographic variable like qualification.

ASSESSMENT OF CORRELATION OF LACTATE /ALBUMIN RATIO IN SEPSIS PATIENTS ADMITTED IN ICU

Sepsis is life-threatening organ dysfunction caused by dysregulated host responses to infection, and septic shock is a subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are sufficiently profound to substantially increase mortality. Patients with sepsis are usually treated in the intensive care unit (ICU). Hence; under the light of above-mentioned data, the present study was undertaken for determining the correlation of lactate /albumin ratio in outcome of patients of sepsis in ICU. The present study was undertaken for determining the correlation of lactate /albumin ratio in outcome of patients of sepsis in ICU. A total of 30 patients were enrolled. The resulting patients were subjected to detailed history and examination followed by investigations (CBC, ESR, CRP), Bacterial culture, liver function test, renal function test, arterial blood gas analysis for lactate, serum albumin level). Mean Lactate value was 4.59 while mean albumin value was 25.12. Mean lactate to albumin ratio was 0.18. While correlating lactate to albumin ratio with Serum Procalcitonin levels, significant results were obtained. While correlating lactate to albumin ratio, it was seen that higher lactate to albumin ratio was associated with higher mortality. Lactate/albumin ratio is an independent predictor for the mortality among sepsis patients admitted to ICU.

A Study on the Efficacy and Safety of a New Endoscopic Nasal Mask for Intravenous Anaesthesia With Respiratory Retention: a Randomized Controlled Trial

Background: General anaesthesia is the most common choice for day surgery, and a laryngeal mask airway is the most commonly used airway management method in general anaesthesia. Many of the complications of laryngeal mask airways are not conducive to a rapid recovery and discharge. The main purpose of this study was to verify the effectiveness and safety of a new endoscopic nasal mask for anaesthesia for a short surgery.Methods: This is a randomized controlled study of 96 patients who were scheduled to undergo hysteroscopy, breast mass resection or great saphenous vein lesion resection. They were randomly divided into two groups. After entering the operating room, 48 patients in the control group were treated with LMA-assisted ventilation, and 48 patients in the experimental group were subjected to assisted ventilation with the new endoscopic nasal mask. Both groups were given dexmedetomidine combined with sufentanil, propofol, dexamethasone, parecoxib sodium, dezocine and ramosetron to complete the intravenous general anaesthesia.The main observation indexes included the occurrence of hypoxemia (SpO2<90%) after anaesthesia induction; the occurrence of hypercapnia (PetCO2>50 mmHg) due to respiratory depression and changes in the PaO2 and PaCO2 values in the arterial blood gas analysis (ABG) results.Results: The occurrence of hypoxemia (SPO2<90%) in the experimental group and the control group was not significantly different (P>0.05). The occurrence of hypercapnia (PetCO2>50 mmHg) in the experimental group was significantly reduced compared to that in the control group (P<0.05), and the difference was statistically significant. According to the results of the preoperative and postoperative arterial blood gas analysis, there was no statistically significant difference in PaO2 and PaCO2 between the two groups (P>0.05). Conclusion: Both methods are safe and effective for anaesthesia during a short operation. The new endoscopic nasal mask can quickly and effectively provide effective ventilation . It is convenient for anaesthesia airway management for clinical short day surgery.Trial registration: Trial Registration: www.chictr.org.cn; registration no.: ChiCTR2000032548; date of registration: 3rd May 2020