Organization of intensive cardiac care units in Europe: Results of a multinational survey

Background: The present survey aims to describe the intensive cardiac care unit organization and admission policies in Europe. Methods: A total of 228 hospitals (61% academic) from 27 countries participated in this survey. In addition to the organizational aspects of the intensive cardiac care units, including classification of the intensive cardiac care unit levels, data on the admission diagnoses were gathered from consecutive patients who were admitted during a two-day period. Admission policies were evaluated by comparing illness severity with the intensive cardiac care unit level. Gross national income was used to differentiate high-income countries ( n=13) from middle-income countries ( n=14). Results: A total of 98% of the hospitals had an intensive cardiac care unit: 70% had a level 1 intensive cardiac care unit, 76% had a level 2 intensive cardiac care unit, 51% had a level 3 intensive cardiac care unit, and 60% of the hospitals had more than one intensive cardiac care unit level. High-income countries tended to have more level 3 intensive cardiac care units than middle-income countries (55% versus 41%, p=0.07). A total of 5159 admissions were scored on illness severity: 63% were low severity, 24% were intermediate severity, and 12% were high severity. Patients with low illness severity were predominantly admitted to level 1 intensive cardiac care units, whereas patients with high illness severity were predominantly admitted to level 2 and 3 intensive cardiac care units. A policy mismatch was observed in 12% of the patients; some patients with high illness severity were admitted to level 1 intensive cardiac care units, which occurred more often in middle-income countries, whereas some patients with low illness severity were admitted to level 3 intensive cardiac care units, which occurred more frequently in high-income countries. Conclusion: More than one-third of the admitted patients were considered intermediate or high risk. Although patients with higher illness severity were mostly admitted to high-level intensive cardiac care units, an admission policy mismatch was observed in 12% of the patients; this mismatch was partly related to insufficient logistic intensive cardiac care unit capacity.

Thrombocytopenia in Intensive care units

Emergency Medicine Specialists (EMS) are supposed to helping/keeping certain patients alive. Although the Intensive Care Unit (ICU) personnel's priority is just saving life of ICU's patients but their approaches are not always in advantage of treated patients [1-5]. Prevalent thrombocytopenia (on ICU admission) occurred in 8.3% to 67.6% of patients; incident thrombocytopenia (developing during the course of the ICU stay) occurred in 13.0% to 44.1% of patients. High illness severity, sepsis, and organ dysfunction often correlated with thrombocytopenia.

Unusually high illness severity and short incubation periods in two foodborne outbreaks ofSalmonellaHeidelberg infections with potential coincidentStaphylococcus aureusintoxication

SUMMARYWe describe the investigation of two temporally coincident illness clusters involving salmonella andStaphylococcus aureusin two states. Cases were defined as gastrointestinal illness following two meal events. Investigators interviewed ill persons. Stool, food and environmental samples underwent pathogen testing.Alabama: Eighty cases were identified. Median time from meal to illness was 5·8 h.SalmonellaHeidelberg was identified from 27 of 28 stool specimens tested, and coagulase-positiveS. aureuswas isolated from three of 16 ill persons. Environmental investigation indicated that food handling deficiencies occurred.Colorado: Seven cases were identified. Median time from meal to illness was 4·5 h. Five persons were hospitalised, four of whom were admitted to the intensive care unit.SalmonellaHeidelberg was identified in six of seven stool specimens and coagulase-positiveS. aureusin three of six tested. No single food item was implicated in either outbreak. These two outbreaks were linked to infection withSalmonellaHeidelberg, but additional factors, such as dual aetiology that includedS. aureusor the dose of salmonella ingested may have contributed to the short incubation periods and high illness severity. The outbreaks underscore the importance of measures to prevent foodborne illness through appropriate washing, handling, preparation and storage of food.