SICU Critical Care Safety Study

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Health & Medicine Education

SICU Journal Club: The Critical Care Safety Study July 25, 2007 Christopher J. Utz, MD

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Methods ,[object Object],[object Object],[object Object],Patient population: MICU & CCU of 720 bed tertiary care hospital

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Results Data collected during nine 3-wk periods (5 in MICU, 4 in CCU) Observed 391 patients 420 admissions 1490 patient-days Patient demographics are different between MICU and CCU

Results ,[object Object],[object Object],[object Object],223 Serious errors – rate of 150 serious errors/1000 pt-days

Results ,[object Object],[object Object],24 serious errors judged to be potentially life-threatening

Results Incident Stats: Discovery of Adverse events & nonintercepted serious errors Patient’s nurse (36%) Another physician (27%) Clinical pharmacist (12%) Responsible physician (9%) Chart review (11%) Intercepted serious errors Patient’s nurse (42%) Another physician (23%) Clinical pharmacist (17%) ,[object Object],[object Object],[object Object]

Results 56 (47%) of adverse events due to ADE including 19 preventable ADE’s Medications contributed to 78% of serious errors Medication errors most commonly associated w/ treatment (87%) Also associated w/ prevention, diagnosis, & monitoring

Results Human & System Factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Discussion Results comparable to prior MICU studies w/ similar definitions Error rates similar in MICU and CCU Most of the errors categorized as slips & lapses – failure to carry out intended plans of action Based on this study, the authors estimate that 148,000 life-threatening intercepted & nonintercepted serious errors occur annually in teaching hospitals ,[object Object],[object Object],[object Object]

Discussion Study limitations Primarily studied interns May not be generalizable to ICU’s w/ markedly different patient populations May not be generalizable to non-teaching ICU’s

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These are simplified slides discussing the regulation of cardiac output and venous return. Learning objectives: 1. Comprehend the determinants of cardiac output and factors affecting cardiac output 2. Comprehend the factors affecting stroke volume and heart rate and total peripheral resistance 3. Identify the factors regulating venous return 4. Discuss the causes of high and low output cardiac failure 5. Enlist the functions of veins and recognise the significance of venous reservoirs Study Resources: 1. Chapter 20, Guyton and Hall Textbook of Medical Physiology, 14th edition 2. Chapter 30 and 32, Ganong’s Review of Medical Physiology, 26th edition 3. Chapter 10, Human Physiology by Lauralee Sherwood, 9th edition 4. Physiology, Cardiac Output - StatPearls https://www.ncbi.nlm.nih.gov/books/NBK470455/

Cardiac Output, Venous Return, and Their Regulation

Cardiac Output, Venous Return, and Their Regulation

Cardiac Output, Venous Return, and Their Regulation

MedicoseAcademics

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ANATOMY AND PHYSIOLOGY OF REPRODUCTIVE SYSTEM.pptx

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Dr. Faiza delivers an insightful lecture on the distinguishing characteristics of skeletal, smooth, and cardiac muscles, offering a comprehensive understanding of their histology, physiological anatomy, electrophysiological properties, and contractile mechanisms. Through meticulous tabulation and comparison, she aims to equip learners with a detailed comprehension of the unique features and functionalities of each muscle type. Beginning with a detailed exploration of histological differences, Dr. Faiza outlines key distinctions such as multinucleation in skeletal muscle, mononucleation in smooth and cardiac muscles, and the presence of striations in skeletal and cardiac muscles. She meticulously elucidates the structural arrangement of each muscle type, highlighting their cellular morphology and organization within tissues. Transitioning to physiological anatomy, Dr. Faiza navigates through various aspects including innervation, level of control, initiation of contraction, and modification by hormones. By delineating the role of the somatic nervous system in skeletal muscle control, and contrasting it with the autonomic nervous system's influence on smooth and cardiac muscles, she offers a nuanced understanding of neural regulation in muscle physiology. Furthermore, Dr. Faiza delves into electrophysiological properties, elucidating the mechanisms underlying action potential generation, duration, and ionic basis in each muscle type. Through insightful analysis, she reveals how differences in action potential characteristics contribute to variations in muscle contraction speed, duration, and resistance to fatigue. Finally, Dr. Faiza meticulously examines the contractile mechanisms of skeletal, smooth, and cardiac muscles, shedding light on the sliding filament theory, mechanisms of calcium action, and speed of contraction. By comprehensively comparing these mechanisms, she provides learners with a deep understanding of the intricate processes governing muscle contraction and function. Through engaging presentation and meticulous analysis, Dr. Faiza's lecture serves as a valuable resource for students seeking a thorough understanding of the fundamental differences between skeletal, smooth, and cardiac muscles.

Difference Between Skeletal Smooth and Cardiac Muscles

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Difference Between Skeletal Smooth and Cardiac Muscles

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ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptx

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In this lecture on circulatory shock, Dr. Faiza, an Assistant Professor of Physiology, delves into the profound implications of inadequate blood flow throughout the body, leading to tissue damage. The session begins by defining circulatory shock and elucidating its physiological causes, including decreased cardiac output, diminished blood volume, decreased vascular tone, obstruction to blood flow, excess metabolic rate, and abnormal perfusion patterns. Dr. Faiza categorizes shock into various types, such as cardiogenic shock, hypovolemic shock, neurogenic shock, obstructive shock, anaphylactic shock, and septic shock, and explores the pathophysiological basis of each. Furthermore, the lecture examines the stages of shock, from the non-progressive phase where compensatory mechanisms aim for full recovery to the progressive phase where shock worsens steadily without intervention, potentially leading to irreversible damage. Dr. Faiza discusses therapeutic interventions for shock, including replacement therapy, blood and plasma transfusion, sympathomimetic drugs, and other adjunctive treatments like head-down positioning, oxygen therapy, and glucocorticoids.

Circulatory Shock, types and stages, compensatory mechanisms

Circulatory Shock, types and stages, compensatory mechanisms

Circulatory Shock, types and stages, compensatory mechanisms

MedicoseAcademics

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Cardiac Output, Venous Return, and Their Regulation

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ANATOMY AND PHYSIOLOGY OF REPRODUCTIVE SYSTEM.pptx

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Difference Between Skeletal Smooth and Cardiac Muscles

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Circulatory Shock, types and stages, compensatory mechanisms

Circulatory Shock, types and stages, compensatory mechanisms

Circulatory Shock, types and stages, compensatory mechanisms

SICU Critical Care Safety Study

1. SICU Journal Club: The Critical Care Safety Study July 25, 2007 Christopher J. Utz, MD

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9. Results Data collected during nine 3-wk periods (5 in MICU, 4 in CCU) Observed 391 patients 420 admissions 1490 patient-days Patient demographics are different between MICU and CCU

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13. Results 56 (47%) of adverse events due to ADE including 19 preventable ADE’s Medications contributed to 78% of serious errors Medication errors most commonly associated w/ treatment (87%) Also associated w/ prevention, diagnosis, & monitoring

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16. Discussion Study limitations Primarily studied interns May not be generalizable to ICU’s w/ markedly different patient populations May not be generalizable to non-teaching ICU’s

18. Additional Info

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