One-stop shopping: federated search engines

Perhaps the simplest and most efficient answer for most clinicians search-ing for information for patient care is a federated search engine such as TRIP, Turning Research into Practice, http://www.tripdatabase.com/ or SUMsearch, http://sumsearch.uthscsa.edu/. Both sources search multiple resources simultaneously and are free. • SUMsearch, produced by the University of Texas, has an excellent search engine that facilitates a clear and focused search on a somewhat limited range of resources. One of the recommendations in the results from a SUMsearch query suggested a search of TRIP. • TRIP has a truly primitive search engine, but it searches synthesised sources (systematic reviews including Cochrane reviews), summarised sources (practice guidelines from North America, Europe, Australia/New Zealand and elsewhere, as well as electronic textbooks including the excel-lent peer-reviewed eMedicine), and pre-appraised sources (Evidence-based Medicine, Evidence-based Mental Health, etc.), as well as searching all clinical query domains in PubMed simultaneously. Moreover, searches can be limited by discipline, such as Anesthesia and Critical care, helping both to focus a search and eliminate clearly irrelevant results, and acknowledg-ing the tendency of medical specialties to prefer the literature in their own journals. Given that most clinicians favour very simple searches, failing the availability of a broad evidence-based summarising resource such as ACP PIER or DynaMed, a TRIP search would probably produce the most satis-factory results from all types of information.
Source -
How to Read a Paper: The Basics of Evidence-Based Medicine; Trisha-Greenhalgh
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Location:Kathmandu

the interpretation of peripheral saturations can be dangerous,but when?

Although convenient,the interpretation of peripheral saturations can be dangerously reassuring to the unwary in three regards.First,although the partial pressure of oxygen, and therefore the haemoglobin oxygen saturation, falls with hypoventilation when breathing air, this iseasily compensated for by very small increases in the fractional inspired oxygen concentrations.If a patient hypoventilates on room air,this is likely to cause alarm when the saturations fall below 90%, at which point the alveolar partial pressure of carbon dioxide (PaCO2) will be high(8.8 kPa), although not dangerously so. In contrast,if the alveolar hypoventilation goes unnoticed and the patient is given supplemental oxygen withan FiO2 of only 28%, the alveolar minute volume would have to fall to 1450mL per minute before the saturations fell to 90%, by which time the PaCO2 would be just under 14 kPa. This degree of hypercapnia would be very likely to cause carbondioxide narcosis,putting the patient at risk of either airway obstruction or aspiration. It is important to realize,therefore, that just because a patient has a reasonable haemoglobin oxygen saturation, if she is receiving supplemental oxygen,she might still be in considerable danger from hypoventilation.Second, the haemoglobin saturation should always be assessed in the context of the FiO2. Forexample,a patient with a haemoglobin oxygen saturation of 88%might in fact not be as much a cause for concern as another patient with saturations of 94% if the former is breathing room air and the latter is breathing 60% oxygen.Finally, the clinician should beware the patient who has carbon monoxide poisoning. Pulseoximeters are unable to distinguish between carboxy-haemoglobin and oxy-haemoglobin,which can only be assessed in blood gas analysers equipped with multiple wavelength spectrophotometers or using a co-oximeter.

Ref - CoreTopicsinMechanicalVentilation

cardiopulmonary exercise test

I just went through this topic in preoperative evaluation of cardiac status for patients scheduled to undergo non-cardiac surgery. It was published in " Recent advances in anaesthesia and analgesia 24". It highlights the role of Cardiopulmonary exercise testing;something very different from the conventional methods of preoperative evaluation of cardiopulmonary reserve.I strongly suggest the anesthesia residents to go through it. It helps a lot to get an idea of how things work,in fact,how the cardiopulmonary system reacts to the perioperative stress...

early advertisement for ether as an anaesthetic

William Thomas Green Morton

"On the 16th of Oct., 18-46, an operation was performed at the hospital upon a patient who had inhaled a preparation administered by Dr. Morton, a dentist of this city, with the alleged intention of producing insensibility to pain. Dr. Morton was understood to have extracted teeth under similar circumstances, without the knowledge of the patient. The present operation was performed by Dr. Warren, and though comparatively slight, involved an incision near the lower jaw of some inches in extent. During the operation the patient muttered, as in a semi-conscious state, and afterwards stated that the pain was considerable, though mitigated; in his own words, as though the skin had been scratched with a hoe. There was, probably, in this instance, some defect in the process of inhalation, for on the following day the vapor was administered to another patient with complete success. A fatty tumor of considerable size was removed, by Dr. Hayward, from the arm of a woman near the deltoid muscle. The operation lasted four or five minutes, during which time the patient betrayed occasional marks of uneasiness; but upon subsequently regaining her consciousness, professed not only to have felt no pain, but to have been insensible to surrounding objects, to have known nothing of the operation, being only uneasy about a child left at home. No doubt, I think, existed, in the minds of those who saw this operation, that the unconsciousness was real; nor could the imagination be accused of any share in the production of these remarkable phenomena."

Bigelow HJ.
Boston Med Surg J 35:309-317, 1846

my department

Maximum Surgical Blood Ordering Schedule (MSBOS)

The Maximum Surgical Blood Order Schedule (MSBOS) is a table of elective surgical procedures which lists the number of units of red cells routinely crossmatched for them pre-operatively.
It allows the more efficient use of blood stocks and reduces wastage.

further inf is available at : British Committee for Standards in Haematology Blood Transfusion Task Force (1990) Guidelines for implementation of a maximun surgical blood order schedule. Cinical and Laboratory Haematology 12: 321-327 .