[Fatal ecstasy intoxication]. / Letalt forløbende ecstasyforgiftning.

A case of full-blown, lethal MDMA intoxication, owing to abuse of ecstasy is described. The increasing popularity of ecstasy among young, otherwise healthy, people prompts health care providers to recognise better the symptoms of systemic intoxication in order to initiate early treatment, such as rehydration, cooling in cases of hyperthermia, seizure treatment, correction of cardiac arrhythmia, and metabolic and electrolyte abnormalities.

Cost consciousness among anaesthetic staff.

BACKGROUND: Anaesthetists, like all other specialists, need to be aware of the costs of drugs, fluids and disposables commonly used in their clinical practice so that excessive costs and waste can be minimized without compromising patient care or safety. The present study describes cost consciousness among 120 anaesthetic staff members in two Danish anaesthetic departments. METHOD: A prospective study questioning 120 anaesthetic staff members (69 anaesthetic nurses, 35 senior anaesthetists and 16 junior anaesthetists) about the costs of 29 drugs, fluids and disposable used in routine anaesthetic practice. RESULTS: After the study period 107 questionnaires (90%) were available for analysis. Thirty-eight percent of all estimated costs were within 50% of the actual costs and 85% were within 100%. The costs of relatively expensive items such as isoflurane, enflurane, sevoflurane and hydroxyethyl starch were consistently underestimated, whereas cheaper items such as narcotic drugs, endotracheal tubes, intravenous tubing, plastic syringes and Quincke spinal needle were consistently overestimated. In general, the anaesthetic staff overestimated the costs by 69% (range -24% to 270%). The anaesthetic nursing group overestimated the costs by 49% (range -24% to 270%), junior anaesthetists by 94% (range 25% to 226%) and senior anaesthetists by 72% (range -14% to 135%). CONCLUSION: This study shows that the overall consciousness of the costs of anaesthetic drugs, fluids and disposables has to be improved in order to permit the staff to optimize resources.

[Fiber optic tracheoscopy in percutaneous dilation tracheostomy]. / Fiberoptisk trakeoskopi ved perkutan dilatationstrakeostomi.

Percutaneous dilatational tracheostomy (PDT) was performed on a 64 year-old female multitraumatised patient. Because of difficulties during the procedure, fiberoptic tracheoscopy was carried out and revealed perforation and dilatation of the endotracheal tube. The error was corrected with little loss of time, and no complications were observed after finishing the procedure. We recommend the use of routine fiberoptic tracheoscopy during and after percutaneous dilatational tracheostomy as suggested by Ciaglia et al (2).