Pandemic ICU triage challenge and medical ethics.

The COVID-19 pandemic has made unprecedented global demands on healthcare in general and especially the intensive care unit (ICU). the virus is spreading out of control. To this day, there is no clear, published directive for doctors regarding the allocation of ICU beds in times of scarcity. This means that many doctors do not feel supported by their government and are afraid of the medicolegal consequences of the choices they have to make. Consequently, there has been no transparent discussion among professionals and the public. The thought of being at the mercy of absolute arbitrariness leads to fear among the population, especially the vulnerable groups.

Discussing and documenting (do not attempt) resuscitation orders in a Dutch Hospital: a disappointing reality.

OBJECTIVE: To determine whether the introduction of a patient information sheet about do not attempt resuscitation (DNAR) orders and personal motivation of the medical staff results in an improvement in the documentation of the DNAR orders in the medical records. DESIGN: Retrospective chart review. METHOD: The medical records for all hospital admissions during February 2005 were checked for age, sex, admission time, admitting specialty, admission type (acute or planned), death, documentation of the DNAR order on the admission form, and if this order was complied with and under whose initiative the order was implemented or not. These data were compared to the medical records from 2 years earlier. RESULTS: In 2005, 119 (9.3%) medical records a DNAR order was found, compared to 10.7% in 2003. In the 43 patients who died DNAR orders were documented more often (18.6%) than in other patients (9%). The DNAR order was written more frequently for patients who were older (46.5 years versus 67.5 years), had a longer hospital admission period (4.2 versus 12.4 days) and for acute admissions. No difference was found for sex. Of the specialties with more than 10 admissions a month, the most frequently written DNAR orders came from internal medicine (36%) and pulmonology (31%); the least from cardiology (2.2%) and thoracic surgery (0%). In 9 of the 119 (7.6%) the DNAR orders were explained, most were initiated by the doctor (7), 1 by the patient an 1 by the family. CONCLUSION: Giving patients more information about DNAR orders and motivating medical staff personally does not influence the documentation of DNAR orders. If documented, it occurred more in the elderly and the deceased patients. Only a few DNAR orders were specified and most were initiated by the doctor.

Sepsis due to gestational psittacosis: A multidisciplinary approach within a perinatological center--review of reported cases.

Chlamydia psittaci is associated with significant morbidity and mortality during pregnancy, and its rarity can delay early diagnosis and treatment. A farmer's wife presented at 31 weeks with febrile illness and developed signs of septic shock, indicating immediate delivery. The child developed uneventfully. The mother survived after symptomatic mechanical ventilation, including extracorporeal lung assistance, for 11 days due to multi-organ failure. Only two weeks after admission antibody titres against Chlamydia were rising. The placenta demonstrated acute intervillositis and destruction of throphoblastic cells. Retrospectively, the infection was presumed to derive from infected pregnant sheep. Pregnant women should be advised to avoid contact with sheep and their gestational products. Proper history, early recognition and appropriate management is mandatory for survival of both mother and child.