Fascia iliaca compartment blocks: Different techniques and review of the literature.

The fascia iliaca compartment block has been promoted as a valuable regional anesthesia and analgesia technique for lower limb surgery. Numerous studies have been performed, but the evidence on the true benefits of the fascia iliaca compartment block is still limited. Recent anatomical, radiological, and clinical research has demonstrated the limitations of the landmark infrainguinal technique. Nevertheless, this technique is still valuable in situations where ultrasound cannot be used because of lack of equipment or training. With the introduction of ultrasound, a new suprainguinal approach of the fascia iliaca has been described. Research has demonstrated that this technique leads to a more reliable block of the target nerves than the infrainguinal techniques. However, more research is needed to determine the place of this technique in clinical practice.

Gamma-hydroxybutyrate (GHB), an unusual cause of high anion gap metabolic acidosis.

The causes of high anion gap metabolic acidosis (HAGMA) are well described in the literature. However, sometimes more frequent causes of HAGMA cannot explain its occurrence.In the case of HAGMA and severe neurological depression in the absence of other causes of HAGMA, clinicians should consider an intoxication with gamma-hydroxybutyrate (GHB) as a possible cause.GHB is endogenous to the mammalian central nervous system (CNS). Synthetic GHB was initially used as an anesthetic but is now only licensed for medical use in a limited number of indications such as the treatment of narcolepsy. Because of its euphoric effects, it became popular for recreational use under the street names: Liquid Ecstasy, Georgia Home Boy, and Liquid G.We describe the clinical case of a patient who suffered from severe neurological depression and HAGMA.

Automated testing combined with automated retraining to improve CPR skill level in emergency nurses.

OBJECTIVES: To investigate the effect of automated testing and retraining on the cardiopulmonary resuscitation (CPR) competency level of emergency nurses. METHODS: A software program was developed allowing automated testing followed by computer exercises based on the Resusci Anne Skills Station™ (Laerdal, Norway). Using this system, the CPR competencies of 43 emergency nurses (mean age 37 years, SD 11, 53% female) were assessed. Nurses passed the test if they achieved a combined score consisting of ≥70% compressions with depth ≥50 mm and ≥70% compressions with complete release (<5 mm) and a mean compression rate between 100 and 120/min and ≥70% bag-valve-mask ventilations between 400 and 1000 ml. Nurses failing the test received automated feedback and feedforward on how to improve. They could then either practise with computer exercises or take the test again without additional practise. Nurses were expected to demonstrate competency within two months and they were retested 10 months after baseline. RESULTS: At baseline 35/43 nurses failed the test. Seven of them did not attempt further testing/practise and 7 others did not continue until competency, resulting in 14/43 not competent nurses by the end of the training period. After ten months 39 nurses were retested. Twenty-four nurses failed with as most common reason incomplete release. CONCLUSION: Automated testing with feedback was effective in detecting nurses needing CPR retraining. Automated training and retesting improved skills to a predefined pass level. Since not all nurses trained until success, achieving CPR competence remains an important individual and institutional motivational challenge. Ten months after baseline the combined score showed important decay, highlighting the need for frequent assessments.