Adverse Drug Reactions in the Intensive Care Unit

Adverse drug reactions (ADRs) are undesirable effects of medications used in normal doses [1]. ADRs can occur during treatment in an intensive care unit (ICU) or result in ICU admissions. A meta-analysis of 4139 studies suggests the incidence of ADRs among hospitalized patients is 17% [2]. Because of underreporting and misdiagnosis, the incidence of ADRs may be much higher and has been reported to be as high as 36% [3]. Critically ill patients are at especially high risk because of medical complexity, numerous high-alert medications, complex and often challenging drug dosing and medication regimens, and opportunity for error related to the distractions of the ICU environment [4]. Table 1 summarizes the ADRs included in this chapter.

A retrospective review of crisis events in diagnostic radiology: an analysis of frequency, demographics, etiologies, and outcomes

OBJECTIVE

The aim of this study was to determine the underlying characteristics of inpatients sustaining crisis events in the radiology department (RD).

METHODS

This is a retrospective case series undertaken in a 715-bed university-based tertiary care referral center in the United States, with a well-established medical emergency response team (MET). Adult hospitalized inpatients sustaining crisis events in the radiology suites of the University of Pittsburgh Medical Center from November 1, 2008, to October 31, 2010, were reviewed.

RESULTS

Ninety-six MET activations met our criteria. There were 92 conditions classified as C. Four conditions were characterized as A, defined as cardiopulmonary arrest. Three condition C calls progressed to cardiopulmonary arrest and were reclassified as A. A number of variables including admission diagnosis, comorbid conditions, time elapsed from admission to condition, admission source of patient, unit of origin before event, and the type of imaging study ordered were analyzed to determine any links or patterns between precursor events, the likelihood of deterioration, and the patient's subsequent clinical outcome.Forty (42%) of the conditions occurred within 24 hours of admission, and 49 (51%) occurred within the first 48 hours. Forty-six of the studies ordered were computed tomographic scans. Of those patients who sustained their condition within the first 48 hours, 41 (84%) were either outside hospital transfers or emergency department admissions. A significant proportion of acute deteriorations occurred in patients with traumatic brain injuries or strokes. Ten events (10%) were due to radiology accidents.Irrespective of etiology, the intervention of the MET allowed the study to be completed in 68 (71%) cases. Of these, 28 (41%) had their condition diagnosed by the study. Of the 10 patients who sustained a radiology accident, no patients had an adverse effect to their outcome; all were returned to their unit of origin.

CONCLUSIONS

Inpatient deterioration in the RD often occurred early in the course of the patient's hospitalization, with more than 40% taking place in the first 24 hours of admission. The MET seemed to have a positive impact on many patients, allowing a substantial percentage of studies to be completed. Interpretation of those studies often identified the etiology of the deterioration. Further study of outside hospital transfers, emergency department admissions, and intensive care unit patients who deteriorate in the RD is warranted to clarify risk factors and to identify early signs of deterioration.

Basic life support: a questionnaire survey to assess proficiency of radiologists and radiology residents in managing adult life support in cardiopulmonary arrest and acute anaphylactic reaction

The aim of this paper is to assess proficiency of radiologists and radiology residents in managing adult life support in cardiopulmonary arrest and acute anaphylactic reaction.