Saudi Critical Care Journal

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Coronavirus disease-2019 (COVID-19) caused by novel coronavirus continues to produce enormous health effects and deaths since it started in 2019. Research till now has shown that COVID-19 manifests with unusual presentations causing various challenges in its management. Hyponatremia is a common condition found in critical care units and syndrome of inappropriate ADH (SIADH) accounts for one-third of those cases. Several infections associated with COVID-19 have been reported, but there are only few case reports of association with SIADH. We report the case of a 30-year-old male admitted with seizure due to acute symptomatic hyponatremia and SIADH attributed to COVID-19.

Context: Health-care systems move rapidly toward evidence-based practice (EBP); however, it is still challenging to determine if nurses who have received professional education have adopted EBP into their daily practice. Aim: This study aimed to investigate the effect of advanced professional programs in EBP beliefs and EBP implementation in Prince Sultan Military Medical City. Setting and Design: A cross-sectional study was conducted including 166 nurses who work at Prince Sultan Military Medical City. Subjects and Methods: Data were obtained using an adopted two questionnaires for the EBP-Beliefs and EBP-Implementation Scales. Statistical Analysis Used: Data were analyzed using SPSS version 23. Descriptive analysis was used to determine statistical significance and correlation between variables. Results: The mean score for EBP beliefs was 57.5 and the average score of EBP implementation was 45. A significant correlation was found between professional programs and EBP beliefs, and there were mean score differences between diploma and the other two groups (graduate and postgraduate). Conclusions: Professional programs showed a relationship with EBP beliefs; however, an increase of EBP beliefs does not always imply an increment on EBP implementation. Despite some obstacle factors such as lack of mentorship and training programs, EBP can benefit from advanced professional nursing programs, as believing of EBP importance increase with higher nurses' education level which can affect positively on patients' outcomes.

Amlodipine toxicity is underrecognized cause of refractory shock. Management of this condition is very challenging. Lipid infusion can be used for the management of this condition as a last resort. Very few cases of drug-induced pancreatitis were reported after Ca-channel blockers overdose. We reported a case of amlodipine toxicity with drug-induced pancreatitis, which was managed with repeated bolus doses of lipid infusion.

Background: Coronavirus disease 2019 (COVID-19) has been a worldwide pandemic in 2020; necessitating significant changes in patient-care procedures. Because of the risk of transmission to health care workers (HCWs) and the shortage of personal protective devices worldwide, novel protective barriers during aerosol-generating procedures have been developed. The intubation box has been proposed and gained popularity. A safe way for extubating patients with COVID-19 in critical care settings does not exist. This report discusses the development and assessment of the efficacy of using a Helium-Oxygen mixture (Heliox) filled bag during the extubation phase for the protection of HCW. Study Design and Methods: This methodology was developed at two tertiary care hospitals in Riyadh, Saudi Arabia and Toronto, Canada. We describe a novel way using a bag filled with Heliox bag. We performed extubation of an intubated manikin with and without using the Heliox bag. The cough during extubation was simulated using a fluorescent dye-filled balloon, which was inflated with a hidden oxygen tube until it bursts. We used an ultraviolet (UV) light source to assess the aerosols generated during extubation. Results: During extubation using the Heliox bag, droplets of the fluorescent dye were all contained within the Heliox bag and only found on the manikin chest. While during extubation without using Heliox bag, using the UV light, we found droplets of the fluorescent dye on the HCW mask and hand, the bed, the floor, and wall of the room. Conclusion: In our simulated experiment, we found that the Heliox bag is an easy and reproducible way for extubating patients with COVID-19 and any other airborne disease. We also found that the Heliox bag is an effective way to protect HCW.

Proning is a medically admissible procedure in which a patient is turned onto their abdomen from their back, by precise, accurate, and secure motions. This procedure often finds itself in use as an adjunctive in the treatment of acute respiratory distress syndrome (ARDS), which is a dreadful complication of many respiratory infections, including the disease of the moment: Coronavirus disease 2019 (COVID-19). Caused by severe acute respiratory syndrome coronavirus 2, COVID-19 can lead to a plethora of complications, with ARDS, causing breathing difficulties and leading to hazardously low levels of oxygen in the blood, taking the forefront. The treatment of this condition often requires invasive ventilation; and to decrease the strain on resources providing such, several protocols have been observed to improve the breathing capability and enhance oxygen exchange, of which one is prone positioning. Here, we review various literature regarding the proning procedure in COVID-19 patients and elaborate the efficacy, merits, and demerits.

Online since 15^th Dec, 2016