Thoracic imaging is regularly performed on the majority of critical care patients. Conventionally, this uses a combination of plain radiography and computed tomography. There is growing enthusiasm for the use of ultrasound to replace much of this radiology and provide more immediate, point-of-care imaging with reduction in patient transfers, ionizing radiation exposure and cost. This article explores the diagnostic performance of thoracic ultrasound in the imaging of pleural effusion, consolidation, extra-vascular lung water (EVLW), and pneumothorax. Current evidence suggests that, in expert hands, thoracic ultrasonography has similar diagnostic accuracy to computed tomography in pleural effusion, consolidation and pneumothorax. The technique also has potential to identify the cause of increased EVLW and accurately quantify pleural effusions. More large-scale studies are required in these areas however. Ultrasonography outperforms bedside chest radiography in all cases.

Objectives: (1) To assess the proportion of patients of triage category 3-5 presenting to the minor side of an urban emergency department who present without taking prior pain relief, and (2) to describe the reasons why they do not take pain relief for their presenting complaint Method: By patient interview of a convenience sample of 60 adult patients in the setting of an urban emergency department. Results: Fifteen of 60 patients had taken analgesia and 45 of 60 (75%) had not. Sixteen reasons were volunteered to the interviewer. Most patients offered one reason only 39 of 45 (87%). The three commonest single reasons cited for not taking pain relief were "don't like taking tablets" 10 (22%), "run out of tablets" 10 (22%), five (11%) said their "pain not bad enough". Six (13%) patients cited two reasons for not taking pain relief. Only three (6%) patients indicated that they "did not think about pain relief". Six (13%) of patients had inappropriate perceptions of how pain killers may interfere with their care. Conclusion: Most patients presenting with painful conditions to the minor side of an urban emergency department had not taken pain relief. The study highlights there are many different reasons for this and staff should not presume that it was because the patient "did not think about it". Ongoing education of staff and patients is needed.

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We conducted a survey of the UK Intensive Care Society regarding physician opinion of national guidance on ICU triage during a viral pandemic. Respondents graded agreement for seventeen triage criteria, ten from the Department of Health. We determined whether respondents accepted the whole tool on the basis of proportion of criteria agreed with. A modified tool was devised and acceptability compared. Five hundred and fifty questionnaires were returned (33.1% from senior physicians). Approximately half of senior physicians (49.5% ) and 44.4% of other respondents found the tool acceptable. This improved to 68.7% and 59.2% for the modified tool. Chi-square analysis revealed no statistically significant difference between the opinions of senior physicians and other respondents (p=0.850 for the original tool, p=0.593 for the modified tool). A small change to the government guidelines produced a tool with improved acceptability among ICU physicians.

Purpose: We aimed to determine if Modified Early Warning Score could be used as a surrogate for the Association of United Kingdom University Hospitals dependency scoring in improving patient flow into higher areas of care. In particular, focus was to be placed on the impact of Critical Care expansion on the size of the populations of patients being managed outside of Critical Care with an Association of United Kingdom University Hospitals requirement of Level 2. Materials and Methods: We conducted snapshot assessments of illness severity using Modified Early Warning Score and Association of United Kingdom University Hospitals dependency scores on all inpatients in a large, rural acute hospital during two five-day periods. Results: A total of 3850 patients were reviewed: 1854 in Study Period 1 and 1996 during Study Period 2. A total of 3113 (80.9%) patients had an Association of United Kingdom University Hospitals care level of 0. There was no statistically significant difference between the patients reviewed in each study period when analysed by Association of United Kingdom University Hospitals care level (p ¼ 0.575). Eighty-nine patients required Level 2 care (inclusive of those in Critical Care). Study Period 1 had 32 Level 2 patients managed on the ward. Study Period 2 demonstrated a statistically significant increase in the proportion of these patients cared for in a Critical Care environment (37.3%-68.4% (p ¼ 0.0036)). This was facilitated by an expansion in Critical Care capacity between the two study periods as a result of the findings in Study Period 1. Conclusion: We have shown that hospital inpatient data on illness severity are an essential tool in bed management and Critical Care capacity planning. We were able to demonstrate a fall in the number of Level 2 patients managed on a general ward environment following an expansion in Critical Care bed capacity. We also demonstrated that a Modified Early Warning Score of greater than 4 was associated with an increase in assessed care level requirement.