y The SNAP-2: EPICCS collaborators are listed in Supplementary material. AbstractBackground: Decisions to admit high-risk postoperative patients to critical care may be affected by resource availability. We aimed to quantify adult ICU/high-dependency unit (ICU/HDU) capacity in hospitals from the UK, Australia, and New Zealand (NZ), and to identify and describe additional 'high-acuity' beds capable of managing high-risk patients outside the ICU/HDU environment. Methods: We used a modified Delphi consensus method to design a survey that was disseminated via investigator networks in the UK, Australia, and NZ. Hospital-and ward-level data were collected, including bed numbers, tertiary services offered, presence of an emergency department, ward staffing levels, and the availability of critical care facilities. Results: We received responses from 257 UK (response rate: 97.7%), 35 Australian (response rate: 32.7%), and 17 NZ (response rate: 94.4%) hospitals (total 309). Of these hospitals, 91.6% reported on-site ICU or HDU facilities. UK hospitals

Perioperative tranexamic acid in a single, parenteral dose might reduce the incidence of primary haemorrhage following paediatric tonsillectomy, facilitating discharge on the day of surgery. The results from this observational study indicate a potential benefit and need for a large, prospective, multicentre, randomised controlled trial.

Both intraoperative peak inspiratory pressure and FiO are independent factors significantly associated with development of a postoperative pulmonary complication in emergency laparotomy patients. Further studies are required to identify causality and to demonstrate if their manipulation could lead to better clinical outcomes.

No abstract

A 61 year old white homosexual man complained of profound fatigue, proximal lower extremity weakness, myalgias, and fever of two days' duration. He also complained of a worsening rash over his proximal upper extremities, trunk, and back for the past month. Two months earlier he had been diagnosed with seronegative rheumatoid arthritis when he presented with bilateral hand and wrist pain. He denied cough, shortness of breath, photosensitivity, Raynaud's phenomenon, dry mouth or eyes, recent travel, pets, morning stiVness, penile discharge, or genital ulcers. He tested HIV negative three months before admission. His past medical history was significant for hypertension, gastro-oesophageal reflux disease, and obstructive sleep apnoea. He had been taking prednisone 15 mg and cimetidine 400 mg daily.On examination, the patient looked acutely ill and uncomfortable. He was febrile at 102.4°F, his blood pressure was 148/80 mm Hg, and his pulse was 90 beats/min. He had confluent erythematous and purpuric plaques on his back, anterior trunk, and proximal upper extremities (see fig 1); some were in a polycyclic arrangement but without scale. No muscle tenderness or weakness was detected. There was no appreciable arthritis or synovial thickening. He had a II/VI systolic murmur throughout his precordium without radiation. The remainder of his physical examination was without abnormalities.The initial evaluation is listed in box 1. A skin biopsy showed superficial and deep perivascular infiltrates with extensive interface damage. Immunofluorescence revealed strong granular C3 and trace granular IgG and IgM at the dermal-epidermal junction.