miscellaneous trauma and critical care considerations

... Neuroanaesthesia and Critical Care Page ii DEDICATION To our patients Page iii Textbook of Neuroanaesthesia and Critical Care Edited by Basil F Matta MB BCh BA BOA DA FRCA Consultant in Anaesthesia and Neuro -Critical ... of Cambridge Director of Neurocritical Care Addenbrookes Hospital University of Cambridge UK John M Turner MBBS FRCA Consultant in Anaesthesia and Neuro-intensive Care Addenbrookes Hospital Associate ... Neurosurgical and Neurological Intensive Care 20 Management of Acute Head Injury: Pathophysiology, Initial Resuscitation and Transfer Mark J Abrahams, David K Menon, Basil F Matta 283 21 Intensive Care...

Ngày tải lên: 10/08/2014, 00:21

... classified as traumatic, ischaemic or hypoxic Traumatic brain injury may be due to the trauma associated with accidents or personal violence Alternatively, the trauma may be iatrogenic and accompany ... physiology Drugs such as mannitol and dexamethasone can reduce posttraumatic and peritumoral oedema respectively and thus augment cerebral perfusion pressure and oxygen delivery Similarly, the ... pressure effects to underlying and distant brain regions, shift of vital structures and axonal disruption, reductions in cerebral blood flow and metabolism, hydrocephalus and herniation However, metabolic...

Ngày tải lên: 10/08/2014, 00:21

... blood and indicator, λb and λi the specific heat of blood and indicator, and ρb and ρi the density of blood and indicator If time is brought into the equation, the volumes become flows and: Figure ... venous flow, and hence CBF, are then calculated using the equation: where Tb, Ti and Tm are the temperature of blood, indicator and mixture of blood and indicator respectively, Vb and Vi the volumes ... CBF and portable units are available The technique is relatively simple and is reliable and reproducible Patient and operator radiation exposure is low, enabling repeated studies on a patient, and...

Ngày tải lên: 10/08/2014, 00:21

... disease should be sought by careful history and thorough examination, noting the presence of angina and its severity, previous myocardial infarction and symptoms and signs of cardiac failure ... pressure and focal neurological deficits The diagnosis and investigation of intracranial neoplasms include MRI and CT scanning and, in older children, stereotactic biopsy Anaesthetic Considerations ... spondyloses, syringomyelia and tethered cord Clinical presentation may include Page 238 signs of motor and sensory deficits, pain and bladder and bowel symptoms Anaesthetic Considerations Potential...

Ngày tải lên: 10/08/2014, 00:21

... thin and very fragile with loss of connective tissue Osteoporosis and bone fractures are common and care is needed when gaining vascular access and positioning the patient Wound healing is slow and ... synthesis and release of ACTH and other pro-opiomelanocortin (POMC)-derived peptides in the pituitary ACTH in turn induces secretion of cortisol and adrenal androgens by the adrenal gland with ... macroglossia and decreased mobility of the neck and temporomandibular joints Hypertrophy of pharyngeal and laryngeal soft tissue obscures the glottis Thyroid enlargement may distort the airway and cause...

Ngày tải lên: 10/08/2014, 00:21

... injury Page 323 ABCS Following trauma, care of the airway and the cervical spine merit equal priority and stabilization of the cervical spine with sandbags/tape or trauma board immobilization should ... of critical care management of comatose, head-injured patients in the United States Crit Care Med 1995; 23: 560–567 20 Matta BF, Menon DK Severe head injury in the United Kingdom and Ireland: ... falls and motor vehicle accidents can produce axonal dysfunction and injury, brain contusions and axial and extraaxial haematomas Such macroscopic injury is associated with microscopic and ultramicroscopic...

Ngày tải lên: 10/08/2014, 00:21

... pneumonia and pulmonary embolism followed by dehydration and renal failure, UTI's and sepsis and other comorbidities for example, ischaemic heart disease and cancer Severe Strokes and Intensive Care ... critical illness polyneuropathy and the critical illness myopathies Critical investigations are a serum creatinine kinase and neurophysiological examination of the nerves, which in skilled hands ... amplitudes and normal sensory amplitudes References Fink ME, Rowland LP Respiratory care: diagnosis and management In: Rowland LP (ed) Merritt's textbook of neurology, 9th edn Williams and Wilkins,...

Ngày tải lên: 10/08/2014, 00:21

... central nervous system and the techniques of doing so and their applications continue to expand Anaesthetists are increasingly involved in both anaesthesia and sedation for adults and children in this ... muscles and lower cranial nerves Patients are conscious and able to blink and produce vertical eye movements Brainstem encephalitis may produce a comatose, areflexic, apnoeic patient, with motor and ... is being considered To minimize the risk of barotrauma and volutrauma, the peak inspiratory ventilatory pressure should be kept below 35 cmH2O and tidal volume less than 10 ml/kg The lowest concentrations...

Ngày tải lên: 10/08/2014, 00:21

... balance of supply and demand between health care providers and the public; a balance between the health care the public needs and that which its want; and a balance between what health care providers ... Critical Care February 2002 Vol No Hawryluck and Crippen involved in the design and/ or funding of a project, then what are the responsibilities and obligations of the investigator ... field We also need to think critically about our ability to reconcile the interests of society, patients, their families, and critical care practitioners, using logic and reaching agreement on...

Ngày tải lên: 12/08/2014, 18:21

... Critical Care February 2002 Vol No Ramakrishnan of hyperglycaemia in critically ill patients A total of 1548 medical and surgical patients were randomised on admission ... cutting edges of science and the wisdom of experts in all aspects of critical care. …’ The Congress provided a forum in which researchers and clinicians could come together and look at the questions ... overall mortality was comparable and lower than in other large national datasets, this thoughtprovoking and colossal study raises an important issue in Critical- care nephrology Dr Carlos Scheinkestel...

Ngày tải lên: 12/08/2014, 18:21

... post-anesthesia care unit (PACU), which is adjacent to the GICU In addition, nine medical intensive care beds are available The GICU is part of the Department of Anesthesiology and Critical Care Medicine ... available on site from general surgery, orthopedic surgery and anesthesiology/ critical care medicine and hospital administration As events evolve and more senior personnel arrive they will take charge ... discharged from the ICU and recovery room Send on-call most experienced physicians to the trauma bay and emergency department Prepare trauma bay, two operating rooms and ICU beds (including PACU)...

Ngày tải lên: 12/08/2014, 22:22

... and coworkers [30] compared efficacy and safety of remifentanil and fentanyl for analgesia and sedation in 152 mechanically ventilated patients Both remifentanil and fentanyl were effective and ... support, CPAP, and T-piece (n = 20 each) During weaning, plasma insulin and glucose as well as urinary vanilmandelic acid increased with pressure support and T-piece but not with CPAP, and plasma ... Using a retrospective methodology in a single, non-teaching 519 Critical Care October 2005 Vol No Brander and Slutsky hospital, Seymour and coworkers [19] studied the impact of failed (defined as...

Ngày tải lên: 12/08/2014, 22:22

... delivery of critical care during an influenza pandemic must include the ability to deal with excessive demand, high and possibly extreme mortality, and the risk to the health of critical care staff ... bombings Crit Care Med 2005, 33: S107-S112 37 Agency for Healthcare Research and Quality: Altered Standards of Care in Mass Casualty Events Rockville: Agency for Healthcare Research and Quality; ... alternative sources of demand for critical care, upgrading level to level facilities and recruitment of theatre recovery areas and even operating theatres may allow expansion of ICU-like care capacity Staff...

Ngày tải lên: 13/08/2014, 03:20

... Education in Anaesthesia, Critical Care & Pain, 5(2), 45À8 Sinclair, R C F & Luxton, M C (2005) Rapid sequence induction Continuing Education in Anaesthesia, Critical Care and Pain, 5(2), 45À8 Smith, ... Anaesthesia and Critical Care, eds Brian Smith, Paul Rawling, Paul Wicker and Chris Jones Published by Cambridge University Press ß Cambridge University Press 2007 35 36 N Wright and to prevent ... trauma or laryngeal spasm They may cough or suffer varying degrees of Core Topics in Operating Department Practice: Anaesthesia and Critical Care, eds Brian Smith, Paul Rawling, Paul Wicker and...

Ngày tải lên: 13/08/2014, 03:21

... different from adults and their responses to disease and injury may differ both physically and psychologically The differences in the anatomy and physiology of neonates, infants and children have ... dorsum of the hands or feet and is covered with an adhesive plastic dressing and sometimes bandaged The cream or gel needs to be covered to allow for the anaesthetic to be absorbed and effectively ... the three critical anatomical areas of the airway which include a) relative tongue/pharyngeal size; b) the mandibular space; and finally, c) the movement of the atlanto-occipital and mandibular...

Ngày tải lên: 13/08/2014, 03:21

... little if at all from standard anaesthetic monitoring and adheres to the recommendations of the Association of Anaesthetists of Great Britain and Ireland (AAGBI, 2000) and OAA The AAGBI regard ... (ABG) analysis is now commonplace in perioperative and acute -care settings and is used to aid diagnosis and to monitor the progress of the patient and the response to any interventions It is essential ... gases It is important to collect and handle the ABG sample carefully in order to reduce the possibility of inaccurate readings The relevant local policies and health and safety precautions relating...

Ngày tải lên: 13/08/2014, 03:21

... the anaesthetic considerations for the patient • How to care for the patient having electro-convulsive therapy • Discuss current standards in electro-convulsive therapy and understand the proposed ... Anaesthesia and Critical Care, eds Brian Smith, Paul Rawling, Paul Wicker and Chris Jones Published by Cambridge University Press ß Cambridge University Press 2007 154 Anaesthesia and electro-convulsive ... anaesthetic and permitted uncontrolled grand mal seizures These were dangerous to the patients and traumatic to the staff Restraining patients often involved enough force to induce injuries and broken...

Ngày tải lên: 13/08/2014, 03:21

... Intensive and Critical Care Nursing, 20, 358À65 Dreyfuss, D & Saumon, G (1998) Ventilator-induced lung injury: lessons from experimental studies American Journal of Respiratory Critical Care Medicine, ... for transfer of the critically ill patient London: Intensive Care Society Juniper, M (1999) Ventilator-associated pneumonia: risk factors, diagnosis and management Care of the Critically Ill, 15(6), ... information and evidence can be collected and stored centrally For some, portfolio building will have begun at an early stage in their career and will mainly include the education and training...

Ngày tải lên: 13/08/2014, 03:21

... supervisor These will include pre- and postoperative patient assessment and care, maintenance anaesthesia and (under direct supervision) conduct the induction and emergence from anaesthesia APs ... obstruction and 80 AVRNT 95 AVRT 95 aspiration 124 broad complex 25, 94–5 burns and 82 effects of 174 haemothorax and 82 hypotension and 174 irregular narrow complex 96 narrow complex 22, 95 pain and ... Committee III the Conduct and Competence Committee 197 198 S Wordsworth Conduct and competence and health committees Following consultation with other Practice Committees the Conduct and Competence Committee...

Ngày tải lên: 13/08/2014, 03:21

Ngày tải lên: 13/08/2014, 08:20