Download Current Essentials of Critical Care Sue by Darryl Sue, Janine Vintch PDF

By Darryl Sue, Janine Vintch

Present necessities of serious CARE is a special, hugely compressed quickly reference in case you deal with severely in poor health sufferers.

*"Nutshell" info at the analysis and remedy of greater than 2 hundred stipulations *One illness consistent with web page with bulleted key issues *Includes surprise; fluids and electrolytes; renal, middle, GI, and breathing difficulties; and different universal stipulations *Handy tabs for speedy reference *A needs to for scientific scholars, citizens, internists, surgeons, anesthetists, nurse practitioners, and general practitioner assistants *Use as a better half to present serious Care prognosis & remedy

UNIQUE speedy REFERENCE! *1 disorder in step with web page – Synoptic info, at a look *1 pearl in line with web page – A memorable medical pearl for every affliction *1 reference in step with web page – One reference for many problems

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Am J Respir Crit Care Med 2000; 162:347. 5–1 g/100 mL per unit (if no ongoing loss) Leukocyte-poor RBCs limit nonhemolytic transfusion reaction and HLA sensitization for potential transplant recipients; washed RBCs for patients sensitive to plasma components Number of transfused RBC units depends on hemodynamic stability, ongoing losses, changes in intravascular volume, bone marrow response Multiple transfusions associated with thrombocytopenia, coagulation factor deficiency; rarely citrate intoxication, hyperkalemia, hypothermia Complications: transfusion reactions (fever, anaphylaxis, hemolysis, alloimmunization); volume overload (especially with heart failure, renal failure); infections (hepatitis B and C, HIV, CMV) Pearl Unnecessary RBC transfusions associated with worse ICU outcome; may be due to increased immunosuppression.

Should have anticoagulation restarted when safe Pearl Without severe bleeding and INR Ͻ 9, low-dose oral vitamin K usually returns INR to therapeutic range quickly and safely. Reference Crowther MA et al: Oral vitamin K lowers the international normalized ratio more rapidly than subcutaneous vitamin K in the treatment of warfarin-associated coagulopathy. A randomized, controlled trial. Ann Intern Med 2002;137:251. 1%), very serious complication of warfarin Suspect in patients with rapid increase in INR with early doses of warfarin, hypercoagulable states (deficiency of proteins C or S, heparin-induced thrombocytopenia, resistance to activated protein C), previous complications suspected to be warfarin skin necrosis Starting warfarin may lead to transient decrease in anticoagulant proteins C and S (short half-lives) while procoagulant factors (factor Xa) not reduced; imbalance favors coagulation and thrombosis; imbalance more likely with deficiency of naturally occurring anticoagulants Disseminated intravascular coagulation with purpura fulminans Necrotizing fasciitis Arterial or venous insufficiency Vasculitis Treatment Stop warfarin Administer vitamin K, fresh frozen plasma Use alternative method of anticoagulation, such as heparin, if necessary • May need skin debridement • Prevention: use low starting dosages of warfarin, usually 5 mg orally daily; overlap with heparin therapy • • • ■ Pearl If INR rapidly rises after the first dose of warfarin, watch patient closely for signs of skin necrosis.

61 Hypophosphatemia ........................................................................... 62 Hypervolemia .................................................................................... 63 Hypovolemia ..................................................................................... 64 Metabolic Acidosis............................................................................ 65 Metabolic Alkalosis ........................................................................... 66 Mixed Acid-Base Disorders ..............................................................

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