Download Key topics in critical care by T M Craft; Jerry Nolan; M J A Parr PDF

By T M Craft; Jerry Nolan; M J A Parr

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45. Standard bicarbonate This is calculated fromthe CO2and pH using the Henderson Hasselbach equation. It is the concentration of bicarbonatein a sample equilibratedto 37°C and PaCOz 40 mmHg. Thus, the metabolic component of acid-base balance can be assessed. The normal value is21-27 mmol 1". Actual bicarbonate This reflectsthe contribution of both the respiratory and metabolic components. The normal value in venous blood21-28 is mmol 1". 4. It is traditionally reported as 'base excess'. The normal range is +2 mmol 1" to -2 mmol 1".

In the presence of extensive hepatocellular damage vitamin K may be ineffective. Liver disease is also associated with thrombocytopenia secondary to splenomegaly. 4. Oral anticoagulant agents. Oral anticoagulantsresultindeficiencies of vitamin K-dependent clotting factors(11, VII, IX,X). FFP will provide short term reversal of anticoagulation (factor V I 1 has a half life of around 7 hours) while vitamin K provides longterm antagonism of warfarin. 5. Heparin. Heparin potentiates the action of anti-thrombin I11 which inhibits coagulation and can be measured by APTT prolongation.

A parenteral form is available insome countries. It should be given regularly itif is to have an opioid sparing effect. (b) Other NSAIDs. Theyhave both acentral and peripheralroleinblocking the prostaglandin mediated lowering of pain receptor thresholds. Salicylates are non-reversible inhibitors of prostaglandins. They are useful forthe management of mildto moderate pain. They can be used in combination with opioids and regional analgesic techniques. (c) Side effects of NSAIDs. 0 Gastrointestinal erosions aredue to local irritation, reduced gastric bloodflow, and increased acid secretion mediated by prostaglandin inhibition.

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