Crit Care Resusc
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A case is described of subarachnoid haemorrhage caused by vertebral artery dissection following general anaesthesia for laparoscopic cholecystectomy. It is postulated that the dissection may have been a result of neck manipulation during intubation or other movements whilst paralysed, or alternatively, due to intra-operative blood pressure changes occurring in a patient with a predisposition to arterial disruption. The case highlights the important symptom of neck pain in a patient with an intracranial catastrophe. Fortunately, despite a dramatic clinical presentation her recovery has been good.
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To review the metabolism and function of potassium and causes and management of hypokalaemia. ⋯ Hypokalaemia can be asymptomatic or it may cause cardiovascular, neurological or skeletal muscle dysfunction. If intravenous potassium therapy is required, then correction with potassium chloride, acetate, or phosphate salts are usually guided by the presence of a metabolic acidosis, alkalosis or hypophosphataemia.
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To review the role of drugs with potential benefit to renal function in critically ill patients. ⋯ The common factor in renal dysfunction and acute renal failure is tubular ischaemia. Prevention of this final common pathway is the chief goal of renal protection in critically ill patients. Despite the plethora of potentially beneficial drugs, volume loading and defence of renal perfusion pressure (and renal blood flow) with pressor agents appear to be the only reliable means of renal protection.
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To review the current status of echocardiography in critically ill patients with special reference to the advantages and disadvantages of the transthoracic and transoesophageal approaches. ⋯ Echocardiography is a rapidly developing technology. Cardiac structures can be imaged in 'real time'. Image quality continues to improve. The use of transoesophageal probe positioning has also widened the potential of this bedside technique in critically ill patients.
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To review the current status of echocardiography in critically ill patients with special reference to the advantages and disadvantages of the transthoracic and transoesophageal approaches. ⋯ Echocardiography often provides useful information in critically ill patients. Intensivists should familiarise themselves with this new technology and if possible become skilled practitioners of this exciting technique. The care of critically ill patients will benefit from its widespread use.