British journal of hospital medicine
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Conventional haemodialysis is not available on all intensive care units (ICUs) and there are relatively few renally trained nurses able to run haemodialysis machines. Continuous arteriovenous haemodialysis provides effective renal replacement therapy for critically ill patients in the ICU. Unlike continuous arteriovenous haemofiltration it provides sufficient control over electrolyte, solute and water balance to obviate the need for additional treatment with intermittent conventional haemodialysis.
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In the second article in this series we describe some of the newer options in respiratory support and pharmacological intervention which, although largely experimental at present, may prove to be of benefit in the future.
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Successful clinical management of schizophrenia entails the skilled provision of neuroleptic drugs, stress management, skills training and specific psychological interventions. The integration of these treatments can only be achieved within the context of an efficient team that includes mental health professionals, social workers, general practitioners and, above all, patients and their families.
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Deaths from smoke inhalation remain depressingly frequent and most often occur because the victim cannot escape the toxic effects of carbon monoxide. Delayed sequelae of smoke inhalation greatly increase the mortality from cutaneous burns. This article outlines the supportive care of smoke casualties and discusses some of the dilemmas in management which result from the absence of specific therapies.
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Fulminant sepsis following splenectomy remains a major problem. Even with the administration of pneumococcal vaccine and prophylactic antibiotics fatalities still occur. A better understanding of the complex immunological function of the spleen, its preservation as much as possible during surgery, potent vaccine and perhaps more effective antibiotics will, hopefully, help reduce mortality in some of these cases in future.