British journal of hospital medicine
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Fast-tracking in cardiac surgery evolved as the pressure on bed space in intensive therapy units (ITU) grew and clinical management improved. It relies on achieving a patient condition that allows for earlier extubation and postoperative management in alternative facilities to the ITU.
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The use of colloid solutions for fluid resuscitation in hypovolaemic patients is widespread in clinical practice. This article describes the types of colloid agents which are currently available, their physicochemical properties, and adverse effects which may follow their administration. The relative merits of colloids compared with crystalloid solutions are discussed.
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Society places a responsibility on the medical profession for the prevention of suicide. In this article, current trends in suicide, social prevention strategies and the role and limitations of medical intervention are reviewed.
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The first article in this series (Vol 52 (11), p.583) discussed the pathophysiological processes involved in burn injury. This article describes the early management of large burns, in which treatment is considered in four stages: resuscitation, assessment, further care and transfer. The mnemonic 'RAFT' is suggested as a means of assisting recall of the management process.
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This article examines the evidence presented in the National Confidential Enquiry into Perioperative Deaths which demonstrates, we believe, that high-risk patients may not be receiving appropriate haemodynamic monitoring and fluid management. This may contribute to their mortality and merits further investigation.