Journal of the Royal College of Surgeons of Edinburgh
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J R Coll Surg Edinb · Apr 2002
ReviewFluid resuscitation in pre-hospital trauma care: a consensus view.
Fluid administration for trauma in the pre-hospital environment is a challenging and controversial area. The available evidence does not clearly support any single approach. Nevertheless, some provisional conclusions may be drawn. ⋯ Transfer should not be delayed by attempts to obtain intravenous access. Entrapped patients require cannulation at the scene. Normal saline may be titrated in boluses of 250 ml against the presence or absence of a radial pulse (caveats; penetrating torso injury, head injury, infants).
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J R Coll Surg Edinb · Oct 2001
ReviewHypoxia and surgical patients--prevention and treatment of an unnecessary cause of morbidity and mortality.
Hypoxia is a common phenomenon peri-operatively. Although mild hypoxaemia of short duration is likely to have little effect more severe and prolonged hypoxaemia can seriously affect surgical outcome. Rational use of oxygen therapy may limit these adverse effects.
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An understanding of the normal functioning of the heart and how it fails is important since it allows rational treatment. Pre-existing cardiac disease and myocardial dysfunction is common in the surgical patient. Moreover, the stress response of surgery and the alterations in body physiology seen in the post-operative period may further aggrivate any cardiac compromise. ⋯ The postoperative patient is at risk of these changes because of the stress response, analgesic therapy, inappropriate fluid management, hypoxia and previous cardiac compromise. The patient with sepsis is at further risk because of alterations in both systolic and diastolic function, which may be the result of inadequate fluid resuscitation and also release of a variety of inflammatory mediators. Until treatments, which are aimed at correcting the effects of these mediators, are proven to be beneficial then the septic patient will continue to be managed according to the physiological principles as outlined by Starling.
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Critically ill patients are hypermetabolic and have increased nutrient requirements. Although it is assumed that nutritional support is beneficial in this group of patients there are no well designed clinical trials to test this hypothesis. The rationale for nutritional support, therefore, is based upon clinical judgement. ⋯ Calorie intake was shown to be often considerably in excess of metabolic requirements alone, and variable study design has made comparisons impossible. Despite the lack of knowledge regarding even the most simple of nutritional requirements in these patients, the administration of specific micronutrients and specialised supplements has attracted attention. Again, many of these more recent studies are limited because of poor study design.
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J R Coll Surg Edinb · Dec 2000
Review Case ReportsPercutaneous transluminal angioplasty and stenting of coeliac artery stenosis in the treatment of mesenteric angina: a case report and review of therapeutic options.
We report the case of a 72-year-old gentleman with mesenteric angina who was successfully treated with stenting of a coeliac artery stenosis using a Palmaz stent, and review the therapeutic options in the management of mesenteric angina.