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Paediatric Anaesthesia
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Only start a case if there are facilities to finish it. In emergency cases without appropriate facilities, the anaesthetic team must oversee the patient's recovery. NEVER start a new case until the last patient is safe. Post-anaesthesia care unit (PACU)—trained competent staff, emergency equipment (drugs, anaesthetic machine).High-dependency unit or intensive care unit.Patients should only be discharged when fully conscious, appropriately hydrated, and pain-free with appropriate analgesia prescribed, and with full handover of the post-operative care to the ward.On discharge, patients should be given information sheets about their procedure that contain contact details should they have any problems.
Vulnerability in the acutely ill patient
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Feeling safe and being safe, physically and emotionally, are therefore essential. If a person feels vulnerable or feels their health and well-being are at risk this may prevent them from making a full recovery. Sometimes, the health of a patient in hospital may deteriorate suddenly and the person becomes acutely ill. There are times when this is more likely to happen, for example, if the patient is an emergency admission to hospital, after surgery and after discharge from a critical care area such as a high-dependency unit. Becoming acutely ill can happen at any time during an illness and this increases a person’s risk of needing to stay longer in hospital, not making a full recovery or dying. At all stages Maslow’s hierarchy will need to be given consideration. Think of patients who are acutely ill and apply Maslow’s model to those patients. All of those who are acutely ill are vulnerable and this may be from a physiological, emotional or psychological perspective.
Anesthetic Management of Laproscopic Colorectal Surgery
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Postoperatively, patients should be managed by multidisciplinary teams involving anesthesiologists, surgeons, nursing staff, nutritional experts, acute pain team, pharmacists, and physiotherapists in a high dependency unit (HDU). Early enteral nutrition has several advantages, such as improved anastomotic healing, improved calorie intake, a reduced incidence of infectious complications, reduced hyperglycemia, and insulin resistance [20]. Enteral nutrition is safe and more cost effective than parenteral nutrition (TPN), which requires a central line. It is also a care component of enhanced recovery.
Outcomes and prognostic factors of cytoreductive surgery and perioperative intraperitoneal chemotherapy in high-volume peritoneal carcinomatosis
Published in International Journal of Hyperthermia, 2022
Lee S. Kyang, Suzannah L. Dewhurst, Valerie A. See, Nayef A. Alzahrani, David L. Morris
The cohort in high PCI groups had significantly higher mean PCI and higher proportion of CC-1 patients (72%) leading to increased operating hours and use of blood products including packed red cell (>8 units) and fresh frozen plasma (FFP; >10 units). The admissions in ICU, high dependency unit (HDU) and hospital were relatively longer and grade 3–4 morbidity complications were more frequent when PCI was ≥ 30. High-volume PC was also associated with elevated level of tumor markers (CEA, CA125, CA19.9 and combination of the three). There was no difference in readmission rates between the two groups following discharge from hospital. However, high volume disease was associated with higher morbidity of complications (grade III/IV) compared to low volume disease (68% vs 36.6%; p < 0.001).
Alpha-Fetoprotein in Predicting Survival of Patients with Ruptured Hepatocellular Carcinoma after Resection
Published in Journal of Investigative Surgery, 2022
Wong Hoi She, Miu Yee Chan, Ka Wing Ma, Simon H. Y. Tsang, Wing Chiu Dai, Albert C. Y. Chan, Chung Mau Lo, Tan To Cheung
Diagnosis of rHCC has been detailed in a previous paper [11]. In patients who had no acute abdominal pain, the diagnosis was made during hepatectomy. Pre-hepatectomy management of spontaneous HCC rupture has been described in previous papers [12]. Patients who were stable at presentation were managed conservatively with tranexamic acid if no contraindications were identified. They were monitored closely by clinical and biochemical means in the minimum setting of a high dependency unit. Before 2005, patients who were fit and whose liver function had recovered were offered an early operation. Since 2005, all patients received a further computed tomographic scan (usually two to four weeks after the initial episode) to reevaluate their tumor status before operation. After initial stabilization and recovery, hepatectomy was considered and planned. Relationship between tumor’s anatomical location (regardless of tumor size) and major hepatic vasculatures would determine resectability. A 1-cm resection margin was aimed for, preferably by anatomical resection. Criteria for major resection (removal of 3 or more continuous Couinaud segments [13] have been listed in an earlier article and resection techniques have been detailed in various papers [14].
Consensus statements on the approach to patients in a methanol poisoning outbreak
Published in Clinical Toxicology, 2019
Hossein Hassanian-Moghaddam, Nasim Zamani, Darren M. Roberts, Jeffrey Brent, Kenneth McMartin, Cynthia Aaron, Michael Eddleston, Paul I. Dargan, Kent Olson, Lewis Nelson, Ashish Bhalla, Philippe Hantson, Dag Jacobsen, Bruno Megarbane, Mahdi Balali-Mood, Nicholas A. Buckley, Sergey Zakharov, Raido Paasma, Bhavesh Jarwani, Amirhossein Mirafzal, Tomas Salek, Knut Erik Hovda
We recommend (Level 1D) that if sufficient fomepizole is available, patients at high risk of toxicity but no current acidosis or end organ damage receive fomepizole. For example, this includes patients with a high osmol gap (>20–30 mOsm after accounting for the effect of ethanol, if any) or methanol concentration >50 mg dL−1 (15.6 mmol L−1). This will allow admission to a non-high dependency unit (HDU)/intensive care unit (ICU) environment, thereby prioritizing such facilities for patients in more need. It is important to emphasize that osmolality must be measured by a freezing-point depression method, and not a vapor-pressure method: The latter will not detect the increased osmolality caused by the volatile alcohols, and thus give a false negative result. Thus, this excludes the osmolality measurements by some blood gas machines [23]. We recommend (Level 1D) that patients requiring antidote treatment also receive optimal treatment with bicarbonate, folic/folinic acid, and supportive treatment as necessary.