OVERVIEW caused by influenza A and B viruses CLINICAL FEATURES fever (>38 C)+/- one systemic symptoms (myalgia)+/- one respiratory symptoms-> 70% chance of having influenza INVESTIGATIONS nasopharyneal viral swab MANAGEMENT Active Treatment neuraminidase inhibitors are of no benefit unless started…
Liver Failure Definitions and Scoring Systems
Gastrointestinal Literature Summaries
Coagulopathy in Liver Dysfunction; defined as INR >1.5 due to liver dysfunction; patients are not 'auto-anticoagulated' - they are often in a procoagulant state!
CAUSES pre-existing liver disease (+/- exacerbation) drug induced (paracetamol, statins, amiodarone, antibiotics, NSAIDs, beta-blockers, ranitidine, volatiles) ischaemic (post clamping above hepatic artery, thrombosis, embolic, hypotension) surgical injury nutrition (TPN, EN) acalculous cholecystitis transfusion related hepatitis ASSESSMENT History pre-operative liver function…
Rapid fluid administration is potentially life-saving in the resuscitation setting; flow rates achieved depend on the devices used in fluid administration, largely in agreement with Poiseuille's law
Perioperative fluid management: an adequate and timely replacement of actual losses with appropriate preparations seems to be an ideal primary approach
Global Increased Permeability Syndrome (GIPS) "is characterised by high capillary leak index (CLI, expressed as the ratio of CRP over albumin x 100), excess interstitial fluid and persistent high extravascular lung water index (EVLWI), no late conservative fluid management (LCFM) achievement, and progression to organ failure"
Fluid Therapy Literature Summaries
Advantages and disadvantages of different methods for assessing fluid status
Albumin: colloid solution; 4, 10, 20%; use in the critically unwell is controversial