When a patient bleeds they lose whole blood, but we also see a reduction in Hb concentration. The reason for this is apparently ‘transcapillary filling’ which always sounded to me like it could be bullshit (see earlier post).
The addition of Metronidazole to an antibiotic regimen is something generally done without much concern. We ‘trust’ Metronidazole to not cause resistance, and to do the job we ask of it. Why is that? I honestly can’t remember ever looking after a patient with an anaerobic infection resistant to Metronidazole.
As far as complications go, anastomotic leak after emergency bowel surgery is not to be recommended. The early identification of a leak is crucial. C-Reactive Protein (CRP) has been suggested as a marker that may be useful to identifying this complication, but the question is whether it is useful in the case of the high risk emergency laparotomy in the critical care environment.
One of our simulation scenarios involves treating a head injured patient. Just before we leave to get into the ambulance, the pupils become fixed and dilated. We then discuss whether to transfer the patient or not, with all groups to date feeling that yes, we should. But what is the prognosis for patients with bilateral fixed dilated pupils (BFDPs) after an acute extradural or subdural haemorrhage?
Two papers for your perusal this month, each looking at throwing all medicine has to offer at two diseases with potentially awful outcomes – cardiac arrest and ischaemic stroke.
It is undoubtedly true that treating (resuscitating) patients with sepsis early is a good thing to do. How we do this is determined internationally largely by the guidelines of the surviving sepsis group. These guidelines are often criticised in that they encourage a group of interventions, many of which have been shown to be non-beneficial when looked at independently (the idea of a care bundle is that the overall effect is greater than it's individual parts however). A classic example is the use of CVP as a resuscitation target despite the overwhelming evidence that this is frankly stupid.
The Surviving Sepsis Guidelines use a mixed venous oxygen saturation of 70% as a resuscitation target, but where does the 70% come from?
This point-prevalence study asked what proportion of patients in ICU would be suitable for cardiac output monitoring using pulse pressure variation (PPV). For a bit of background, have a look at the review article.:
This is a collection of blog posts written about new research or topics of interest.
This site is written for healthcare professionals. Nothing on it constitutes medical advice, and opinions expressed are those of the authors.
Dr Peter Hersey & Dr Laura O'Connor