Ugeskrift for laeger
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Ugeskrift for laeger · Dec 2006
[Transthoracic ultrasound: a necessary standard within intensive, acute and pre-hospital medicine].
The introduction of focus assessed transthoracic echocardiographic (FATE) protocols has brought ultrasound into the first line in evaluating the critically ill patient. The technical advancements within ultrasound technology with miniaturisation and refinements of equipment have made the advantages of imaging available in the hemodynamic monitoring, and this modality now surpasses more conventional methods in feasibility and specificity. It seems reasonable to expect echocardiography to be incorporated as a new standard in the immediate assessment of the critically ill patient in the emergency and the intensive care unit as well as in the pre-hospital setting.
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Surgical patients with pulmonary disease are at increased risk of developing postoperative pulmonary complications and some patients may need postoperative ventilatory support. Stratifying and planning the right strategies for these patient categories are important since complications increase morbidity and mortality. Predictive tests, however, are few and preoperative interventions are of limited value. This brief review summarizes the current knowledge on perioperative measures to reduce pulmonary complications.
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Daily smokers and heavy drinkers develop two to four times more complications after major as well as minor surgery. Increased postoperative morbidity is probably due to tobacco and alcohol-related organ dysfunctions which are, however, reversible during abstinence. ⋯ Preoperative prevention programs are cost-effective. In conclusion, according to present evidence the smoking and drinking patient should be identified, informed, and offered preoperative prevention whenever possible.
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Management of perioperative treatment with anticoagulants and antiplatelet drugs is a complex medical problem. Careful preoperative evaluation of the risk of bleeding and thromboembolism with and without of antithrombotic therapy is the key prerequisite to secure safe outcome of elective, invasive procedures performed on patients treated with antithrombotic agents. In emergency cases, knowledge of the pharmacokinetics and pharmacodynamics of antithrombotic drugs and of the effect of antidotes and blood-derived, recombinant, and other haemostatic products is important.