Anaesthesia and intensive care
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It is widely accepted and taught that the accidental placement of a tracheal tube in the oesophagus can be readily detected if it is looked for, though it is recognised that death from this cause occurs from time to time. Evidence is now presented of instances where anaesthetists have been misled by a range of tests which are commonly used to check the correct placement of a tracheal tube. An explanation is offered for this unexpected finding, and some recommendations are formulated to improve patient safety.
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Haemolytic transfusion reactions can be defined as the occurrence after transfusion of measurably increased destruction of red cells, of donor or recipient, by alloantibodies. They may be acute (occurring within 24 hours of transfusion) or delayed (when signs of red cell destruction do not occur until 4 to 10 days after transfusion). ⋯ The subjective responses of pain, restlessness, nausea, skin flushing, dyspnoea and shock are mediated by cleavage products of complement (C3a, C5a) activated by red cell antigen-antibody reaction. The bleeding and renal failure complications that follow are multi-factoral in aetiology but also stem from the activation of intravascular clotting and from the vasomotor disturbances following histamine and kinin release.