Minerva anestesiologica
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In Italy (130,000 new strokes in the general population per year) ischemic stroke is the third cause of death, after cardiovascular disease and neoplastic disease with a prevalence of 6.5%. Different physicians are involved in the emergent evaluation and treatment of the acute ischemic stroke. As other acute events, the initial evaluation must be addressed to assess the patient's airway and breath-ing and cardiocirculatory conditions. ⋯ The goal is to achieve and to maintain an adequate cerebral perfusion by lowering the intracranial pressure (treating the cerebral oedema) and by increasing the mean arterial pressure, with an appropriate volemic expansion and/or with inotropic or vasopressor drugs. The thrombolytic therapy with intravenous recombinant tessutal plasminogen activator (r-TPA) when not specifically contraindicated, is recommended within 3 hours of onset of ischemic stroke. The benefit of intravenous r-TPA for acute ischemic stroke beyond 3 hours from the onset has never been proved.
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Over the past 15 years, there have been dramatic changes in the management of blunt hepatic trauma, specifically in the imaging techniques, and in the non-operative management. Actually, in more than 80% of blunt hepatic trauma, non operative management is used. In the last 20% the surgical option has to be taken without delay, sometimes in extreme emergency, using the adapted surgical techniques. In this article the author describes the nonoperative management of blunt hepatic trauma: classification, presentation, initial decision, treatment, possible complications and results.
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Minerva anestesiologica · Apr 2002
Principles, protocols and patients: the practical management of a limit in ICU.
The definition and management of a limit is a common but sometimes extremely complex problem in the Intensive Care Unit (ICU). Guidelines and consensus documents have been published in order to help clinicians. ⋯ In this sense, the practical management of a limit in ICU is usually run by a dual normativity: an external one, which derives from the cultural, moral and legal values of the society, and an internal one, which depends on the particular clinical and human situation, namely the values of everybody involved in (the patient, his/her relatives, the health staff) and the relationships among these people. The considerable freedom left for the decision by an open communication is a great and favourable potential which must be used in the interest of the patient's and of his/her family.
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The new OxiMax Pulse Oximetry System includes the Nellcor N-595 Pulse Oximeter and a new line of OxiMax sensor. The main feature of this platform is the digital memory chip inserted within each OxiMax sensor that contains all the calibration and operating characteristics for that individual sensor. It allows an information exchange between the sensor and the monitor improving monitoring performance during difficult acquisition periods. We reviewed several studies showing that the more centrally placed forehead sensor can offer significant advantage over finger sensor when monitoring patient with low pulse perfusion, especially in situation where rapid detection of hypoxemia is critical.