Crit Care Resusc
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To review the technology and the role of continuous intra-arterial blood gas monitoring in critical illness. ⋯ Over the last 10 years, a number of continuous intra-arterial blood gas monitoring systems have been developed. Only a few have reached commercial availability. While the performance characteristics of these systems are comparable, the levels of accuracy of these systems obtained in vitro are not consistently obtained in clinical trials. Arterial blood flow, wrist movement, wall effect and variability of blood gas analysers are some of the factors which determine the accuracy and reproducibility of these systems. Evidence to support the clinical usefulness of these monitors exists only in the form of case studies. Controlled studies demonstrating an improvement in outcome with the use of these monitors are lacking.
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To discuss the reasons why 250 ml 7.5% hypertonic saline was chosen as a pre-hospital resuscitation fluid for head injured patients in a multicentred, prospective, randomised controlled trial investigating its long term effects on central nervous system outcome. ⋯ Pre-hospital resuscitation of head injured and hypotensive trauma patients using hypertonic saline, has the potential to reduce long term cerebral injury and reduce social and financial costs to the community.
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To review the function and use of intravenous magnesium in magnesium depleted and non-magnesium depleted patients. ⋯ Magnesium is required in patients who are magnesium depleted and is also of benefit in non-magnesium depleted patients with pre-eclampsia. It may also be of benefit in non-magnesium depleted patients with acute coronary syndromes, arrhythmias, acute asthma, stroke, seizures and spinal cord injury.
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Clostridium perfiringens may cause myonecrosis (i.e. gas gangrene), acute food poisoning or necrotic enteritis (e.g. enteritis necroticans or Pig Bel). We describe a case of enteritis necroticans in a 33 year old man with acute myeloid leukaemia. ⋯ Treatment of enteritis necroticans requires urgent surgery to remove dead bowel and in adults intravenous penicillin (1g 2-hourly) and metronidazole (500 mg 8-hourly) or clindamycin (600 mg 6-hourly). While antibiotics may also reduce toxin formation, beta toxoid has not been found to be of benefit in established disease.