Brit J Hosp Med
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The British Orthopaedic Association's Standards for Trauma and Orthopaedics outline the essential clinical standards for spinal clearance and management of spinal cord injury in the acute trauma patient. From initial presentation in the hospital setting to long-term rehabilitation, the recommendations for clinical assessment, imaging, treatment priorities and the role of trauma networks are summarised.
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Malnutrition is the disturbance of normal form or function, arising from the deficiency of one or more nutrients, and is a significant issue in the older adult population. Despite their reduced energy requirements, older patients need the same protein intake and micronutrients as younger patients, but age-related changes may impact the ability to meet these requirements. The cause of malnutrition in individuals is likely to be multifactorial and can therefore be complex to manage. ⋯ Management strategies for optimising nutrition can be divided into systems and supplementation. With an ageing population, most doctors will inevitably become increasingly involved with treating older patients and this article highlights the need to consider a patient's nutritional status. Nutrition should be considered during every ward round and the multidisciplinary team as a whole should maintain an awareness and responsibility for managing malnutrition.
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There has been a significant rise in the incidence of contrast-associated nephropathy caused by administration of contrast media during cardiac interventions. This is one of the major complications of percutaneous coronary interventions, which may proceed to acute renal failure. Risk factors, including pre-existing renal dysfunction, older age and use of high osmolar contrast media, predispose patients to the development of contrast-associated nephropathy. ⋯ Prehydration, before administering contrast media, seems to be crucial. The results of studies of the relative efficacy of sodium bicarbonate and/or N-acetylcysteine in reducing the development of contrast-associated nephropathy are not consistent and any beneficial effects may depend on the pre-existing state of the kidney. This review discusses hydration of patients who are at risk of developing contrast-associated nephropathy using intravenous fluid.