Brit J Hosp Med
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Central venous pressure is no longer routinely used to guide therapy in UK intensive care units, owing to evidence that it poorly predicts fluid responsiveness. This article reviews whether central venous pressure monitoring should be used to guide critical care management in certain patients.
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Major trauma networks reduce mortality in critically injured patients. Trauma patients should be appropriately triaged straight from the scene of injury, avoiding secondary transfer from a trauma unit. Selection criteria in regionally agreed triage tools are designed to identify which patients should be taken directly to the major trauma centre. ⋯ This article presents a theoretical case of a haemodynamically unstable patient with penetrating injuries, and discusses the management of chest trauma, including diagnosis of life-threatening injuries, resuscitation strategies and definitive surgical management. Secondary transfer to the major trauma centre should be considered after instituting the minimal life-saving interventions. What constitutes a life-saving intervention requires an individual dynamic risk assessment and an understanding of major trauma networks.
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Spondylodiscitis is often diagnosed late in its course because its symptoms are vague. The incidence in adults increases with age, being seen most commonly in men in their 50s and 60s, so the presence of other medical conditions or infections can make it more difficult to identify spondylodiscitis. Diagnosis is made based on clinical suspicion, raised levels of inflammatory markers, a positive blood or tissue biopsy culture and radiological findings. ⋯ The mainstay of treatment is medical management, with antibiotics tailored to the relevant organism, as well as immobilisation. Where surgery is indicated, the aims are debridement of infected tissue, tissue sampling, neural decompression and stabilisation. Spondylodiscitis is associated with high rates of mortality and morbidity and should be treated promptly to ensure the best outcome.
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In the UK, harm caused by alcohol has worsened since 2020. A recent report from the Institute of Alcohol Studies projecting future rates of major alcohol-related diseases highlights what this means for health and healthcare. The authors argue that this additional burden is not inevitable if effective policies are introduced.
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Clinicians and institutions must recognise the unique set of considerations required by breastfeeding patients, a small but vulnerable cohort of patients. Modification of existing perioperative pathways, diligent prescribing and multidisciplinary involvement can facilitate safe and patient-centred perioperative care.