Articles: function.
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To review the pathophysiology and management of patients with clinical manifestations of fat embolism. ⋯ Fat embolism occurs in many traumatic and atraumatic conditions and is largely asymptomatic. Preventative measures include early immobilization of fractures and methods to reduce intramedullary pressure during surgical manoeuvres. Treatment is largely symptomatic with therapy for respiratory failure similar to that used in management of acute respiratory distress syndrome. Corticosteroids have not been found to be of significant benefit.
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To review the pharmacodynamic and pharmacokinetic properties of digoxin in health and disease and the potential use and toxic effects of digoxin in the critically ill patient. ⋯ Digoxin is a therapeutic agent with unique effects. It should be considered in all patients with systolic heart failure, supraventricular tachycardia, and, in association with other treatment, as a single dose of 750 -1000 mug/70 kg in patients not treated previously with digoxin who have septic shock. It should be avoided in patients with critical coronary artery disease and ischaemic or hypertrophic diastolic failure.
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To describe a new approach to circulating volume control in critically ill patients. ⋯ Use of a P(msa) volume signal enables prolonged stable closed loop volume servocontrol. In global heart dysfunction the dimensionless variable (P(msa )- RAP)/P(msa )may be used to guide inotropic therapy.
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To review the role of drugs with potential benefit to renal function in critically ill patients. ⋯ The common factor in renal dysfunction and acute renal failure is tubular ischaemia. Prevention of this final common pathway is the chief goal of renal protection in critically ill patients. Despite the plethora of potentially beneficial drugs, volume loading and defence of renal perfusion pressure (and renal blood flow) with pressor agents appear to be the only reliable means of renal protection.
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To review the metabolism and function of potassium and causes and management of hypokalaemia. ⋯ Hypokalaemia can be asymptomatic or it may cause cardiovascular, neurological or skeletal muscle dysfunction. If intravenous potassium therapy is required, then correction with potassium chloride, acetate, or phosphate salts are usually guided by the presence of a metabolic acidosis, alkalosis or hypophosphataemia.