Handbook of General Surgical Emergencies by Hindmarsh, Andrew; Mehta, Sam; Rees, Leila

By Hindmarsh, Andrew; Mehta, Sam; Rees, Leila

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This may be of benefit to patients with cardiac failure, but can cause cardiovascular collapse in the hypovolaemic patient. Non-invasive positive pressure ventilation (NIPPV) is an alternative and can be delivered via a face mask. Intubation and ventilation may be required if: . . g. facial trauma), poorly tolerated or fails there is a need for suctioning of secretions. However intubation and ventilation can: . . . decrease venous return because of increased intrathoracic pressure cause gastric dilatation lead to atrophy of respiratory muscles cause barotrauma result in development of a pneumothorax/surgical emphysema.

0 mmol/l 50 The critically ill patient . fluid overload complications of uraemia. Both haemofiltration and haemodialysis can be performed via a dual-lumen central line. In haemofiltration, blood is driven through a semi-permeable membrane. Haemofiltration is better tolerated in patients with cardiovascular disease. Haemodialysis involves the passage of blood over a semi-permeable membrane, allowing equilibrium to occur with dialysis fluid on the other side. Haemodialysis allows quicker correction of acidosis.

4 A suitable regime of maintenance fluid for a 70 kg adult is 1 l normal saline and 2 l 5% dextrose with 20 mmol KCl per litre, over 24 h. Fluid balance 21 Crystalloids Crystalloids are electrolyte solutions in water. Up to 40 mmol KCl can be added to each litre on the ward. 2 shows the concentrations of electrolytes in commonly prescribed crystalloids. 9% Normal saline Hartmann’s solution Dextrose saline 5% Dextrose Na+ K+ HCO3 Cl – Ca2+ 154 – – 154 – 131 5 29 111 2 30 – – – – – 30 – – – Colloids Colloids contain higher molecular weight molecules than crystalloids and will therefore remain longer in the intravascular compartment.

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