Anaesthesia, pain, intensive care and emergency A.P.I.C.E.: by A. Gullo

By A. Gullo

Improving criteria of care is a true problem in extensive Care medication. enhancing scientific functionality, sufferer defense, chance administration and audit represents the cornerstone for elevating the standard of care in ICU sufferers. verbal exchange is the platform from the place to begin to arrive a consensus in an exceptionally crowded quarter, a special multidisciplinary and multiprofessional setting within which caliber of care and, finally, sufferer survival must be ameliorated.

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Extra resources for Anaesthesia, pain, intensive care and emergency A.P.I.C.E.: proceedings of the 22st postgraduate course in critical medicine: Venice-Mestre, Italy - November 9-11, 2007

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As RV pressure and volume increase, the LV develops a “D” shape. As a result of increased pressure in the RV, the right atrial pressure exceed LAP, hypoxaemia may results from rightto-left shunting across a PFO. Tricuspid regurgitation occurs as a result of an increased RV afterload and/or RV dilatation. The definitive diagnosis is made by direct visualization of the thrombus in the pulmonary artery, with distinct borders, different echogenicity from the blood or vascular wall, evidence of protrusion into the arterial lumen and alteration of flow on Doppler imaging [25].

The increase in lactate is soon followed by a decrease in pyruvate due to the decrease in glucose supplied by the capillary blood. The result will be an increase in the lactate/pyruvate ratio. Continuous Monitoring of Organ Chemistry – a Paradigm Shift in Management of Intensive Care 31 In the case of energy metabolism (Fig 1) it is of obvious value to sample glucose metabolism using markers such as glucose, lactate and pyruvate where the lactate/pyruvate ratio is a well known marker of the redox state of the tissue and an indicator of tissue ischaemia [6].

When evaluating valves, the abnormality should be correctly diagnosed, quantified, and the underlying disease identified. Regurgitation is screened with colour Doppler, and a turbulent retrograde flow can be detected. Alternatively, when stenosis is the question, flow acceleration through a stenotic valve is measured by spectral Doppler interrogation. Acute subaortic stenosis is a relatively rare condition that is rarely diagnosed, but which may have devastating consequences if left unrecognized.

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