By Senior Registrar Department of Anaesthesia Nian Chih Hwang, Peng Jin London Lucien Ooi
Global specialists in ailments of the adrenal glands current new medical info and sensible instructions for surgeons, citizens, endocrinologists and practicing physicians. The publication covers all points of adrenal gland illnesses in nice aspect. comprises approx. 2 hundred illustrations resembling radiographs, CTMRI photographs, graphs and microscopic pathological slides, and so forth. a number of tables and colour illustrations of surgical innovations with emphasis at the laparoscopic method are incorporated.
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5) Hourly measurements of fluid input and urine output. (6) Continuous ECG, BP, pulse, arterial oxygen saturation monitoring. (7) Nil by mouth. Indications for admission to intensive care unit Head injured patients who require mechanical ventilatory support or who have cardiovascular instability requiring support, should be admitted to the intensive care unit (ICU). The management in the ICU should include: (1) Obtaining blood samples for full blood count and analysis of serum urea and electrolyte concentrations, prothrombin time and partial thromboplastin time.
Urinary catheterisation is absolutely necessary before administration of mannitol. Mannitol is contraindicated in heart failure and endstage renal failure because fluid overload may result. Mild hyperventilation (to achieve a Pco2 of 30– 35 mmHg) will also help to reduce raised ICP as will head elevation of 15° to 30°. After these initial measures, a CT brain scan should be performed as soon as possible to determine the appropriate management for the patient. In the majority of cases, endotracheal intubation is not necessary and the clinical picture will be that of an uncomplicated stroke.
The lobar location is more associated with other causes, such as amyloid angiopathy, AVM, neoplasm and drug abuse rather than with hypertension. Damage to the internal capsule on CT scan is of prognostic importance. Haemorrhages extending through the internal capsule are likely to produce permanent neurologic deficit. Haematomas which merely compress the internal capsule are more likely to be associated with neurologic improvement. Haemorrhage in the cerebellum (Fig. 3) has to be evaluated very carefully.