Essential Guide to Acute Care
Essential Guide to Acute Care
Product Description
Author by:
Paul Cramp
Kirsty Forrest
Paperback: 216 pages
Publisher: BMJ Books; 2 edition (August 21, 2006)
Language: English
ISBN-10: 1405139722
ISBN-13: 978-1405139724
What you really need to know, but no one told you.
The Essential Guide to Acute Care contains everything you really need to know about acute care that you can’t find in a standard textbook and have probably never been taught before.
Starting with the concept of patients at risk, the Essential Guide to Acute Care explains how to recognise and manage the generic altered physiology that accompanies acute illness.
The principles of acute care are explained simply yet comprehensively. Throughout the book ‘mini-tutorials’ expand on the latest thinking or controversies, and practical case histories reinforce learning at the end of each chapter. The chapters are designed to be read by individuals or used for group tutorials in acute care.
Extensively rewritten and updated, this second edition is essential reading for anyone who looks after acutely ill adults, including:
* Foundation Programme trainees and trainers
* Trainees in medicine, surgery, anaesthesia and emergency medicine
* Final year medical students
* Nursing staff and allied professionals working in critical care
Contents
Foreword
Introduction
Acknowledgements
Units used in this book
Chapter 1 Patients at risk
Chapter 2 Oxygen therapy
Chapter 3 Acid–base balance
Chapter 4 Respiratory failure
Chapter 5 Fluid balance and volume resuscitation
Chapter 6 Sepsis
Chapter 7 Acute renal failure
Chapter 8 Brain failure
Chapter 9 Optimising patients before surgery
Chapter 10 Pain control and sedation
Appendix Practical procedures
Index
CHAPTER 1
Patients at risk
By the end of this chapter you will be able to:
• Define resuscitation
• Understand the importance of the generic altered physiology that accompanies
acute illness
• Know about national and international developments in this area
• Know how to assess and manage an acutely ill patient using the ABCDE system
• Understand the benefits and limitations of intensive care
• Know how to communicate effectively with colleagues about acutely ill patients
• Have a context for the chapters that follo
What is resuscitation?
When we talk about ‘resuscitation’ we often think of cardiopulmonary resuscitation (CPR), which is a significant part of healthcare training. International organisations govern resuscitation protocols. Yet survival to discharge after in-hospital CPR is poor, around 6% if the rhythm is non-shockable (the majority of cases). Public perception of CPR is informed by television which has far better outcomes than in reality [1].
A great deal of attention is focused on saving life after cardiac arrest. But the vast majority of in-hospital cardiac arrests are predictable. Until recently, hardly any attention was focused on detecting commonplace reversible physiological deterioration and in preventing cardiac arrest in the first place. However, there have been an increasing number of articles published on this subject. As a Lancet series on acute care observed, ‘the greatest opportunity to improve outcomes for patients over the next quarter century will probably not come from discovering new treatments but from learning how to deliver existing effective therapies’ [2].
In one study, 84% of patients had documented observations of clinical deterioration or new complaints within 8 h of cardiopulmonary arrest [3]; 70% had either deterioration in respiratory or mental function observed during this time. While there did not appear to be any single reproducible warning sign, the average respiratory rate of the patients prior to arrest was 30/min. The investigators observed that the predominantly respiratory and metabolic derangements which preceded cardiac arrest (hypoxaemia, hypotension and acidosis) were not rapidly fatal and that efforts to predict and prevent arrest
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