By Simon M. Whiteley
A pocketbook of in depth take care of junior doctors/residents engaged on the intensive/critical care unit.
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Extra resources for Churchill’s Pocketbook of Intensive Care
Isoﬂurane and other volatile agents may be useful in asthma and severe bronchospasm because of their bronchodilator properties. Speciﬁc systems for delivering volatile agents into ventilator circuits on the ICU have been developed. Nitrous oxide may be of value for changes of burns dressings, but should not be used for more than 12 h because of bone marrow suppression. v. 2–2 μg / kg / h Clonidine is an α2 agonist at presynaptic terminals, and has a general sedative effect. The main side-effect is hypotension and a small test dose is usually given to assess the effect on blood pressure.
Lead-time bias results from the stabilization of patients in the referring hospital prior to transfer. This artiﬁcially lowers the score for the patient arriving at the referral centre. The GCS component is difﬁcult to assess in patients receiving sedative or neuromuscular blocking agents. There is an important difference between a GCS 3 due to head injury and due to the effects of drugs. The physiological components are based on adults. They do not translate to paediatrics. For children the ‘Pim’ (paediatric index of mortality) or ‘Prism’ (paediatric risk of mortality) score is usually used instead.
Patients have often had no opportunity to discuss intensive care treatment prior to admission. They are admitted on the presumption that they would wish to undergo life-sustaining treatments, if given the choice. g. ) is questionable in this context. Nevertheless, it is often still considered normal practice to do so. gov. uk/acts/acts2005/en/ukpgaen_20050009_en_1). When is consent required? Patients in the ICU will have repeated interventions performed, for example, tracheal suction, arterial and venous line insertion, and passage of tubes into various oriﬁces.