Archive for the 'Managment' Category

Fruit and vegetables as part of a healthy diet.

Tuesday, October 3rd, 2006

Consumption of sufficient amounts of fruit and vegetables are recommended as part of a healthy diet. Fruit and vegetables may reduce chronic diseases and more specifically, coronary heart disease (CHD) by means of their protective constituents such as potassium, folate, vitamins, fiber, and other phenolic compounds. These nutrients act through a variety of mechanisms, such as reducing antioxidant stress, improving lipoprotein profile, lowering blood pressure, increasing insulin sensitivity, and improving hemostasis regulation . However, the recommendation to eat fruit and vegetables to prevent chronic diseases is mainly based on observational epidemiological studies.

Acute Medicine

Thursday, September 7th, 2006

Fluid/blood replacement
Blood – in haemorrhagic shock
Complication – temperature change, coagulation defect, metabolic acidosis/alkalosis,
Red cell concentration
Crystalloid solutions – saline,
Colloidal solution – Dextrans, albumin,

Oxygen delivery to tissue

Can monitor by p02 or pulse-oximetry.
Heart rate and stroke volume.
Gas exchange in the lungs – airway obstruction, restriction…etc.

Mechanical ventilation
Intermittent positive-pressure ventilation – commonly use
Indicate
Acute respiratory failure – asthma
Acute ventilatory failure – myasthenia gravis
Head injury
Trauma in the chest
Coma with breathing difficulties

Acute disturbance of haemodynamic function - Shock

Thursday, September 7th, 2006

Shock is Acute disturbance of haemodynamic function.
Cardiogenic – Ischaemic..
Obstruction – pulmonary embolus
Hypovolaemic – blood loss
Normovolaemic – anaphylaxis
Can lead to multiple organ failure – Liver, Kidney, Brain..

Clinical feature of Shock
Hypovolaemic shock –

Skin - cold, pale, blue
Kidney –oliguria, anuria
Increase heart rate, sweating, low BP
Cardiogenic shock – Lung basal crackles.
Anaphylactic shock – erythema, brochospasm,
Septic shock – high fever,

Management of Shock
Oxygen and ventilation
Clear air way,
O2,
Mechanical ventilation,
Cardiac function
Fluid, blood,
Drug for cardiac functions –inotropic

Common problem in Medical Intensive Care

Thursday, September 7th, 2006

Hemodynamic instability (hypotension)
Airway or respiratory problem.
Renal failure.
All of them.

Most case we need System approach
More system approach to treatment.

Monitor

cardiovascular system
respiratory system
central nervous system
endocrine system
gastro-intestinal tract/nutritional condition
Hematology
Microbiology/sepsis status
Renal/metabolic