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Perioperative goal-directed fluid therapy (GDFT) may improve outcome after high-risk surgery. Minimal invasive measurement of stroke volume variation (SVV) has been recommended to guide fluid therapy. We intended to study how perioperative GDFT with arterial-based continuous SVV monitoring influences postoperative complications in a high-risk surgical population. From February 1st 2012, all ASA 3 and 4 patients undergoing abdominal surgery in two university hospitals were assessed for randomization into a control group or GDFT group. An arterial-line cardiac output monitor was used to measure SVV, and fluid was given after an algorithm in the intervention group. Restrictions of the method excluded patients undergoing laparoscopic surgery, patients with atrial fibrillation and patients with severe mitral/aortal stenosis. To detect a decrease in number of complication from 40 % in the control group to 20 % in the GDFT group, n = 164 patients were needed (power 80 %, alpha 0.05, two-sided test). To include
Intravenous fluid therapy provides numerous benefits to our sick patients, which include providing for rehydration, correction of hypotension, correction of electrolyte disturbances, a route for administering parenteral nutrition, and a route for the administration of many important medications. Following along the lines that no medication is perfectly safe, this paper will review the types of various complications that can arise from intravenous fluid therapy. Some of these problems are minor while others can be of life threatening proportions to the patient.. Thrombophlebitis, Catheter Sepsis, and Catheter Embolus. These are three of the most catastrophic complications associated with indwelling intravenous catheters. All catheters support infection and may trigger thrombophlebitis. There are differences between plastics as cannulas made of fluoroethylenepropylene (Teflon) are associated with lesser incidence of venous irritation than those made of polyvinyl chloride and tetrafluoroethylene. ...
Fluid replacement or fluid resuscitation is the medical practice of replenishing bodily fluid lost through sweating, bleeding, fluid shifts or other pathologic processes. Fluids can be replaced with oral rehydration therapy (drinking), intravenous therapy, rectally such as with a Murphy drip, or by hypodermoclysis, the direct injection of fluid into the subcutaneous tissue. Fluids administered by the oral and hypodermic routes are absorbed more slowly than those given intravenously. Oral rehydration therapy (ORT) is a simple treatment for dehydration associated with diarrhea, particularly gastroenteritis/gastroenteropathy, such as that caused by cholera or rotavirus. ORT consists of a solution of salts and sugars which is taken by mouth. For most mild to moderate dehydration in children, the preferable treatment in an emergency department is ORT over intravenous replacement of fluid. It is used around the world, but is most important in the developing world, where it saves millions of children a ...
There is described a fluid treatment system comprising an array of independent fluid treatment reactors. The reactors are arranged in a manner whereby a flow of fluid may be passed through the array in a substantially helical direction. The fluid treatment system is capable of treating large volumes of fluid (e.g., water) while requiring a relatively small foot print. In essence, the present fluid treatment system concentrates a relatively large number of radiation sources in a relatively small amount of space resulting in the ability to treat large volumes of fluid (e.g., water).
Influence of stroke volume variation on fluid treatment and postoperative complications in thoracic surgery Cengiz Sahutoglu, Erbil Turksal, Seden Kocabas, Fatma Zekiye Askar Department of Anesthesiology and Reanimation, Ege University School of Medicine, Izmir, Turkey Background: Fluid management in critically ill patients usually relies on increasing preload to augment cardiac output. In the present study, we aimed to evaluate whether stroke volume variation (SVV) can guide fluid therapy and reduce complications.Patients and methods: In this retrospective study, a total of 88 patients who underwent lobectomy were divided into two groups: group 1 (SVV, n=43) and group 2 (conventional or central venous pressure [CVP], n=45). Heart rate, blood pressure, oxygen saturation, SVV (only group 1), CVP (all patients), urea, creatinine, and hemoglobin levels before and after surgery, use of fluid, blood and inotropic agents, and postoperative complications were recorded retrospectively.Results: The mean age of
Swift and adequate fluid loading is a cornerstone of septic shock therapy. Yet, careful assessment of volume responsiveness and volume amount during the resuscitation process is a prerequisite. Both overzealous initial fluid administration and late fluid overload are harmful and may be associated with increased mortality. Static (i.e., central venous or pulmonary artery occlusion) pressure readings are erroneous for monitoring fluid resuscitation and should be abandoned. Dynamic measurements (i.e., stroke volume and pulse pressure variation) better predict fluid responsiveness than static filling pressures but the conditions necessary for these parameters to correctly evaluate preload dependency are frequently not met. The passive leg raising maneuver as a means to alter biventricular preload in combination with real-time measurement of cardiac output changes is an easy-to-use, fast, relatively unbiased, and accurate bedside test to guide fluid management and to avoid fluid overload during early septic
It is important to achieve a fluid status that is good enough to avoid low urine production. Low urine output has various limits, but an output of 0.5 mL/kg/h in adults is usually considered adequate and suggests adequate organ perfusion. The parkland formula is not perfect and fluid therapy will need to be titrated to hemodynamic values and urine output.. The speed of fluid replacement may differ between procedures. The planning of fluid replacement for burn patients is based on the Parkland formula (4mL Lactated Ringers X wt.in kg X % TBSA burned= Amount of fluid ( in ml) to give over 24 hours). The Parkland formula gives the minimum amount to be given in 24 hours. Half of the volume is given over the first eight hours after the time of the burn (not from time of admission to ED) and the other half over the next 16 hours. In dehydration, 2/3 of the deficit may be given in 4 hours, and the rest during approx. 20 hours.. The initial volume expansion period is called the fluid challenge, and may ...
It is important to achieve a fluid status that is good enough to avoid low urine production. Low urine output has various limits, but an output of 0.5 mL/kg/h in adults is usually considered adequate and suggests adequate organ perfusion. The parkland formula is not perfect and fluid therapy will need to be titrated to hemodynamic values and urine output.. The speed of fluid replacement may differ between procedures. The planning of fluid replacement for burn patients is based on the Parkland formula (4mL Lactated Ringers X wt.in kg X % TBSA burned= Amount of fluid ( in ml) to give over 24 hours). The Parkland formula gives the minimum amount to be given in 24 hours. Half of the volume is given over the first eight hours after the time of the burn (not from time of admission to ED) and the other half over the next 16 hours. In dehydration, 2/3 of the deficit may be given in 4 hours, and the rest during approx. 20 hours.. The initial volume expansion period is called the fluid challenge, and may ...
books.google.comhttps://books.google.com/books/about/Oral_Rehydration_Therapy_for_Treatment_o.html?id=g-VFAAAAYAAJ&utm_source=gb-gplus-shareOral Rehydration Therapy for Treatment of Diarrhoea in the Home ...
ALVES, Josélia T. L.; TROSTER, Eduardo J. and OLIVEIRA, Carlos Augusto C. de. Isotonic saline solution as maintenance intravenous fluid therapy to prevent acquired hyponatremia in hospitalized children. J. Pediatr. (Rio J.) [online]. 2011, vol.87, n.6, pp.478-486. ISSN 0021-7557. http://dx.doi.org/10.2223/JPED.2133.. OBJECTIVES: This review aims to evaluate if the use of hypotonic saline solutions as maintenance intravenous fluid therapy in hospitalized children increases the risk of hyponatremia, if the administration of isotonic fluids is able to protect against acquired hyponatremia and if the isotonic solutions increase the risks of deleterious effects such as hypernatremia or fluid overload. SOURCES: We researched the relevant literature on the PubMed (Jan 01 1969 to Jul 13 2011), EMBASE (1989 to 2011) and Cochrane Library (1989 to 2011) databases. Furthermore, references of selected studies were included. SUMMARY OF THE FINDINGS: Hospitalized children are potentially at risk of developing ...
TY - JOUR. T1 - Pulse pressure power spectrum predicts volume responsiveness in shock patients without sedation. AU - Lee, Chih Hsin. AU - Wang, Jann Yuan. AU - Wu, Yao Kuang. AU - Chiu, Hung Wen. AU - Lan, Chou Chin. AU - Chang, Hung. AU - Chen, Chi Yuan. PY - 2010. Y1 - 2010. N2 - The authors investigated whether the pulse pressure power spectrum (PPPS) could predict the effect of volume expansion (VE) in shock patients under mechanical ventilation without sedation. The PPPS within a frequency band of 0.15 to 0.75 Hz was developed with an animal model using nine domesticated piglets simulating acute hemorrhagic shock and then validated in 17 nonsedated mechanically ventilated shock patients. Hemodynamic parameters were recorded before and after VE. In the animal model under anesthesia and pressure-controlled ventilation, the absolute and proportional change of cardiac index after VE (ΔCI and ΔCI%) positively correlated with the square root of PPPS (SQRT-PPPS, r = 0.34 and r = 0.72, ...
Bacterial infections As described earlier, phagocytic innate untouched cells are carping for the ini- tial exempt awareness of bacteria toe PAMPs such as lipopolysaccharide and lipoteichoic acids in the bacterial cubicle embankment. The Start initial intravenous fluid therapy with determination of central venous pressure might RingerпїЅs acetate or 5% glucose in regular saline even be essential in the treatment of severe answer on the fee of 10-20 ml/kg body weight cases of shock that arent easily reversible. On theoretical grounds, it has Treatment of the sperm with comparatively heavy doses of x-rays induces the occurrence of true "gene mutations" in a high proportion the treated germ cells appeared to the present author that radiations of short wave size must be especially promising for the manufacturing of mutational modifications, and for this and different causes a sequence of experiments concerned with this drawback has been undertaken in the course of the previous year on the fruit ...
Bacterial infections As described earlier, phagocytic innate untouched cells are carping for the ini- tial exempt awareness of bacteria toe PAMPs such as lipopolysaccharide and lipoteichoic acids in the bacterial cubicle embankment. The Start initial intravenous fluid therapy with determination of central venous pressure might RingerпїЅs acetate or 5% glucose in regular saline even be essential in the treatment of severe answer on the fee of 10-20 ml/kg body weight cases of shock that arent easily reversible. On theoretical grounds, it has Treatment of the sperm with comparatively heavy doses of x-rays induces the occurrence of true "gene mutations" in a high proportion the treated germ cells appeared to the present author that radiations of short wave size must be especially promising for the manufacturing of mutational modifications, and for this and different causes a sequence of experiments concerned with this drawback has been undertaken in the course of the previous year on the fruit ...
Why this is important:- In recent years, the use of glucose-containing hypotonic IV fluids in children and young people has been questioned, because of the risk of hyponatraemia. Many children and young people are now prescribed non-glucose-containing isotonic IV fluids for maintenance. However, there are several groups of children and young people, in particular, neonates and some children in the perioperative period (for example, those who underwent prolonged fasting preoperatively, and those who had central blocks during anaesthesia), who may benefit from glucose-containing IV solutions to prevent hypoglycaemia. A blanket prescription of 5 or 10% glucose solution for all may result in hyperglycaemia in some children and young people. However, the use of IV fluids containing lower concentrations of glucose may be sufficient to prevent hypoglycaemia and also avoid unnecessary hyperglycaemia. This may have a clinical application across all age groups, including neonates.. ...
Controversy: whether or not aggressive fluid resuscitation is beneficial in the setting of hypotensive trauma. Hypovolemic trauma patients do reliably respond to volume infusion, thus in the past ATLS recommended administration of 2L IVF as rapidly as possible. This recommendation has recently been questioned, as the downsides of dilutional anemia in the trauma setting (namely decreased O2 delivery, hypothermia, coagulopathies, and electrolyte abnormalities) and hypertension in the setting of hemorrhage (increased bleeding) the have come to light. Aggressive fluid administration often leads to a transient rise in BP which leads to increased bleeding and another episode of hypotension, producing a vicious cycle. For this reason, resuscitation has been divided into two phases: early (during active hemorrhage) and late (when hemorrhage has been controlled).. Data Supporting Routine Aggressive Fluid Resuscitation:. (insert text here). Equivocal Data Regarding Routine Aggressive Fluid ...
Before admission to the operating room, the patients were assigned to the control or the GDT group. For both groups of patients, anesthesia was induced with propofol 2.0-2.5 mg/kg and fentanyl 0.25 mg and maintained with propofol 5-10 mg·kg−1·h−1 and remifentanil 1.75-2.25 mg/h via the central venous access. Orotracheal intubation was facilitated with cisatracurium (0.1 mg/kg) except in one patient for whom it was considered to require rapid-sequence induction because of gastroesophageal reflux and thus succinylcholine (1 mg/kg) was used. Via nasal access an esophageal Doppler probe (Deltex Medical, Chichester, United Kingdom) was placed in the mid esophagus guided by visual and auditory signals from the descending aorta. A CardioQ monitor (Deltex Medical) was used to measure flow velocity to calculate SV from a nomogram based on the subjects height, weight, and age.17 In addition, a corrected flow time was estimated, representing the time of the systole corrected to a heart rate (HR) of ...
The cannula of a conventional intravascular catheter is placed into the peritoneal cavity through a small shallow incision in antiseptically prepared skin. The stylet or trocar of the conventional catheter is removed; and a stainless steel elongated flexible guide is inserted through the catheters cannula into the peritoneal cavity. The catheters cannula is removed and a flexible elongated cannula inserted into the cavity over the guide and secured in place with a suture. Fluid operation means is connected to the elongated cannula by connector means to permit fluid treatment after removal of the guide. Apparatus to effect peritoneal fluid treatment are placed in sterile openable sealed packages for storage and transport.
The invention concerns a novel procedure and apparatus for controlling opening and closing of venous and arterial lines in single lumen catheter fluid treatment procedures. Different types of apparatus useful for different types of fluid treatment procedures, in particular hemodialysis, hemofiltration, and plasmapheresis procedures, are disclosed.
Fluid therapy optimization in the perioperative period has been considered as major contributor to improve oxygen delivery. A recent, noninvasive approach to estimate fluid requirements in the anesthetized patient with arterial line is the assessment of difference in pulse pressure (dPP). Intraoperative fluid management by dPP is a goal-directed fluid management approach to avoid both hypervolemia and hypovolemia. However, several clinical factors may impede dPP measurements. Surgical manipulations in abdominal procedures may interfere with hemodynamic stability due to obstruction of the caval vein. Physiological considerations make us hypothesize that only intense pressure impedes caval blood flow and thus hemodynamics and dPP. Therefore, the investigators want to assess those changes after standardized application of three different pressure levels (2 N, 5 N, 10 N) on the caval vein ...
Peri-operative fluid therapy is a controversial area with few randomized trials to guide practice. Fluid management has a significant influence on outcome following surgery. Yet practically, fluid prescription practice during this period is sub-optimal, resulting in avoidable iatrogenic complications.. Several studies have assessed the effect of a liberal vs. a restrictive perioperative fluid regimen on post-operative outcome. However, most of these studies have focused primarily on intra-operative fluid management, whereas postoperative strategies have been less well defined, even though the immediate postoperative period is of critical importance to the patients recovery. Moreover, whereas intra-operative fluid administration is monitored by the anesthesiologist, postoperatively it is less supervised and may result in excess or lack of intravenous (IV) fluids. Therefore, fluid management audit at the post-anesthesia care unit (PACU) is of paramount importance for patient healthcare. The ...
Stanford University, Stanford, California, USA. INTRODUCTION. The Mass Media and Health Practices (MMHP) project builds on a fairly extensive history of attempts to use mass media and communication campaigns to carry out health education and health behaviour change programmes. Previous efforts had used different aspects of the approach- research for planning, integrated multi-channel campaign strategy, pre-testing of messages, social marketing techniques, and the use of behavioural methodologies to analyse and generate change - but none had combined all the components and none had tackled the complex set of objectives related to introducing oral rehydration therapy. The MMHP project was thus established with the twin goals of testing and refining the methodology of this type of campaign, and of assessing the campaigns impact on health through the promotion of oral rehydration therapy in a field setting. Because success in both objectives would have implications for health behaviour efforts in ...
Background: In morbidly obese individuals (MO) cardiorespiratory comorbidities and body habitus challenge the perioperative management of anesthesia. To implement safe and reproducible routines for anesthesia and fluid therapy is the cornerstone in order to minimize anesthesia-related complications and to meet individual variability in rehydration needs. Methods: Paper I: Impact of rapid-weight-loss preparation prior to bariatric surgery was investigated. Prevalence of preoperative dehydration and cardiac function were assessed with transthoracic echocardiography (TTE). Paper II: The anesthetic technique for rapid sequence induction (RSI) in MO based on a combination of volatile and i.v. anesthetics was developed. Pre- and post-induction oxygenation, blood pressure levels and feasibility of the method was evaluated. Paper III: The preoperative ideal body weight based rehydration regime was evaluated by TTE. Paper IV: Need of rehydration during bariatric surgery was evaluated by comparing ...
The management of fluid in the postoperative surgical patient can vary from simple to complex.Postoperative intravenous maintenance fluid therapy ensures adequate organ perfusion, prevents catabolism, ensures electrolyte- and pH-balance, and may be a
We treat knee pain with joint fluid therapy. Non-surgical treatment for osteoarthritis, joint overuse & sports injury with Hyalgan Knee Injections
Fluid resuscitation for children with fever and signs of shock has been controversial. This is partly because many clinical definitions of shock encompass a continuum from adaptive physiological changes to fever, to states of severe hypotension and dysoxia. Fluid therapy for shock has also been controversial because fluid therapy alone will not deal with shock apart from that which occurs solely from extracellular fluid losses. Therefore, in settings where intensive care support is unavailable, fluid therapy alone in some forms of shock will be insufficient. Many children with fever and 1 or 2 clinical cardiovascular signs of shock do not have hypovolemia or dysoxia. They have high levels of adrenaline and renin-angiotensin, leading to tachycardia and vasoconstriction, and raised levels of ADH, which leads to fluid retention, thus protecting them from hypovolemia and shock. The assumption that fluid boluses will improve cardiac output and in turn augment oxygen delivery to tissues is not certain ...
The Endoscopy Fluid management system market during the forecast period will be driven by the increasing prevalence of many chronic diseases related to Urology, Gastroenterology, Gynecology/Obstetrics, Neurology related disorders. Increasing demand and awareness of the minimally invasive an non-invasive surgical processes, an introduction of advanced fluid management and visualization systems, rising government initiatives in reimbursements and support in healthcare, and increasing healthcare infrastructure are also anticipated to drive the Endoscopy Fluid management system market during the forecast period. Furthermore, the rising disposable income predominantly in the developing countries is also likely to take the Endoscopy Fluid management system market forward.. Regionally, the Endoscopy Fluid Management Systems market has been segmented into North America, Western Europe, Asia-Pacific excluding Japan, Latin America, Japan, Eastern Europe and Middle East & Africa. Amid them, North America ...
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The objective of this article is to provide a review of the fundamental aspects of body fluid balance and the physiological consequences of water imbalances, as well as discuss considerations for the optimal composition of a fluid replacement beverage across a broad range of applications
Fluid ingestion during exercise has the twin aims of providing a source of carbohydrate fuel to supplement the bodys limited stores and of supplying water and electrolytes to replace the losses incurred by sweating. Increasing the carbohydrate content of drinks will increase the amount of fuel which can be supplied, but will tend to decrease the rate at which water can be made available; where provision of water is the first priority, the carbohydrate content of drinks will be low, thus restricting the rate at which substrate is provided. The composition of drinks to be taken will thus be influenced by the relative importance of the need to supply fuel and water, this in turn depends on the intensity and duration of the exercise task, on the ambient temperature and humidity, and on the physiological and biochemical characteristics of the individual athlete. Carbohydrate ingested during exercise appears to be readily available as a fuel for the working muscles, at least when the exercise intensity does
... for Optimal Energy and Performance With many athletes trying to get the competitive edge over their opponents, opti...
Dynamic and flow-based parameters are more informative than conventional parameters in determining fluid responsiveness and may help you avoid excessive and insufficient fluid administration.7 Clinical studies have shown that conventional volume management methods, based on conventional parameters, are misleading and insensitive.6 Advanced hemodynamic parameters such as stroke volume (SV) and stroke volume variation (SVV), are key to optimal fluid administration.. SVV has been proven to be a highly sensitive and specific indicator for preload responsiveness when managing perfusion. As a dynamic parameter, SVV has been shown to be an accurate predictor of fluid responsiveness in loading conditions induced by mechanical ventilation.6,8,9. ...
Type 2 diabetes in Asia occurs largely in the absence of obesity. The metabolically-obese normal-weight (MONW) phenotype refers to lean subjects with metabolic dysfunction that is typically observed in people with obesity, and is associated with increased risk for diabetes. Previous studies evaluated MONW subjects who had greater BMI or total body fat than respective control groups, making interpretation of the results difficult. We evaluated insulin sensitivity (hyperinsulinemic-euglycemic clamp), insulin secretion (mixed meal with oral minimal modeling), intra-abdominal, muscle, and liver fat contents (magnetic resonance), and fasting and postprandial glucose and insulin concentrations in 18 MONW subjects and 18 metabolically-healthy controls matched for age (43{plus minus}3 and 40{plus minus}3 y; P=0 ...
Index: Intravenous fluid therapy :: Printer friendly Original article by: Michael Tam Bag of IV fluids The easy (autopilot) way: Assumptions: That the patient is relatively normal normal size relatively well no kidney failure no heart failure no electrolyte disturbance no particular abnormal losses patient is nil-by-mouth (i.e., they have no other sources of hydration)…
Leon graduated as a Doctor of Veterinary Medicine from Murdoch University (Western Australia) in 2009. Following graduation, he undertook an internship in anaesthesia, emergency and critical care medicine. Leon joined the anaesthesia section at the University of Melbourne Veterinary Hospital in 2010 where he completed a three-year specialty training program in anaesthesia and pain management as well as a clinical Master degree in Anaesthesia. In 2015, he completed an externship in paediatric anaesthesia and trauma management at The Austin and Royal Melbourne Hospitals. Leon is a Diplomate of the American College of Veterinary Anesthesia and Analgesia and a Member of the Australian College of Veterinary Scientists anaesthesia chapter. Leons research focuses on pain-management, and he is completing a PhD in Perioperative Assessment and Management of Pain in Cats. His clinical interests are intravenous fluid therapy, pain management, and strategies for improving outcomes in field anaesthesia of ...
Abstract of Paper: Glucose-Containing/Glucose-Free Alternating Intraoperative Fluid Regimen Modulates Blood Glucose Levels In Neurosurgical Non-Diabetic Patients , Author: Ehab El-Shahat, MD, Mohamed Ahmed Al-Rabiey, MD, Ehab Abdel Aziem, MD & Ahmed Saleh, MD , Year: 2006 , Faculty of Medicine, Benha University
A 5 year old boy passed 18 loose stools in last 24 hour and vomited twice in last 4 hour. he is irritable but drinking fluids. The optimal therapy for this child is: 1. Intravenous fluids.2. Oral rehydration therapy.3. Intravenous fluid initially for 4 hours followed by oral fluids.4. Plain water... ...
Establishing adequate venous access, in some cases through a central venous catheter, is essential to ensure ease of fluid replacement and adequate monitoring of the patient. In patients with ascites, the elderly patients, and those with associated medical conditions such as ischaemic heart disease, the right atrial pressure may not accurately reflect left sided heart pressures so fluid replacement should be monitored with a Swan- Ganz catheter.. Detailed attention to fluid replacement is important for any gastrointestinal bleed and even more so in patients with established chronic liver disease. These patients may have reduced vascular tone and fail to mobilise pooled venous blood from the splanchnic circulation.3Failure to achieve prompt volume replacement may jeopardise renal and hepatic function, a major factor in the morbidity and mortality associated with a variceal bleed.3It is equally important to avoid overfilling as this may precipitate rebleeding, so the right atrial pressure should ...
Content published by José Luis Do Pico about aki contraste pfdvi Haemodynamic-guided fluid administration for the pre. 14 Views, 0 Likes on Docs.com.
The CRAM diet (cereal, rice, applesauce, and milk) is a short term dietary treatment for diarrhea and gastroenteritis. The CRAM diet has more complete protein and fat content than the BRAT diet. The use of cereals, rice and milk as a stop-gap eating plan for stomach upset, has been validated as a more effective remedy to manage diarrhea than BRAT by recent research in hospitals in South America and Asia.[citation needed] According to John Snyder, M.D., professor of pediatrics at the University of California at San Francisco Medical Center and a member of the American Academy of Pediatrics subcommittee on treating acute diarrhea: "Not only does the CRAM diet seem to ease the diarrhea symptoms faster, but the milk gives the child more complete protein and needed fat, which is lacking in the BRAT diet." Due to severe dehydration caused by both diarrhea and gastroenteritis, the CRAM eating plan should be combined with oral rehydration therapy (ORT) through the administration of liquids (e.g. ...
Biology Assignment Help, Maintain nutrition in diarrhoea, Maintain nutrition Your responsibility as a nurse is to take care of nutrition and prevent the child from starvation. Breast feedingshould be continued during the diarrhoea even if the child is on oral rehydration therapy. In case of non-breas
A cultural revolution has quietly taken place in the West over the past 2 decades of intensive study of the causes of diarrheal diseases. Improved culture and laboratory techniques now permit etiologic identification of the cause of 50% to 70% of acute diarrhea episodes whereas studies of molecular pathogenesis and pathophysiology have led to the discovery of the cyclic adenosine monophosphate- or guanosine 35-monophosphate- mediated intestinal secretion pathways. The scientific development and introduction of oral rehydration therapy is undoubtedly responsible for the greatest reduction in childhood mortality in the developing nations of any medical advance since the introduction of antimicrobials. ...
Vibrio cholerae is a Gram-negative organism that can be subdivided into over 200 serogroups based on the somatic O antigen, with only serogroups O1 and O139 causing epidemic and pandemic disease. Historically it has killed millions from dehydrating diarrhoea, encouraged the birth of modern epidemiology, the sanitary revolution, and oral rehydration therapy; it persists today as a glaring reminder of poverty and inadequate water/sanitation. Contaminated food (especially undercooked seafood) is the usual route of transmission in developed countries; contaminated water and street food vendors are more common vehicles in less developed countries....
Health interventions in development are normally relatively successful. The outcomes are easy to measure: levels of infection and mortality. The goal of saving lives is politically uncontroversial both domestically and in the West. Often, individual agencies will assume responsibility for a particular threat within a particular territory, providing ideal conditions for strong accountability for success. These favourable conditions have translated into successes such as: the virtual eradication of measles in southern Africa between 1996 and 2000 through immunisation and vaccine; radical reduction in diarrhoea-related deaths in Egypt in the 1980s through oral rehydration therapy; the virtual elimination of polio from Latin America from 1985; drastic reduction in the leading cause of blindness, trachoma, in Morocco from 1997; drastic reductions in maternal death in Sri Lanka; reductions in TB in China during the 1990s; the elimination of river blindness in West Africa from 1974; etc, etc. It is ...
Johns Hopkins Bloomberg School of Public Health, John Hopkins, eradicate smallpox worldwide, research, education, biostatistics, epidemiology, virology, discovery of vitamins, vaccines, oral rehydration therapy, prevent death,
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Perioperative fluid therapy - INTRODUCTION Perioperative fluid therapy - Much controversy / Effects on the outcome inconclusive Intravenous fluid resuscitation : (a) fluid and electrolytes required for normal existence (daily maintenance) and (b) resuscitation or replacement of abnormal losses. The
After institutional approval of the study protocol (by the Comite Consultatif de Protection des Personnes dans la Recherche Biomedicale de Lille), 16 patients admitted to our surgical intensive care unit for sepsis-induced hypotension, as defined by the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee [11] (systolic blood pressure , 90 mmHg or its reduction by ,or= to 40 mmHg from usual values, in the absence of other causes for hypotension), were studied prospectively. Signs of sepsis included two or more of the following conditions as a result of infection: body temperature more than 38 [degree sign]C or less than 36 [degree sign]C; an increased heart rate of more than 90 beats/min; a respiratory rate of more than 20 breaths/min, or a partial pressure of carbon dioxide in arterial blood less than 32 mmHg; and an altered leukocyte count of more than 12,000 cells/mm3or less than 4,000 cells/mm3, or the presence of 10% immature neutrophils. ...
Yes it does. This hypercatabolic metabolic state is characterized by an increase in oxygen consumption and energy expenditure [ 95 ]. Fluid therapy: double-edged sword during critical care? In patients with septic shock, hemodynamic stabilization using intravenous fluids remains a major therapeutic challenge as numerous questions remain regarding the type, dose and timing of fluid administration. Marik PE. If fluid is needed at this phase, the use of albumin seems to have positive effects on vessel wall integrity facilitates achieving a negative fluid balance in hypoalbuminemia and may be less likely to cause nephrotoxicity [ 81 ].. ...
BACKGROUND: Off-line calculation of the pulse pressure variation (PPV(ref)) has repeatedly been shown to be a reliable predictor of fluid responsiveness in mechanically ventilated patients. This study was designed to assess the ability of two algorit