#16
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#17
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Öèòàòà:
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#18
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Öèòàòà:
Äàëåêî íå âñåõ ïðè òàêîé ñõåìå ïðèõîäèòñÿ èíòóáèðîâàòü, îáû÷íî ïðè íàëè÷èè ñîïóòñòâóþùåé ïàòîëîãèè: òÿæåëîé ïíåâìîíèè èëè åùå ÷åãî-òî... Åñëè äåëî èäåò ê èíòóáàöèè, òî ïåðåõîäèì íà èíôóçèþ ïðîïîôîëà - ó íàñ îí îáû÷íî èìååòñÿ (ïðè îòñóòñòâèè - ìîæíî è òèîïåíòàë), õîòÿ òàêèõ òîâàðèñ÷åé ìàëî...íî îíè íàäîëãî çàïîìèíàþòñÿ... |
#19
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#20
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Öèòàòà:
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#21
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Öèòàòà:
Íåîáõîäèìîñòü îáåñïå÷åíèÿ âåíòèëÿöèè - âèäèìî, íå îáñóæäàåì, êóäà æ áåç ýòîãî. |
#22
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ïîä ðóêó ïîïàëèñü èçâåñòíûå ðåêîìåíäàöèè, ìîæåò êîìó áóäåò èíòåðåñíî (õîòÿ, êàæåòñÿ óæå ýòî áûëî íà ôîðóìå):
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
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#23
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íåæíåå íàäî ... åùå íåæíåå
Öèòàòà:
Ìîæåò ÿ íå ïðàâèëüíî ïîíÿë ñìûñë äèñêóññèè, íî íà ìîé âçãëÿä àëêîãîëüíûé äåëèðèé íå ïîêàçàíèå äëÿ èíòóáàöèè è ïðîäëåííîé ÈÂË (è äëÿ íàçíà÷åíèÿ àíòèáèîòèêîâ, êñòàòè, òîæå). À "òèîïåíòàëîâàÿ êîìà" (áîëåå 3-4 ã/ñóòêè) êîòîðàÿ î÷åíü îñòîðîæíî ðåêîìåíäóåòñÿ òîëüêî áîëüíûì ñ òÿæåëîé ×ÌÒ è ðåçèñòåíòíîé âíóòðè÷åðåïíîé ãèïåðòåíçèè, (High-dose barbiturate therapy may be considered in hemodynamically stable salvageable severe head injury patients with intracranial hypertension refractory to maximal medical and surgical ICP lowering therapy.), åñòü âîîáùå êðàéíÿÿ ìåðà ê êîòîðîé ïðèáåãàòü íóæíî êðàéíå ðåäêî. Òàê ÷òî íåæíåå è åùå ðàç íåæíåå, êîëëåãè ). Äîáðûì ñëîâîì, ôèêñàöèåé è óìåðåííîé ñåäàöèåé ìîæíî äîñòè÷ü íåïëîõèõ ðåçóëüòàòîâ ñ ìåíüøèì ðèñêîì äëÿ áîëüíîãî. Ê ñëîâó ñêàçàòü, ìíîãèå àëêàøè, êîòîðûå â "êðèòè÷åñêèé" ìîìåíò îêàçûâàþòñÿ íå â ÐÀÎ à â îòäåëåíèÿõ ñ ìåíåå ñòðîãèì ðåæèìîì âîîáùå ïðîõîäÿò áåç äåëèðèÿ (ìîæåò áûòü ïîòîìó, ÷òî íàõîäÿò ñïîñîá "îïîõìåëèòüñÿ"). |
#24
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Ó íàñ è â îòäåëåíèÿõ äîñòàòî÷íî ñòðîãèé ðåæèì
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#25
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Öèòàòà:
-íóó âåäü ÷àñòî áîëüíûå ñ äåëèðèåì è ïîïàäàþò èç ïðîôèëüíûõ â ÐÀÎ, ïîñëå åãî ðàçâèòèÿ..... |
#26
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Öèòàòà:
1. 20 - 30 àìïóë ðåëàíèóìà â ñóòêè íà ñïîíòàííîì äûõàíèè íà ìîé (ìàëîîïûòíûé åùå) âçãëÿä ýòî ìíîãî è ìîæåò áûòü äîñòàòî÷íî äëÿ äåïðåññèè äûõàíèÿ ó ïðåäðàñïîëîæåííûõ áîëüíûõ. "Ìÿãêîé" ñåäàöèåé ÿ áû ýòî íå íàçâàë. Ìû íàçíà÷àåì îáû÷íî íå áîëåå 50 - 60 ìã ðåëàíèóìà â ñóòêè (íà ñðåäíåñòàòèñòè÷åñêîãî àëêîãîëèêà íà ñïîíòàííîì äûõàíèè) è íèêîãäà áîëåå 100 ìã. 2. Åñëè èìååò ìåñòî òÿæåëàÿ ïàòîëîãèÿ, ñêàæåì ïàíêðåîíåêðîç, àëêîãîëüíûé äåëèðèé çíà÷èòåëüíî îñëîæíÿåò ñèòóàöèþ. Çäåñü êîíå÷íî íóæíî ðåøàòü ïî îáñòîÿòåëüñòâàì. Àëêîãîëüíûé äåëèðèé è íåîáõîäèìîñòü ñåäàöèè ìîæåò áûòü â òàêèõ ñëó÷àÿõ àðãóìåíòîì â ïîëüçó ÈÂË (íî äàëåêî íå ãëàâíûì). À ïîêà ÿ íå ñîâñåì ïîíèìàþ î ÷åì ðå÷ü - ïðåäëàãàåòå âñåõ áóéíûõ àëêîãîëèêîâ ãðóçèòü äî êîìû è íà èñêóññòâåííóþ âåíòèëÿöèþ ? peace |
#27
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Èçìåðèòü ëèêâîðíîå äàâëåíèå - ãèïåðòåíçèÿ - òèîïåíòàë.
ãèïåðòåíçèè íåò - ãàëîïåðèäîë. Äàëåê îò ðåêîìåíäàöèé, àëêîãîëüíûé äåëèðèé âèäåë ïîñëåäíèé ðàç â îðäèíàòóðå. Ïðî äîçû áàðáèòóðàòîâ â êàðäèîõèðóðãèè - åñëè èíòåðåñíî â äðóãîé âåòêå |
#28
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Öèòàòà:
Öèòàòà:
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#29
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Alcohol prescription by surgeons in the prevention and treatment of delirium tremens: historic and current practice
ABSTRACT Milton Rosenbaum M.D.a and Teresita McCarty M.D.a June 2002 Abstract Beer, other alcohol beverages, and IV alcohol are still used to prevent or treat alcohol withdrawal delirium on surgical services. The history of the use of alcohol by surgeons may play a role in its continued use for withdrawal. In this policy survey 32 inpatient hospital pharmacies were called and asked if alcohol was available, if it was used to treat alcohol withdrawal, and the medical specialties that requested it. Recommendations about the use of alcohol were examined in recent textbooks and from those published early in the twentieth century. One half of the 32 hospitals surveyed had alcoholic beverages available for patient use and eleven hospitals used either package alcohol or IV alcohol in the treatment of alcohol withdrawal. Surgeons used alcohol before anesthesia to help patients tolerate procedures, and the use of alcohol for treatment of alcohol withdrawal still appears in the surgical literature. This preliminary survey indicates that some hospitals still provide beverage alcohol for the treatment of alcohol withdrawal and that surgeons are the specialty ordering alcohol for their patients. |
#30
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Âèêåíòèé Âåðåñàåâ
Öèòàòà:
ñàì ïèòàëñÿ ÷àéíîþ êîëáàñîþ" |