Anesthesiology and Intensive Care

◆ Cardiac contusion, or other trauma including surgery, ablation, pacing, etc. ◆ Congestive heart failure—acute and chronic. ◆ Aortic dissection. ◆ Aortic valve disease. ◆ Hypertrophic cardiomyopathy. ◆ Tachy- or bradyarrhythmias, or heart block. ◆ Apical ballooning syndrome (Takotsubo). ◆ Rhabdomyolysis with cardiac injury. ◆ Pulmonary embolism, severe pulmonary hypertension. ◆ Renal failure. ◆ Age (>70 years). ◆ Acute neurological disease, including stroke or subarachnoid haemorrhage. ◆ Infiltrative diseases, e.g. amyloidosis, haemochromatosis, sarcoidosis, and scleroderma. ◆ Inflammatory diseases, e.g. myocarditis or myocardial extension of endo- and pericarditis. ◆ Drug toxicity or toxins. ◆ Critically-ill patients, especially with respiratory failure or sepsis. ◆ Burns, especially if affecting >30% of body surface area. ◆ Extreme exertion .

TREATMENT ALGORITHM OF HYPERLACTATAEMIA click to zoom the image

Anaerobic causes ◆ Macrocirculatory shock. ◆ Microcirculatory shunting. ◆ Carbon monoxide poisoning (carboxyhaemoglobin). Aerobic causes ◆ Increased aerobic glycolysis:     • Catecholamine-stimulated increased Na+–K+-pump activity.     • Cytokine-mediated glucose uptake. ◆ Mitochondrial dysfunction. ◆ Pyruvate dehydrogenase dysfunction:     • Sepsis.     • Thiamine deficiency. ◆ Reduced clearance:     • Liver insufficiency/surgery.     • Sepsis. ◆ Alkalosis. ◆ Malignancy (Warburg effect). ◆ Epileptic seizure (grand mal). ◆ Congenital metabolic diseases. ◆ Drugs and intoxications:     • Nucleoside reverse transcriptase inhibitors.     • Epinephrine.     • Metformin.     • Propofol (propofol infusion syndrome).     • Corticosteroids.     • Cyanide.     • Ethylene glycol.     • Methanol.     • Carbon monoxide po...

Click the link below to access PDF file Michigan checklist for central vascular access.

There are currently no licensed pharmacological therapies for ARDS, although there are a number of novel agents under development. Appropriate treatment of risk factors including pneumonia, non-pulmonary sepsis (e.g. peritonitis), aspiration of gastric contents, major trauma, transfusion, and acute pancreatitis. Protective mechanical ventilation using tidal volumes of 6 mL/kg predicted body weight (PBW), and a plateau pressure less than 30 cmH2O, confers a mortality benefit, and should be undertaken whenever possible Extracorporeal membrane oxygenation & extracorporeal carbon dioxide removal have not been proved to be of universal benefit in ARDS, although it is possible that there may be sub-populations of ARDS patients (e.g.H1N1 influenza patients and ECMO ) that derive benefit from these interventions. Fluid restriction , after patients are appropriately resuscitated, is probably of benefit. There is no evidence to support a specific feeding regimen in ARDS ...

 Patient should be placed in the head-down position on the right side and should have also immediate tracheal suction to maintain a clear airway.  Correct hypoxia and support pulmonary function by assisted ventilation or positive-pressure oxygen.  Endotracheal intubation should be considered for patients who are unable to protect their airways.  The use of corticosteroids in the treatment of chemical pneumonitis is controversial . The administration of corticosteroids cannot be recommended in patients with ARDS. The prophylactic use of antibiotics is not recommended. Empirical antibiotic therapy is appropriate for patients who aspirate gastric contents and who have small-bowel obstruction or other conditions associated with colonization of the gastric contents. Antibiotic therapy should be considered for patients with aspiration pneumonitis that fails to resolve within 48 hours following aspiration.  Empirical therapy with broad...

Preload                   Full Afterload                Increased Contractility          Decreased, avoid inotropes Rate                        Normal Rhythm                  Sinus, atrial pacing if required ________________________________________________ Преднагрузка        Полная Постнагрузка        Увеличить Сократимость       Уменьшить, избегать инотропов ЧСС                         Поддерживать в норме Ритм                        Синусовый, стимуляция предсердий при                                 ...