tailieunhanh - Critical Care Obstetrics part 21

Critical Care Obstetrics part 21 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | Dialysis develop as are fluid overload and uremic complications Table . In patients with diabetes who often have other end-organ damage including autonomic neuropathy and vascular disease dialytic support may be required even earlier when the GFR reaches 15mL min. Table Signs and symptoms of uremia. Organ involvement Subjective complaints Objective findings Neurologic Cognitive difficulties Sleep-wake reversal Dysesthesias Hyperreflexia asterixis Seizures encephalopathy Peripheral neuropathy Hematopoietic Easy bruising and bleeding Fatigue Anemia Prolonged bleeding time Gastrointestinal Metallic taste Constipation Nausea Angiodysplasia Musculoskeletal Weakness Bone pain Myopathy Carpal tunnel syndrome Bone fractures Cardiovascular Dyspnea Chest pain Pericarditis Hypertension Pulmonary edema Dermatologic Pruritus Cutaneous calcifications Endocrine Decreased libido Dysmenorrhea amenorrhea Decreased fertility Table Indications for initiation of dialysis. Hyperkalemia Metabolic acidosis Volume overload Uremic pericarditis Uremic encephalopathy Glomerular filtration rate GFR 5-10mL min The physiology of dialysis is based on diffusive and convective transport. Diffusion refers to the random movement of a solute down its concentration gradient. It is by this means that the majority of urea and solute clearance is achieved. Convection is that solute movement that occurs by means of solvent drag as water is removed either by hydrostatic or osmotic force. A lesser degree of clearance is obtained during fluid removal by ultrafiltration. Modes of dialysis Options for dialysis include hemodialysis and peritoneal dialysis with the latter consisting of continuous ambulatory peritoneal dialysis CAPD continuous cycling peritoneal dialysis CCPD and nocturnal intermittent peritoneal dialysis NIPD . Hemodialysis Hemodialysis requires a vascular access for extracorporeal therapy. This is usually a surgically created artificial arteriovenous AV shunt or a native AV .