tailieunhanh - CLINICAL SKILLS - PART 10

Máu nhuộm màu - đánh giá việc khai thác đẫm máu, tức là máu lần đầu tiên sau đó thanh toán bù trừ, hoặc xuất huyết dưới nhện (máu phù hợp với xanthochromia của dịch não tủy sau khi ly tâm tế bào màu đỏ). | 284 Chapter 15 Common Emergency Treatments cerebrospinal fluid CSF for culture bacterial PCR for viruses biochemistry and microscopy Cloudy CSF white cells prompt . antibiotics after blood cultures. Blood-stained assess whether bloody tap . blood at first then clearing or subarachnoid haemorrhage consistent blood with xanthochromia of CSF after centrifuging down red cells . Other systems Acute renal failure rapid increase in plasma creatinine urine output 30ml h Consider prerenal cause patient dehydrated dry tongue low skin turgor empty veins low CVP low blood pressure give fluid challenge and continue until JVP is 2-3 cm above the manubriosternal junction. Consider postrenal cause . enlarged prostate bilateral ureteric stones renal pelviureteric obstruction . If large prostate and large bladder consider passing catheter. If no obvious cause of renal failure ultrasound abdomen dilated ureters or dilated renal pelves or small kidneys indicating chronic renal failure. Check plasma potassium sodium creatinine urea if potassium 6mmol l and ECG changes give . glucose insulin . calcium gluconate and rectal cation exchange resin . Check urine sodium and osmolality in prerenal failure urine osmolality 400mosmol kg and sodium 30 mmol l in renal failure 400mosmol kg and 30 mmol l respectively Microscope urine sediment for red cells white cells casts and bacteria. Check arterial pH. If incipient renal tubular necrosis for . frusemide 80-500 mg. When fluid-replete restrict fluid to 500 ml per day previous day s losses. Other Systems 285 High-energy low-protein diet. Watch for infection. Consider dialysis if creatinine 400 mmol l or potassium remains 6 mmol l fluid overload acidosis or pericarditis. Diabetic ketoacidosis usually known diabetic patient ketoacidosis induced by infection vomiting missing insulin injections patient is drowsy dehydrated ketotic breath Check plasma glucose electrolytes arterial pH CRP troponin blood and urine culture ECG and CXR. .