Skip to main content Accessibility help
×
Hostname: page-component-8448b6f56d-m8qmq Total loading time: 0 Render date: 2024-04-20T02:02:18.138Z Has data issue: false hasContentIssue false

Exam G: - Answers

Published online by Cambridge University Press:  21 January 2017

Keith Davies
Affiliation:
Severn Deanery, Bristol
Christopher Gough
Affiliation:
Severn Deanery, Bristol
Emma King
Affiliation:
Severn Deanery, Bristol
Benjamin Plumb
Affiliation:
Severn Deanery, Bristol
Benjamin Walton
Affiliation:
North Bristol NHS Trust
Get access

Summary

A 28-year-old man suffered a traumatic transection of his spinal cord at the level of T4. Six weeks post-injury, he remains in the intensive care unit undergoing a respiratory wean via his tracheostomy. He suddenly complains of a headache and looks flushed.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2016

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

References

Bycroft, J, Shergill, I, Choong, E, et al. Autonomic dysreflexia: a medical emergency. Postgrad Med J. 2005;81(954):232235.Google Scholar
Krassioukov, A, Warburton, DE, Teasell, R, Eng, JJ; Spinal Cord Injury Rehabilitation Evidence Research Team. A systematic review of the management of autonomic dysreflexia following spinal cord injury. Arch Phys Med Rehabil. 2009;90(4):682695.CrossRefGoogle Scholar

References

Joint Formulary Committee. British National Formulary. 69th ed. London: BMJ Group and Pharmaceutical Press; 2015.Google Scholar
Solomon, T, Michael, BD, Smith, PE, et al. Management of suspected viral encephalitis in adults – Association of British Neurologists and British Infection Association National Guidelines. J Infect. 2012;64(4):347373.CrossRefGoogle Scholar

References

Aksoy, DY, Unal, S. New antimicrobial agents for the treatment of Gram-positive bacterial infections. Clin Microbiol Infect. 2008;14(5):411420.Google Scholar
Bassetti, M, Merelli, M, Temperoni, C, Astilean, A. New antibiotics for bad bugs: where are we? Ann Clin Microbiol Antimicrob. 2013;12(1):22.Google Scholar
Boucher, HW, Talbot, GH, Benjamin, DK, et al. 10 × 20 Progress – development of new drugs active against Gram-negative bacilli: an update from the Infectious Diseases Society of America. Clin Infect Dis. 2013;56:16852694.Google Scholar

Reference

O'Driscoll, BR, Howard, LS, Davison, AG. BTS guideline for emergency oxygen use in adult patients. Thorax. 2008;63(Suppl VI):vi1vi68.Google Scholar

References

Guérin, C, Reignier, J, Richard, J-C, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013:368:21592168.Google Scholar
Papazian, F, Forel, JM, Gacouin, A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010;363:11071116.Google Scholar
Peek, GJ, Mugford, M, Tiruvoipati, R, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374(9698):13511363. doi:10.1016/S0140–6736(09)61069–2.Google Scholar
Ranieri, VM, Rubenfeld, GD, Thompson, BT, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526–33. doi:10.1001/jama.2012.5669.Google ScholarPubMed
Santa Cruz, R, Rojas, J, Nervi, R, et al. High versus low positive end-expiratory pressure (PEEP) levels for mechanically ventilated adult patients with acute lung injury and acute respiratory distress syndrome [review]. Cochrane Database Syst Rev. 2013;(6).CrossRefGoogle Scholar
Slutsky, AS, Ranieri, VM. Ventilator-induced lung injury. N Engl J Med. 2013;369(22):21262136.CrossRefGoogle ScholarPubMed

References

McGrath, BA, Bates, L, Atkinson, D, Moore, JA. Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies. Anaesthesia. 2012;67(9):10251041.CrossRefGoogle ScholarPubMed
Wilkinson, K, Martin, I, Freeth, H, et al. National Confidential Enquiry into Patient Outcome and Death. On the Right Trach? A review of the care received by patients who underwent a tracheostomy. 2014. http://www.ncepod.org.uk/2014report1/downloads/On%20the%20Right%20Trach_FullReport.pdf (accessed January 2016).Google Scholar

Reference

Du Rand, IA., Blaikley, J, Booton, R, et al. British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE. Thorax. 2013;68:i144.CrossRefGoogle ScholarPubMed

Reference

Association of Paediatric Anaesthetists of Great Britain and Ireland. APA Consensus guideline on perioperative fluid management in children, v1.1 2007. http://www.apagbi.org.uk/publications/apa-guidelines (accessed August 2015).Google Scholar

Reference

Peck, TE, Hill, SA, M Williams, M. Pharmacology for Anaesthesia and Intensive Care. 3rd edition. Cambridge: Cambridge University Press.Google Scholar

Reference

Scottish Intercollegiate Guidelines Network (SIGN). Management of acute upper and lower gastrointestinal bleeding. A national clinical guideline (SIGN publication no. 105). Edinburgh: SIGN; 2008.Google Scholar

Reference

Higgins, JPT, Altman, DG. Chapter 8: Assessing risk of bias in included studies. In Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series. Higgins, JPT, Green, S. Chichester, UK: The Cochrane Collaboration. J Wiley, 2008.CrossRefGoogle Scholar

Reference

Resuscitation Council (UK). Chapter 8: Peri-arrest arrhythmias. Advanced Life Support Manual. 6th edition. 2011. https://www.resus.org.uk/pages/GL2010.pdf (accessed October 2014).Google Scholar

Reference

Kidney Disease: Improving Global Outcomes. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2013;3(1):103.Google Scholar

References

Cushman, M, Lim, W, Zakai, NA. American Society of Hematology. 2014 Clinical practice guide on antithrombotic drug dosing and management of antithrombotic-associated bleeding complications in adults. http://www.hematology.org (accessed April 2015).Google Scholar
Siegal, DM, Garcia, DA, Crowther, MA. How I treat target-specific oral anticoagulant-associated bleeding. Blood. 2014;123(8):11521158.Google Scholar

References

Kieninger, AN, Lipsett, PA. Hospital-acquired pneumonia: pathophysiology, diagnosis and treatment. Surg Clin North Am. 2009;89(2):439461.CrossRefGoogle ScholarPubMed
Lim, WS, Baudouin, SV, George, RC, et al. BTS guidelines for the management for community acquired pneumonia in adults: update 2009. Thorax. 2009;64(Suppl III):iii1iii55.Google Scholar

Reference

Gill, P, Martin, R. Smoke inhalation injury. Contin Educ Anaesth Crit Care Pain. May 2014. doi:10.1093/bjaceaccp/mku017CrossRefGoogle Scholar

Reference

Whitehouse, T, Snelson, C, Grounds, M, on behalf of the Intensive Care Society. Intensive Care Society Review of best practice for analgesia and sedation in the critical care. June 2014. http://www.ics.ac.uk/ics-homepage/guidelines-and-standards (accessed April 2015).Google Scholar

References

Appleton, R, Kinsella, J. Intensive care unit–acquired weakness. Contin Educ Anaesth Crit Care Pain. 2012;12(2):6266.Google Scholar
Kress, JP, Hall, JB. ICU-acquired weakness and recovery from critical illness. N Engl J Med. 2014;370(17):16261635.Google Scholar

References

Myburgh, J. Vasodilators and antihypertensives. In Bersten, AD, Soni, N. Oh's Intensive Care Manual. 6th edition. Oxford: Butterworth Heinemann Elsevier, 2009, Chapter 83.Google Scholar
Woodrum, D, Kheterpal, S. Anaesthetic management of phaeochromocytoma. World J Endocr Surg. 2010;2(3):111117.Google Scholar

References

Cook, T, Woodall, N, Frerk, C. 4th National Audit Project (NAP4) of The Royal College of Anaesthetists and The Difficult Airway Society: Major complications of airway management in the United Kingdom. Report and Findings. London: Royal College of Anaesthetists, March 2011.Google Scholar
Difficult Airway Society. Intubation Guidelines. http://www.das.uk.com/guidelines (accessed January 2016).Google Scholar

Reference

Blood pressure measurement. In Davis, P, Kenny, G. Basic Physics and Measurement in Anaesthesia. 5th edition. London: Elsevier, 2003, pp 187198.Google Scholar

Reference

National Institute for Health and Clinical Excellence (NICE). Nutrition support in adults: Oral nutrition support, enteral tube feeding and parenteral nutrition (CG32). London: NICE, 2006.Google Scholar

References

Doy, R, Burroughs, D, Scott, J. Mental health: consent, the law and depression-management in emergency settings. Emerg Med J. 2005;22(4):279285.Google Scholar
General Medical Council. Good Medical Practice 2013. http://www.gmc-uk.org/guidance/ethical_guidance/children_guidance_24_26_assessing_capacity.asp (accessed January 2015).Google Scholar
Hull, A, Haut, F. Managing patients with deliberate self harm who refuse treatment in accident and emergency departments : Advice and procedure require correction. BMJ. 1999;319(7214):916 (and the letters thereafter). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1116734/pdf/916.pdf. (accessed July 2015).CrossRefGoogle ScholarPubMed
United Kingdom Clinical Ethics Network. Education resources: Mental Capacity Act and Mental Health Act. http://www.ukcen.net/index.php/education_resources/mental_capacity/mca_and_the_mental_health_act (accessed May 2015).Google Scholar

Reference

The United States Centers for Disease Control and Prevention. Ventilator-associated event (VAE). 2014 http://www.cdc.gov/nhsn/pdfs/pscManual/10-VAE_FINAL.pdf (accessed July 2014).Google Scholar

Reference

Spasovski, G, Vanholder, R, Allolio, B, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Intensive Care Med. 2014;40:320333.Google Scholar

Reference

MacDuff, A, Arnold, A, Harvey, J. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65(Suppl 2 D):ii1831.Google Scholar

Reference

McMurray, JJV, Adamopoulos, S, Anker, SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Eur Heart J. 2012;33(14):17871847.Google ScholarPubMed

Reference

Solomon, T, Hart, IJ, Beeching, NJ. Viral encephalitis: a clinician's guide. Pract Neurol. 2007;7:288305.Google Scholar

References

American College of Surgeons (ACS) Committee on Trauma. Advanced Trauma Life Support Student Course Manual. 9th edition. Chicago, IL: ACS, 2012.Google Scholar
Goarin, JP, Riou, B. Traumatic aortic injury. Curr Opin Crit Care. 1998;4(6):417423.Google Scholar
Lee, WA, Matsumura, JS, Mitchell, RS, et al. Endovascular repair of traumatic thoracic aortic injury: clinical practice guidelines of the Society for Vascular Surgery. J Vasc Surg; 2011;53(1):187192.Google Scholar

References

Barr, J, Fraser, GL, Puntillo, K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41(1):263306.CrossRefGoogle ScholarPubMed
Reade, MC, Finfer, S. Sedation and delirium in the intensive care unit. N Engl J Med. 2014;370(5):444454.Google Scholar
Van Romcompaey, B, Elseviers, MM, Schuurmans, MJ, et al. Risk factors for delirium in intensive care patients: a prospective cohort study. Crit Care. 2009;13:R77.CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×