Coagulation monitoring Basic coagulation screen

The basic screen consists of a platelet count, prothrombin time, activated partial thromboplastin time and thrombin time. Close attention to blood sampling technique is very important for correct interpretation of coagulation tests. Drawing blood from indwelling catheters should, ideally, be avoided since samples may be diluted or contaminated with heparin. The correct volume of blood must be placed in the sample tube to avoid dilution errors. Laboratory coagulation tests are usually performed...

Acute coronary syndrome 2 Angina

Ischaemic or, rarely, spasmodic constriction of coronary arteries resulting in pain, usually precordial, pressing or crushing, and with or without radiation to jaw, neck or arms. The sedated, ventilated patient will not usually complain of pain but signs of discomfort may be apparent, e.g. sweating, hypertension, tachycardia. The ECG should be regularly scrutinised for ST segment and or T wave changes. Unstable angina encompasses a spectrum of syndromes between stable angina and myocardial...

Platelet disorders Thrombocytopenia

Rarely symptomatic until the platelet count < 50 x 109 l spontaneous bleeding is more likely < 20 x 109 l. Although bleeding is often minor, e.g. skin petechiae, oozing at intravascular catheter sites, it may be massive or life-threatening, e.g. haemoptysis, intracranial haemorrhage. Sepsis in the ICU this is the commonest cause of a low platelet count often provides a good barometer of recovery or deterioration Disseminated intravascular coagulation Related to antiplatelet antibody...

Systemic lupus erythematosis SLE

A non-organ specific autoimmune disease characterised by antinuclear antibodies with high titres of antidouble-stranded DNA antibodies. A vasculitis is prominent, although cutaneous and central nervous system involvement are not vasculitic. SLE may present to intensive care through pulmonary, renal or central nervous system involvement. Renal failure is vasculitic in origin and may progress to end stage renal failure requiring long term dialysis. Early treatment with systemic steroids and...

Continuous positive airway pressure

Continuous positive airway pressure CPAP is the addition of positive pressure to the expiratory side of the breathing circuit of a spontaneously ventilating patient who may or may not be intubated. This sets the baseline upper airway pressure above atmospheric pressure, prevents alveolar collapse and possibly recruits already collapsed alveoli. It is usually administered in increments of 2.5cmH2O to a maximum of 10cmH2O and applied via either a tight-fitting face mask face CPAP , nasal mask...