1. Acute upper GI bleeding:
a. Abdominal tenderness is uncommon in uncomplicated upper GI bleeding.
b. Bowel sounds are usually normal.
c. The absence of blood, coffee grounds or bile in nasogastric aspirate suggests that the bleeding is not from the upper GI tract or stopped a few hours ago.
d. A paper reviewed in this issue of the Monitor suggests that a restrictive transfusion policy improves outcome.
2. Citrate anticoagulation for continuous renal replacement therapy:
a. Citrate accumulation is associated with a fall in total ionized calcium ratio.
b. May be complicated by metabolic alkalosis.
c. Citrate is partially removed by convection or diffusion.
d. Two papers reviewed in this issue of the Monitor indicate that citrate increases filter life when compared to unfractionated heparin.
a. Can be carried out using a conventional continuous venovenous haemofiltration circuit.
b. Ultrafiltration flow should not exceed 25% of blood flow to minimize the risk of circuit clotting.
c. Complement activation is a significant issue even when using modern filters.
d. A paper reviewed in this issue demonstrates that ultrafiltration improves outcome in patients with decompensated heart failure and cardiorenal syndrome.
4. Intracranial pressure monitoring:
a. Parenchymal monitoring is less accurate than subdural pressure monitoring.
b. The incidence of haemorrhage associated with monitoring is about 1.5%.
c. The threshold for treatment of intracranial hypertension
is predominantly determined by the need to maintain cerebral perfusion pressure.
d. A paper reviewed in this issue of the Monitor demonstrates that patients with traumatic brain injury managed with intracranial pressure monitoring have a worse outcome than those managed with clinical examination and frequent imaging.