By Helen F. Galley, Helen Galley
The most recent quantity within the well known severe Care concentration sequence discusses problems with specific significance at the extensive care unit. in addition to its spouse volumes it specializes in present components of dialogue and alter, and is meant as an replace for all extensive care employees and trainees.
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Extra resources for Critical Care Focus 8. Blood and Blood Transfusion
Another relatively cheap system readily available in the United Kingdom is the platelet function analyser, in which a small volume of blood is drawn through a membrane. The device records the time to closure of the membrane and also calculates the volume of blood passing through during the closure time. This provides a very good mimic of in vivo primary haemostasis – in other words the ability of platelets to adhere to the hole in the membrane. This gives a very good indication of platelet transfusion 26 HAEMOSTATIC PROBLEMS IN THE INTENSIVE CARE UNIT requirements or indeed can also be used as a monitor of the effectiveness of transfusion.
Generally speaking, platelet counts above 40–50 ϫ 109/l are rarely associated with spontaneous bleeding although microvascular “ooze” at the traumatic lesion, surgical or otherwise, may occur. However, when platelet counts fall below 40 ϫ109/l, bleeding is common but not always present. 1). 1 Platelet count thresholds • Normal 150–400 ϫ 109/l • Ͼ40 ϫ 109/l Spontaneous bleeding uncommon except with associated platelet dysfunction Bleeding only after trauma/lesion • Ͻ40 ϫ 109/l Bleeding common but not always present • Ͻ10 ϫ 109/l Severe bleeding It is recommended that the platelet transfusion or prophylactic threshold is set at 10 ϫ 109/l and that is certainly the case in most leukaemia units.
23 Previous pre-clinical and clinical studies showed that the administration of activated protein C may improve the outcome of severe sepsis. 26 Eligible patients were enrolled into a randomised, double-blind, placebo-controlled trial, conducted at 164 centres in 11 countries from July 1998 until June 2000. 27 Patients were eligible for the trial if they had a known or suspected infection on the basis of clinical data at the time of screening and if they met the following criteria within a 24-hour period: three or more signs of systemic inflammation and sepsis-induced dysfunction of at least one organ or system that lasted no longer than 24 hours.