By Louise Gluck
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0 kPa). It is entered at around 35–50 cm (14–20 in). (4) Wedge tracing/pulmonary artery occlusion pressure: this resembles reappearance of the central venous waveform and indicates that the catheter is ‘wedged’ in the pulmonary artery. The pressure at this level reflects the filling pressures of the left side of the heart. The catheter should not be advanced any further as it may go on to rupture the pulmonary artery. 0 kPa) in an optimally fluid resuscitated patient with no vasoconstrictor or PEEP therapy.
Fresh frozen plasma, cryoprecipitate, and platelet transfusions may be required but only if bleeding or severe thrombocytopenia occur. Thromboprophylaxis is appropriate: antiembolic stockings, early mobilization, and heparin should be given. 28 36–38: Questions 36 36 The patient with the shown X-ray (36) is best treated by: A Gastroscopy and conservative treatment. B Urgent surgery. C Elective surgery in all cases. D Elective surgery for symptomatic cases only. E Elective surgery for cases only with reflux esophagitis.
Reflux esophagitis is usually not a common symptom with this disease. 37 A syndrome of hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia, called tumor lysis syndrome, occurs in rapidly proliferating tumors that undergo cell lysis. It is an oncologic emergency. Uric acid, xanthine, and calcium phosphate salts precipitate in the renal tubules leading to oliguria, acute renal failure, and lethal hyperkalemia. Although it can occur spontaneously, it is most often precipitated by cytotoxic therapy.
Against Sincerity by Louise Gluck