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Biomedical subjects

Michael J A Parr

Publications and source records attributed to Michael J A Parr.

4 recordsLinked to original sources
PubMed2004

Damage control surgery and intensive care.

The introduction and establishment of the 'damage control surgery' concept has led to increasing numbers of severely injured and unstable patients being presented to Intensive Care Units (ICU) for ongoing resuscitation. These patients present many challenges for the Intensive Care team and emphasise the need for a multidisciplinary approach to optimise trauma patient management. Multiple issues need to be addressed simultaneously while the overall aim is to rapidly achieve a physiological environment that will allow the best possible recovery. The 'lethal triad' of hypothermia, acidosis, and coagulopathy due to initial hypovolaemia require aggressive correction. From the outset ICU management must also attempt to minimise the complications of these injuries and the resuscitative process. This review will address some of the key issues relating to the care of these patients in the ICU.

Acidosis↗
PubMed2002

Life-threatening hyperkalaemia following therapeutic barbiturate coma.

OBJECTIVE: To report the occurrence of life-threatening hyperkalaemia following treatment with therapeutic thiopentone coma. SETTING: The neurosurgical intensive care units of Royal North Shore Hospital and Liverpool Hospital, Sydney, Australia. PATIENTS: Three patients treated with theraputic thiopentone coma. One patient with raised intracranial pressure secondary to a severe traumatic brain injury and two patients with refractory vasospasm secondary to subarachnoid haemorrhage. Two of the three patients developed hypokalaemia on starting thiopentone, which was resistant to potassium supplementation. All three patients developed severe hyperkalaemia during the recovery phase of coma. This was life-threatening in all three patients and fatal in one. CONCLUSIONS: Severe hypokalaemia refractory to potassium therapy may occur during therapeutic thiopentone coma. Severe rebound hyperkalaemia may occur after cessation of thiopentone infusion. Protocols for the management of patients with therapeutic barbiturate coma should recognise this potentially serious complication.

Adult↗
PubMed2002

Resuscitation for major trauma.

Disability from traumatic injury is on the increase worldwide. Dogma rather than scientific evidence has tended to be responsible for determining the treatment of major trauma victims. Evidence is now beginning to emerge, however, questioning the dogma, and suggesting that different treatment options may yield better outcomes. This review examines the recent literature in resuscitation for major trauma.

Journal Article↗