In message <[log in to unmask]>, Francis Andrews
<[log in to unmask]> writes
>Tim
>
>Why not ring up your nearest ITU for these patients. Many DGHs
>without renal physicians on site have ICUs with the capability to
>perform venovenous filtration. You need to check that the machine has
>a warming circuit (most have), and the patient could be rapidly warmed
>this way. Unlike dialysis, no special water supply is needed and
>theoretically it could be done in A&E with ICU support. Only venous
>access is required for the line. An example of this was recently
>published in the journal of A&E medicine.
>
>Francis Andrews FFAEM
>Lecturer in Intensive Care Medicine
>Department of Medicine
>University of Liverpool
>Daulby St
>L693GA
>
As there have been no takers for this particular line in the thread, I
might as well take it up!
A cardiopulmonary bypass machine gives a reasonable perfusion pressure.
Does a venovenous circuit do likewise? I suspect not. A high venous
pressure from an extracorporeal pump would lead to problems in a renal
patient. Does taking the filter out of the circuit allow the pump to
develop a high enough head of pressure?
In our arrested hypothermic patient, some other means of maintaing
perfusion would probably need to be employed.
Tim suggests that a cold chest does not compress well, so a thoracotomy
would be required.
The case report referred to by Francis Andrews was indeed interesting.
However, I cannot find it at home. What was the reference?
--
Stephen Hughes
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