Sedation, Analgesia Delirium in the ECMO Patient

The goal of this chapter is to identify medications frequently utilized for sedation and analgesia in Extracorporeal Membrane Oxygenation (ECMO) patients. In addition to describing basic pharmacologic principles of these medications, we discuss their benefits and disadvantages and explain the effects the ECMO circuitry will have on pharmacokinetics of each drug. We also discuss need for various depths of sedation and the utility of neuromuscular blocking agents. Emerging techniques for achieving appropriate sedation will be identified. An explosion of literature in recent years has led to Intensive Care Unit (ICU) delirium increasingly being recognized as an indicator of poor outcomes in the general ICU population. We discuss strategies to manage this complex and multifactorial issues, and how they can be applied to our particular subpopulation of ECMO patients

Changing patterns in diagnostic strategies and the treatment of blunt injury to solid abdominal organs

Background: In recent years there has been increasing interest shown in the nonoperative management (NOM) of blunt traumatic injury. The growing use of NOM for blunt abdominal organ injury has been made possible because of the progress made in the quality and availability of the multidetector computed tomography (MDCT) scan and the development of minimally invasive intervention options such as angioembolization. Aim: The purpose of this review is to describe the changes that have been made over the past decades in the management of blunt trauma to the liver, spleen and kidney. Results: The management of blunt abdominal injury has changed considerably. Focused assessment with sonography for trauma (FAST) examination has replaced diagnostic peritoneal lavage as diagnostic modality in the primary survey. MDCT scanning with intravenous contrast is now the gold standard diagnostic modality in hemodynamically stable patients with intra-abdominal fluid detected with FAST. One of the current discussions in the l erature is whether a whole body MDCT survey should be implemented in the primary survey. Conclusions The progress in imaging techniques has contributed to NOM being currently the treatment of choice for hemodynamically stable patients. Angioembolization can be used as an adjunct to NOM and has increased the succe