Annual Update in Intensive Care and Emergency Medicine 2013 by C. Lipp, R. Dhaliwal, E. Lang (auth.), Jean-Louis Vincent

By C. Lipp, R. Dhaliwal, E. Lang (auth.), Jean-Louis Vincent Prof. (eds.)

The Yearbook compiles the newest advancements in experimental andclinical examine and perform in a single complete reference booklet. Thechapters are written by way of good well-known specialists within the box of in depth care and emergency drugs. it really is addressed to every body all in favour of inner medication, anesthesia, surgical procedure, pediatrics, in depth care and emergency medicine.​

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Among the proposed pharmacological interventions, uterotonics are the mainstay of therapy. Goals of resuscitation should be adequate fluid therapy and early administration of blood products, ideally according to a mass transfusion protocol. A major priority in anesthesiology management is the maintenance of a basic framework that is needed for coagulation, including normocalcemia, prevention or correction of acidosis, normothermia and platelet count. 5 g/l, are currently being investigated in larger trials and have the potential for broad application.

Prostaglandin derivates are widely used, especially PGE1 (misoprostol), which can be administered vaginally, rectally and sublingually. It is usually the drug of choice in low-resource countries, and has limited cardiovascular side-effects. However misoprostol is associated with a higher blood loss than oxytocin [51, 52]. Currently, many delivery units use misoprostol in addition to oxytocin, as this combination appears to have fewer side-effects than other combinations, though conclusive data are lacking.

Antifibrinolytic drugs are recommended in current European Postpartum Hemorrhage 27 guidelines for trauma care [69]. In obstetrics, tranexamic acid has been found to reduce blood loss after vaginal and Cesarean delivery in a Cochrane review and two recent randomized trials [70–72]. However, the evidence for tranexamic acid as a treatment for manifest PPH has been poor [73]. Last year, a first randomized study in 144 women diagnosed with peripartum blood loss > 800 ml showed a significant reduction in blood loss with a high dose of tranexamic acid (4 g), albeit only 50 ml difference [74].

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