Central venous cannulation in patients with thrombocytopenia and coagulopathies

Two simple technical maneuvers are presented that minimize bleeding and hematomas while inserting central venous catheters in patients with coagulation problems. If using this technique, a careful and gentle central venous line insertion is performed, patients with low platelet counts or underlying disorders of hemostasis should have less frequent bleeding complications

Acute pancreatic nine years of surgical lCU experience

Acute pancreatitis has a variety of presentations from self-limiting abdominal pain to development of local and systemic complications resulting in sepsis, multi-organ dysfunction, extended intensive care stay and death. Very good quality of life in survivors justifies an optimal therapy in an intensive care setup. The records of 91 patients with acute pancreatitis were reviewed retrospectively. There was a significant difference [p<0.001] between those with edematous pancreatitis and those with necrotic pancreatitis as regards the length of ICU stay and severity scores: Ranson and SOFA [Sepsis-related Organ Failure Assessment]. The most common cause of pancreatitis was biliary [70.3 percent] followed by hyperlipidemia [12.1 percent], post ERCP [5.5 percent], trauma [4.4 percent], idiopathic [6.6 percent] and in one case, ascariasis. Common associated diseases were hypertension [33 percent] and diabetes mellitus [25.3 percent]. Six patients with necrotic pancreatitis died. It is concluded that acute pancreatitis treated in an intensive care unit has a favorable outcome and that a combination of Ranson and SOFA scores with CT index helps in establishing the prognosis