{"title":"Gastrointestinal dysfunction in the intensive care unit","authors":"Patrick Eaton, Matthew Faulds","doi":"10.1016/j.mpsur.2024.07.005","DOIUrl":"10.1016/j.mpsur.2024.07.005","url":null,"abstract":"<div><div>Critical illness can disrupt the many functions of the gastrointestinal (GI) system and signs of gut failure are a clear marker of critical illness severity. Prevention and management of GI dysfunction aims to improve outcomes for the critically ill patient. Early enteral nutrition is protective on the gut and encourages GI motility. A careful balance must be struck to deliver sufficient calories and protein while avoiding overfeeding with its associated complications. Gut dysmotility at any level of the GI tract is a common barrier to nutrient delivery in the critically ill. The microbiome is central to gut health and critical illness has an invariably harmful effect on its composition and function. Gut-derived sepsis is one possible consequence that carries high mortality. GI bleeding, intra-abdominal hypertension and bowel ischaemia represent severe manifestations of gut dysfunction. Management of all these complications in the ICU should involve prevention strategies, detection through regular and thorough assessment, and systematic approach to treatment.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 10","pages":"Pages 759-764"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"End-of-life care in the intensive care unit","authors":"Sean R Bennett, Maria Rita Maccaroni","doi":"10.1016/j.mpsur.2024.07.010","DOIUrl":"10.1016/j.mpsur.2024.07.010","url":null,"abstract":"<div><div>Death on the intensive care unit (ICU) is common. As with any condition, it is important that the clinician recognizes when a patient is close to death and alters management towards end-of-life care (EoLC). This allows a good death through ensuring patient comfort and dignity while supporting the family. The main obstacle in allowing a good death being the failure to recognize patients who are approaching the end of their life. This leads to prolonged suffering and needless distress for the family and the patient. The same quality of care that supported the patient before EoLC should continue until they die. The correct process is a clinical skill with the foundations being communication and timing. Managed correctly, the patient's family will have positive memories of not only the death but of the person who has died and the care they received. Guidance from the General Medical Council (GMC) is clear and written to protect the patient and the physician. This article includes the updated guidance (2022) from the GMC and will detail the process involved. Relevant aspects of the legal framework and most recent guidelines are included to inform the physician of what to do and what not to do. Examples of patients who die on the ICU are given to illustrate these points resulting in a good death or a bad death.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 10","pages":"Pages 771-778"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142417989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Shock and haemodynamic monitoring","authors":"Abigail Butler, Tony Rostron","doi":"10.1016/j.mpsur.2024.07.009","DOIUrl":"10.1016/j.mpsur.2024.07.009","url":null,"abstract":"<div><div>Shock is a life-threatening clinical condition that arises when there is inadequate oxygen metabolism at a cellular level. It can occur in a wide range of clinical conditions and without prompt identification and management it has a high morbidity and mortality. Treatment focuses on both correcting the cause and managing the abnormal physiology associated with shock. Clinicians use a number of tools including clinical examination, biochemical markers and haemodynamic monitoring to both identify and treat shock. In this article we will review the normal physiology of oxygen delivery, the aetiology and pathophysiology of shock and how haemodynamic monitoring is used to manage patients presenting with shock.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 10","pages":"Pages 724-730"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Diseases of the adenoids and tonsils in children","authors":"Emma McNeill, Rory Houston","doi":"10.1016/j.mpsur.2024.05.017","DOIUrl":"10.1016/j.mpsur.2024.05.017","url":null,"abstract":"<div><p>Diseases of the tonsils<span><span> and adenoids are extremely common in children and make up a significant part of the paediatric<span> ENT surgeon's practice, as well as presenting frequently to paediatric and primary care<span><span> teams. The majority of adenotonsillar pathology in children is either infective or obstructive in nature. This article discusses the anatomy and </span>pathophysiology of acute and chronic adenotonsillar disease and discusses how to evaluate a child with suspected adenotonsillar pathology clinically, in both the outpatient and emergency scenario. Surgical management and the </span></span></span>adenoidectomy<span><span> and tonsillectomy techniques are described. The current multidisciplinary working group guidelines regarding surgery for </span>obstructive sleep apnoea in children are also highlighted.</span></span></p></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 9","pages":"Pages 694-701"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142117398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Topography of the neck","authors":"Peter J Bazira","doi":"10.1016/j.mpsur.2024.05.020","DOIUrl":"10.1016/j.mpsur.2024.05.020","url":null,"abstract":"<div><p>This article offers a comprehensive overview of the neck's topography, with a focus on the anterior cervical region due to its relevance to most pathological conditions. It describes the arrangement of important fascial layers, muscular planes, and their relationship to major vessels and cervical viscera<span>. The article also outlines key landmarks and their corresponding vertebral levels to help in the precise location of skin incisions<span>. Finally, it explores the topography of the triangles of the neck, tissue planes, muscles of the neck, the visceral column of the neck, and cervical lymph nodes. These insights are crucial for surgeons and medical professionals involved in head and neck surgeries to ensure optimal outcomes.</span></span></p></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 9","pages":"Pages 631-637"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142117404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The management of facial trauma","authors":"Robert Stuart McCormick, Graham Putnam","doi":"10.1016/j.mpsur.2024.05.016","DOIUrl":"10.1016/j.mpsur.2024.05.016","url":null,"abstract":"<div><p>Facial or maxillofacial trauma occurs as a consequence of physical injury to the face and can include damage to soft tissue and bony structures either in isolation or combination. There is a male predominance with highest incidence in the age group of 20–40 years. The range of injuries include soft tissue damage, bruising, lacerations, burns and fractures of the underlying facial skeleton including the zygomatic complex, mandible, maxilla, orbit and nasoethmoidal complex. The concentration of special senses in the head and neck region means that even seemingly minor injuries can have a significant impact upon the long-term outcome for a patient. Careful assessment of an injured patient must include a full ATLS evaluation to ensure that associated potentially life-threatening injuries are not missed. This article describes the signs, symptoms and treatment of maxillofacial trauma, including management of hard and soft tissue trauma.</p></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 9","pages":"Pages 707-714"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142117400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Infections and foreign bodies in ENT","authors":"Mriganka De, Shahram Anari","doi":"10.1016/j.mpsur.2024.05.019","DOIUrl":"10.1016/j.mpsur.2024.05.019","url":null,"abstract":"<div><p>Infections of the ear, nose and throat are common. The majority of these infections are managed by the primary care<span> physicians and they settle with conservative and medical management. However, a small group can progress to become troublesome and develop complications to the extent that they may require surgical intervention. Some of the infections can lead to life-threatening complications, therefore awareness and correct diagnosis along with appropriate management is paramount. Foreign bodies in the ear, nose and throat are commonly encountered. The location and type of foreign body can have an implication on the urgency of action and the possible complications. In this article the common ENT infections and foreign bodies and their management are discussed.</span></p></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 9","pages":"Pages 668-674"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142117408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Evaluation and management of acute upper airway obstruction","authors":"Constantina P. Yiannakis, Omar J. Hilmi","doi":"10.1016/j.mpsur.2024.05.014","DOIUrl":"10.1016/j.mpsur.2024.05.014","url":null,"abstract":"<div><p><span>Upper airway obstruction<span> can occur suddenly and result in a patient’s rapid deterioration. In this article we provide a structured approach to identifying those patients with acute airway compromise and stratifying them according to clinical urgency. This includes ways of distinguishing both the level of obstruction and its severity, based on the clinical signs and symptoms, and the role and timing of investigations. We describe the key aspects of emergency management, including temporizing measures and airway adjuncts. Management of rare, but important, situations are discussed such as post-thyroidectomy haematoma, occlusion of tracheostomy and </span></span>laryngectomy stomas, and post-obstruction pulmonary oedema (POPE) is discussed. We describe the situation when an emergency surgical airway should be considered, along with our technique of performing one.</p></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 9","pages":"Pages 675-683"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142117450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Irene Benaran, Katharine EL Hamlett, Natasha Grimmond, May MC Yaneza
{"title":"Epistaxis","authors":"Irene Benaran, Katharine EL Hamlett, Natasha Grimmond, May MC Yaneza","doi":"10.1016/j.mpsur.2024.05.021","DOIUrl":"10.1016/j.mpsur.2024.05.021","url":null,"abstract":"<div><p>Epistaxis is a common problem that can affect the whole population and is the most common ENT presentation to the emergency department.<sup>1</sup> The majority of cases are self-limiting and do not require any medical intervention, however epistaxis can be associated with morbidity and even death in very rare circumstances. If epistaxis does not resolve with first aid measures, or episodes are frequent, patients may require specialist assessment and treatment by ENT, either in the outpatient clinic or via an unscheduled (emergency) admission to the hospital. Here, we provide an overview of the management of epistaxis in the outpatient setting and during an emergency admission in both paediatric and adult patients. We highlight the key considerations in the history and management, covering the common and rare conditions that are associated with epistaxis. This article provides an update from our most recent version published in 2021 including updated resources from British Rhinology Society guidance and review of the recent literature regarding epistaxis management.</p></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 9","pages":"Pages 652-667"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142117407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Test yourself: MCQ and Single Best Answer","authors":"Adrian Ben Cresswell","doi":"10.1016/j.mpsur.2024.05.023","DOIUrl":"10.1016/j.mpsur.2024.05.023","url":null,"abstract":"","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 9","pages":"Pages 715-716"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142117401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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