Skip to main content Accessibility help
×
Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-26T08:49:12.543Z Has data issue: false hasContentIssue false

Chapter 14 - Management of Perioperative Medical Emergencies

Published online by Cambridge University Press:  18 August 2022

Daniel Rodger
Affiliation:
Senior Lecturer in Perioperative Practice, London South Bank University
Kevin Henshaw
Affiliation:
Associate Head of Allied Health Professions, Edge Hill University, Ormskirk
Paul Rawling
Affiliation:
Senior Lecturer in Perioperative Practice, Edge Hill University, Ormskirk
Scott Miller
Affiliation:
Consultant Anaesthetist, St Helens and Knowsley Hospitals NHS Trust
Get access

Summary

Surgery represents a physiologic challenge to even healthy patients - and many patients enter surgery with risk-intensifying co-morbidities. As a result, medical emergencies can occur during any surgery. Recognition and early management of these crises is crucial. Thus, this chapter seeks to provide an overview of serious medical emergencies that may arise in the preoperative period, ranging from anaphylaxis to diabetic ketoacidosis. To provide context for investigations and treatment, a brief outline of the relevant pathophysiology and/or epidemiology accompanies each problem. Building upon that foundation, this chapter describes the rudiments of recognising the emergencies and managing them appropriately. It is not the goal of the chapter to address the included issues comprehensively but to impart basic, essential knowledge of medical emergencies that will help the reader to participate in the provision of safe care in the operative setting.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Soar, J.. Emergency treatment of anaphylaxis in adults: concise guidance. Clinical Medicine 2009; 9: 181.CrossRefGoogle ScholarPubMed
Sampson, H. A., Muñoz-Furlong, A., Campbell, R. L., et al. Second Symposium on the Definition and Management of Anaphylaxis: summary report – Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network Symposium. Journal of Allergy and Clinical Immunology 2006; 117: 391397.CrossRefGoogle ScholarPubMed
Hepner, D. L. andCastells, M. C.. Anaphylaxis during the perioperative period. Anesthesia and Analgesia 2003; 97: 13811395.Google Scholar
Sheikh, A., Shehata, Y., Brown, S., and Simons., F. Adrenaline for the treatment of anaphylaxis: Cochrane Systematic Review. Allergy 2009; 64: 204212.CrossRefGoogle ScholarPubMed
Soar, J., Pumphrey, R., Cant, A., et al. Emergency treatment of anaphylactic reactions: guidelines for healthcare providers. Resuscitation 2008; 77: 157169.Google Scholar
Dewachter, P., Mouton-Faivre, C., and Hepner, D. L. Perioperative anaphylaxis: what should be known? Current Allergy and Asthma Reports 2015; 15: 21.Google Scholar
Working Group of Resuscitation Council UK. Emergency Treatment of Anaphylaxis: Guidelines for Healthcare Providers. London: Resuscitation Council UK, 2021.Google Scholar
Lin, R. Y., Curry, A., Pesola, G. R., et al. Improved outcomes in patients with acute allergic syndromes who are treated with combined H1 and H2 antagonists. Annals of Emergency Medicine 2000; 36: 462468.CrossRefGoogle ScholarPubMed
Andersson, M., Møller, A., and Wildgaard., K. Butyrylcholinesterase deficiency and its clinical importance in anaesthesia: a systematic review. Anaesthesia 2019; 74: 518528.CrossRefGoogle ScholarPubMed
Orebaugh, S. L.. Succinylcholine: adverse effects and alternatives in emergency medicine. The American Journal of Emergency Medicine 1999; 17: 715721.Google Scholar
Royal College of Anaesthetists. Suxamethonium apnoea (succinylcholine or scoline apnoea) (SA), 2018. Available from: www.rcoa.ac.uk/sites/default/files/documents/2019-11/Factsheet-Suxapnoeaweb.pdf.Google Scholar
Rubinstein, H. M., Rosenberg, M. K., Bolgla, J. H., and Cohen., B. M. Prolonged apnea after administration of succinylcholine. New England Journal of Medicine 1960; 262: 11071111.Google Scholar
Glahn, K., Ellis, F., Halsall, P., et al. Recognizing and managing a malignant hyperthermia crisis: guidelines from the European Malignant Hyperthermia Group. British Journal of Anaesthesia 2010; 105: 417420.Google Scholar
El-Boghdadly, K., Pawa, A., and Chin, K. J. Local anesthetic systemic toxicity: current perspectives. Local and Regional Anesthesia 2018; 11: 35.CrossRefGoogle ScholarPubMed
Christie, L. E., Picard, J., and Weinberg., G. L. Local anaesthetic systemic toxicity. BJA Education 2015; 15: 136142.Google Scholar
Barrera, L. M., Perel, P., Ker, K., et al. Thromboprophylaxis for trauma patients. Cochrane Database of Systematic Reviews 2013; 3: CD008303.Google Scholar
Davison, S. P., Venturi, M. L., Attinger, C. E., Baker, S. B., and Spear., S. L. Prevention of venous thromboembolism in the plastic surgery patient. Plastic and Reconstructive Surgery 2004; 114: 43e51e.Google Scholar
Niesen, A. D., Jacob, A. K., Aho, L. E., et al. Perioperative seizures in patients with a history of a seizure disorder. Anesthesia and Analgesia 2010; 111: 729735.Google Scholar
Knake, S., Hamer, H. M., and Rosenow., F. Status epilepticus: a critical review. Epilepsy and Behavior 2009; 15: 1014.Google Scholar
Kofke, W. A.. Anesthetic management of the patient with epilepsy or prior seizures. Current Opinion in Anesthesiology 2010; 23: 391399.Google Scholar
Perks, A., Cheema, S., and Mohanraj., R. Anaesthesia and epilepsy. British Journal of Anaesthesia 2012; 108: 562571.CrossRefGoogle ScholarPubMed
Selim, M.. Perioperative stroke. New England Journal of Medicine 2007; 356: 706713.CrossRefGoogle ScholarPubMed
Jorens, P., Van Marck, E., Snoeckx, A., and Parizel., P. Nonthrombotic pulmonary embolism. European Respiratory Journal 2009; 34: 452474.Google Scholar
Stansby, G. and Donald., I. Reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism in medical inpatients. Clinical Medicine 2019; 19: 100.CrossRefGoogle ScholarPubMed
Ruohoniemi, D. M., Sista, A. K., Doany, C. F., andHeerdt., P. M. Perioperative pulmonary thromboembolism: current concepts and treatment options. Current Opinion in Anaesthesiology 2018; 31: 7582.Google Scholar
Piazza, G. and Goldhaber., S. Z. Acute pulmonary embolism, part I: epidemiology and diagnosis. Circulation 2006; 114: e28e32.Google Scholar
Van Es, N., Kraaijpoel, N., Klok, F. A., et al. The original and simplified Wells rules and age‐adjusted D‐dimer testing to rule out pulmonary embolism: an individual patient data meta‐analysis. Journal of Thrombosis and Haemostasis 2017; 15: 678684.Google Scholar
Bĕlohlávek, J., Dytrych, V., and Linhart., A. Pulmonary embolism, part I: epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism. Experimental and Clinical Cardiology 2013; 18: 129.Google Scholar
Schulman, S., Konstantinides, S., Hu, Y., and Tang., L. V. Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. Observations on NICE guideline [NG158]. Thrombosis and Haemostasis 2020; 120: 11431146.Google Scholar
Kumar, V. A., Qaqi, O., Mclendon, C., et al. Ultrasound enhanced catheter directed thrombolysis for patients with massive and submassive pulmonary embolism presenting to the emergency department. Circulation 2016; 134(suppl._1): A17801.Google Scholar
Mellin‐Olsen, J., Fasting, S., and Gisvold., S. Routine preoperative gastric emptying is seldom indicated. A study of 85 594 anaesthetics with special focus on aspiration pneumonia. Acta Anaesthesiologica Scandinavica 1996; 40: 11841188.Google Scholar
Olsson, G., Hallen, B., and Hambraeus‐Jonzon., K. Aspiration during anaesthesia: a computer‐aided study of 185 358 anaesthetics. Acta Anaesthesiologica Scandinavica 1986; 30: 8492.Google Scholar
Warner, M. A., Warner, M. E., and Weber., J. G. Clinical significance of pulmonary aspiration during the perioperative period. Anesthesiology: The Journal of the American Society of Anesthesiologists 1993; 78: 5662.CrossRefGoogle ScholarPubMed
Robinson, M. and Davidson., A. Aspiration under anaesthesia: risk assessment and decision-making. Continuing Education in Anaesthesia Critical Care and Pain 2014; 14: 171175.CrossRefGoogle Scholar
Engelhardt, T. and Webster., N. Pulmonary aspiration of gastric contents in anaesthesia. British Journal of Anaesthesia 1999; 83: 453460.CrossRefGoogle ScholarPubMed
Marik, P. E.. Pulmonary aspiration syndromes. Current Opinion in Pulmonary Medicine 2011; 17: 148154.Google Scholar
Nason, K. S.. Acute intraoperative pulmonary aspiration. Thoracic Surgery Clinics 2015; 25: 301307.Google Scholar
Jenkins, K. and Baker., A. B. Consent and anaesthetic risk. Anaesthesia 2003; 58: 962984.Google Scholar
Mandell, L. A. and Niederman., M. S. Aspiration pneumonia. New England Journal of Medicine 2019; 380: 651663.Google Scholar
Bynum, L. J. and Pierce., A. K. Pulmonary aspiration of gastric contents. American Review of Respiratory Disease 1976; 114: 11291136.Google ScholarPubMed
Dragan, V., Wei, Y., Elligsen, M., et al. Prophylactic antimicrobial therapy for acute aspiration pneumonitis. Clinical Infectious Diseases 2018; 67: 513518.Google Scholar
Wolfe, J. E., Bone, R. C., and Ruth., W. E. Effects of corticosteroids in the treatment of patients with gastric aspiration. The American Journal of Medicine 1977; 63: 719722.CrossRefGoogle ScholarPubMed
Sukumaran, M., Granada, M., Berger, H., Lee, M., and Reilly., T. Evaluation of corticosteroid treatment in aspiration of gastric contents: a controlled clinical trial. The Mount Sinai Journal of Medicine 1980; 47: 335.Google Scholar
Yarmus, L. and Feller-Kopman., D. Pneumothorax in the critically ill patient. Chest 2012; 141: 10981105.CrossRefGoogle ScholarPubMed
Macduff, A., Arnold, A., and Harvey., J. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010; 65(suppl. 2): ii18ii31.Google Scholar
Sharma, A. and Jindal., P. Principles of diagnosis and management of traumatic pneumothorax. Journal of Emergencies, Trauma and Shock 2008; 1: 34.Google Scholar
Lee, T. H., Marcantonio, E. R., Mangione, C. M., et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999; 100: 10431049.Google Scholar
Thygesen, K., Alpert, J. S., Jaffe, A. S., et al. Fourth universal definition of myocardial infarction (2018). Journal of the American College of Cardiology 2018; 72: 22312264.Google Scholar
Ferry, A. V., Anand, A., Strachan, F. E., et al. Presenting symptoms in men and women diagnosed with myocardial infarction using sex‐specific criteria. Journal of the American Heart Association 2019; 8: e012307.Google Scholar
Landesberg, G., Beattie, W. S., Mosseri, M., Jaffe, A. S., and Alpert., J. S. Perioperative myocardial infarction. Circulation 2009; 119: 29362944.Google Scholar
Duceppe, E., Parlow, J., and Macdonald, P., et al. Canadian Cardiovascular Society guidelines on perioperative cardiac risk assessment and management for patients who undergo noncardiac surgery. Canadian Journal of Cardiology 2017; 33: 1732.Google Scholar
Fleisher, L. A., Fleischmann, K. E., Auerbach, A. D., et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130: e278e333.Google Scholar
De Hert, S., Staender, S., Fritsch, G., et al. Pre-operative evaluation of adults undergoing elective noncardiac surgery. European Journal of Anaesthesiology 2018; 35: 407465.Google Scholar
Carson, J. L., Guyatt, G., Heddle, N. M., et al. Clinical practice guidelines from the AABB: red blood cell transfusion thresholds and storage. Journal of the American Medical Association 2016; 316: 20252035.Google Scholar
Semler, M. W., Self, W. H., Wanderer, J. P., et al. Balanced crystalloids versus saline in critically ill adults. New England Journal of Medicine 2018; 378: 829839.Google Scholar
Self, W. H., Semler, M. W., Wanderer, J. P., et al. Balanced crystalloids versus saline in noncritically ill adults. New England Journal of Medicine 2018; 378: 819828.Google Scholar
Perel, P. and Roberts., I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database of Systematic Reviews 2012; 6: CD000567.Google Scholar
Alder, L. and Tambe, A.. Acute anemia. In Statpearls [Internet]. Treasure Island, FL: StatPearls Publishing, 2019.Google Scholar
Norfolk, D.. Transfusion management of major haemorrhage. In Norfolk, D. (ed.), Handbook of Transfusion Medicine, 5th ed. London: United Kingdom Blood Services, 2014, pp. 8287.Google Scholar
National Institute for Health and Care Excellence. Blood transfusion: NICE guideline NG24. Available from: www.nice.org.uk/guidance/ng24.Google Scholar
Singer, M., Deutschman, C. S., Seymour, C. W., et al. The Third International Consensus definitions for sepsis and septic shock (Sepsis-3). Journal of the American Medical Association 2016; 315: 801810.Google Scholar
Howell, M. D. and Davis., A. M. Management of sepsis and septic shock. Journal of the American Medical Association 2017; 317: 847848.CrossRefGoogle ScholarPubMed
Levy, M. M., Evans, L. E., and Rhodes., A. The Surviving Sepsis Campaign bundle: 2018 update. Intensive Care Medicine 2018; 44: 925928.Google Scholar
Ferrer, R., Martin-Loeches, I., Phillips, G., et al. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program. Critical Care Medicine 2014; 42: 17491755.Google Scholar
Liu, V. X., Fielding-Singh, V., Greene, J. D., et al. The timing of early antibiotics and hospital mortality in sepsis. American Journal of Respiratory and Critical Care Medicine 2017; 196: 856863.Google Scholar
Mouncey, P. R., Osborn, T. M., Power, G. S., et al. Trial of early, goal-directed resuscitation for septic shock. New England Journal of Medicine 2015; 372: 13011311.Google Scholar
Rivers, E., Nguyen, B., Havstad, S., et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. New England Journal of Medicine 2001; 345: 13681377.Google Scholar
Sethi, M., Owyang, C. G., Meyers, C., et al. Choice of resuscitative fluids and mortality in emergency department patients with sepsis. The American Journal of Emergency Medicine 2018; 36: 625629.Google Scholar
Vasu, T. S., Cavallazzi, R., Hirani, A., et al. Norepinephrine or dopamine for septic shock: systematic review of randomized clinical trials. Journal of Intensive Care Medicine 2012; 27: 172178.Google Scholar
De Backer, D., Aldecoa, H. Njimi, and J.-L. Vincent., Dopamine versus norepinephrine in the treatment of septic shock: a meta-analysis. Critical Care Medicine 2012; 40: 725730.Google Scholar
Guly, H., Bouamra, O., and Lecky., F. The incidence of neurogenic shock in patients with isolated spinal cord injury in the emergency department. Resuscitation 2008; 76: 5762.Google Scholar
Jensen, J. K., Poulsen, S. H., and Mølgaard., H. Cardiac tamponade: a clinical challenge. E-Journal of Cardiology Practice 2017; 15; 27 September.Google Scholar
Lindman, B. R., Bonow, R. O., and Otto., C. M. Current management of calcific aortic stenosis. Circulation Research 2013; 113: 223237.Google Scholar
Lindman, B. R., Clavel, M.-A., Mathieu, P., et al. Calcific aortic stenosis. Nature Reviews Disease Primers 2016; 2: 128.Google Scholar
Christ, M., Sharkova, Y., Geldner, G., and Maisch., B. Preoperative and perioperative care for patients with suspected or established aortic stenosis facing noncardiac surgery. Chest 2005; 128: 29442953.Google Scholar
Mittnacht, A. J., Fanshawe, M., and Konstadt., S. Anesthetic considerations in the patient with valvular heart disease undergoing noncardiac surgery. Seminars in Cardiothoracic and Vascular Anesthesia 2008; 12: 3359.Google Scholar
Vahanian, A., Alfieri, O., Andreotti, F, et al. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal 2012; 33: 24512496.Google Scholar
Kristensen, S. D. Knuuti, J., Saraste, A, et al. ESC/ESA guidelines on non-cardiac surgery – cardiovascular assessment and management. The Joint Task Force on Non-Cardiac Surgery: Cardiovascular Assessment and Management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). European Heart Journal 2014; 35: 23832431.Google Scholar
Brown, J. and Morgan-Hughes., N. J. Aortic stenosis and non-cardiac surgery. Continuing Education in Anaesthesia Critical Care and Pain 2005; 5: 14.Google Scholar
Van Diepen, S., Katz, J. N., Albert, N. M., et al. Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association. Circulation 2017; 136: e232–e268.Google Scholar
Doust, J., Lehman, R., and Glasziou., P. The role of BNP testing in heart failure. American Family Physician 2006; 74: 18931898.Google Scholar
Korenstein, D., Wisnivesky, J. P., Wyer, P., et al. The utility of B-type natriuretic peptide in the diagnosis of heart failure in the emergency department: a systematic review. BMC Emergency Medicine 2007; 7: 19.Google Scholar
Squara, P., Hollenberg, S., and Payen., D. Reconsidering vasopressors for cardiogenic shock: everything should be made as simple as possible, but not simpler. Chest 2019; 156: 392401.Google Scholar
Vahdatpour, C., Collins, D., and Goldberg., S. Cardiogenic shock. Journal of the American Heart Association 2019; 8: e011991.Google Scholar
Levy, B., Buzon, J., and Kimmoun., A. Inotropes and vasopressors use in cardiogenic shock: when, which and how much? Current Opinion in Critical Care 2019; 25: 384390.Google Scholar
Joint British Diabetes Societies Inpatient Care Group. The Management of Diabetic Ketoacidosis in Adults, 2nd ed. London: Joint British Diabetes Societies Inpatient Care Group for NHS Diabetes, 2014.Google Scholar
Kitabchi, A. E., Umpierrez, G. E., Miles, J. M., and Fisher., J. N. Hyperglycemic crises in adult patients with diabetes. Diabetes Care 2009; 32: 13351343.Google Scholar
Burge, M. R., Hardy, K. J., and Schade., D. S. Short-term fasting is a mechanism for the development of euglycemic ketoacidosis during periods of insulin deficiency. The Journal of Clinical Endocrinology and Metabolism 1993; 76: 11921198.Google Scholar
Qiu, H., Novikov, A., and Vallon., V. Ketosis and diabetic ketoacidosis in response to SGLT2 inhibitors: basic mechanisms and therapeutic perspectives. Diabetes/Metabolism Research and Reviews 2017; 33: e2886.Google Scholar
Kohler, K. and Levy., N. Management of diabetic ketoacidosis: a summary of the 2013 Joint British Diabetes Societies guidelines. Journal of the Intensive Care Society 2014; 15: 222225.Google Scholar
National Institute for Health and Care Excellence. Diabetic ketoacidosis: management. Available from: www.nice.org.uk/guidance/ng17/ifp/chapter/diabetic-ketoacidosis.Google Scholar
Stanisstreet, D., Walden, E., and Graveling., A. The Hospital Management of Hypoglycaemia in Adults with Diabetes Mellitus.. London: Joint British Diabetes Societies Inpatient Care Group for NHS Diabetes, 2018.Google Scholar
Boucai, L., Southern, W. N., and Zonszein., J. Hypoglycemia-associated mortality is not drug-associated but linked to comorbidities. The American Journal of Medicine 2011; 124: 10281035.Google Scholar
Drews III, H. L., Castiglione, A. L., Brentin, S. N., et al. Perioperative hypoglycemia in patients with diabetes: incidence after low normal fasting preoperative blood glucose versus after hyperglycemia treated with insulin. AANA Journal 2012; 80: S17S24.Google Scholar
Turchin, A., Matheny, M. E., Shubina, M., et al. Hypoglycemia and clinical outcomes in patients with diabetes hospitalized in the general ward. Diabetes Care 2009; 32: 11531157.Google Scholar
Curkendall, S., Natoli, J., Alexander, C., et al. Economic and clinical impact of inpatient diabetic hypoglycemia. Endocrine Practice 2009; 15: 302312.Google Scholar
Finfer, S., Chittock, D. R, Su, S. Y-S., et al. Intensive versus conventional glucose control in critically ill patients. New England Journal of Medicine 2009; 360: 12831297.Google Scholar
American Diabetes Association. Defining and reporting hypoglycemia in diabetes: a report from the American Diabetes Association Workgroup on Hypoglycemia. Diabetes Care 2005; 28: 12451249.Google Scholar
Hulkower, R. D., Pollack, R. M., and Zonszein., J. Understanding hypoglycemia in hospitalized patients. Diabetes Management 2014; 4: 165.Google Scholar
Triplitt, C. L.. Examining the mechanisms of glucose regulation. American Journal of Managed Care 2012; 18: S4.Google Scholar
Sreedharan, R. and Abdelmalak., B. Diabetes mellitus: preoperative concerns and evaluation. Anesthesiology Clinics 2018; 36: 581597.Google Scholar
Gando, S., Levi, M., and Toh., C.-H. Disseminated intravascular coagulation. Nature Reviews Disease Primers 2016; 2: 116.Google Scholar
Levi, M., Toh, C., Thachil, J., and Watson., H. Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Journal of Haematology 2009; 145: 2433.Google Scholar
Taylor, F. B., Toh, C.-H., Hoots, W. K., Wada, H., and Levi., M. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thrombosis and Haemostasis 2001; 86: 13271330.Google Scholar
Wada, H., Thachil, J., Di, M. N., et al. Guidance for diagnosis and treatment of DIC from harmonization of the recommendations from three guidelines. Journal of Thrombosis and Haemostasis 2013; Feb 4; DOI 10.1111/jth.12155.Google Scholar
Squizzato, A., Hunt, B. J., Kinasewitz, G. T., et al. Supportive management strategies for disseminated intravascular coagulation. Thrombosis and Haemostasis 2016; 116: 896904.Google Scholar
Gando, S., Sawamura, A., and Hayakawa., M. Trauma, shock, and disseminated intravascular coagulation: lessons from the classical literature. Annals of Surgery 2011; 254: 1019.Google Scholar
Gould, M. K., Garcia, D. A., Wren, S. M., et al. Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012; 141: e227Se277S.Google Scholar
Wada, H., Matsumoto, T., and Yamashita., Y. Diagnosis and treatment of disseminated intravascular coagulation (DIC) according to four DIC guidelines. Journal of Intensive Care 2014; 2: 15.Google Scholar
Martí‐Carvajal, A. J., Anand, V., and Sola., I. Treatment for disseminated intravascular coagulation in patients with acute and chronic leukemia. Cochrane Database of Systematic Reviews 2015; 6: CD008562.Google Scholar
Martí‐Carvajal, A. J., Comunián‐Carrasco, G., and Peña‐Martí., G. E. Haematological interventions for treating disseminated intravascular coagulation during pregnancy and postpartum. Cochrane Database of Systematic Reviews 2011; 3: CD00857.Google Scholar
Delaney, M., Wendel, S., Bercovitz, R. S., et al. Transfusion reactions: prevention, diagnosis, and treatment. The Lancet 2016; 388: 28252836.Google Scholar
Tinegate, H., Birchall, J., Gray, A., et al. BCSH Blood Transfusion Task Force. Guideline on the investigation and management of acute transfusion reactions. British Journal of Haematology 2012; 159: 143153.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×