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SHOCK RESUSCITATION Immediate resuscitation manoeuvres for patients presenting in - shock are to ensure a patent airway and adequate oxygenation and ventilation. Once ‘airway’ and ‘breathing’ are assessed and - controlled, attention is directed to cardiovasc...

SHOCK Shock is a systemic state of low tissue perfusion that is inade quate for normal cellular respiration. With insu ffi cient delivery of oxygen and glucose, cells switch from aerobic to anaerobic metabolism. If perfusion is not restored in a timely fashio...

TRANSFUSION The transfusion of blood and blood products has become commonplace since the first successful transfusion in 1818. Although the incidence of severe transfusion reactions and infections is now very low , in recent years it has become - apparent tha...

Transfusion reactions If antibodies present in the recipient’s serum are incompatible with the donor’s cells, a transfusion reaction will result. This usually takes the form of an acute haemolytic reaction. Severe immune-related transfusion reactions due to ...

Vasopressor and inotropic support Vasopressor or inotropic therapy is not indicated as first-line therapy in hypovolaemia. Administration of these agents in the absence of adequate preload rapidly leads to decreased coro nary perfusion and depletion of myocar...

Antenatal fetal hydronephrosis Hydronephrosis /uni00A0 – /uni00A0 a dilated renal pelvis /uni00A0 – /uni00A0 is found in 1% of - antenatal scans and most commonly it resolves, especially if the dilatation is mild to moderate. Severe dilatation is asso - ciated...

DISORDERS OR DIFFERENCES IN SEX DIFFERENTIATION Some, but not all, children with abnormalities of their sex chromosomes, gonads or reproductive anatomy are consid ered to have a disorder or di ff erence in sex di ff erentiation (DSD). Isolated undescended teste...

EMBRYOLOGY Four areas of developmental biology are relevant: (i) the two stages of testicular descent; (ii) the Weigert–Meyer rule a duplex system the ectopic upper pole ureter has an orifice lying inferomedial to the lower pole ureter; (iii) the role of the ...

Epispadias/bladder exstrophy Epispadias is a rare dorsal penile defect with an opening whose upper limit lies anywhere from the penopubic junction to the glans ( Figure 20.3 ). Epispadias may be part of the bladder exstrophy–epispadias complex in which the bl...