New insights into the pathophysiology of aspiration pneumonia.
نویسندگان
چکیده
and emphasizes the need for careful history taking. As outlined in our editorial, there are several congenital bleeding disorders, including mild VWD, which may present with a completely normal coagulation screen and therefore may be missed unless a very careful history and clinical assessment is undertaken. As there actually was a clear personal and family history of bleeding in this case that would have led to coagulation testing if the patient had been aware of it, one has to ask if routine testing to identify an extremely small number of cases whereby the patient is unaware of the history is warranted, given the large number of tests needed. It also highlights the importance of how questions are asked, as members of families unaware of the symptoms of mild bleeding disorders may consider pronged bleeding after minor trauma or procedures such as cuts or dental extraction as ‘normal’. Specific questioning about duration of bleeding after minor trauma or procedures can clarify this. By and large, both the BCSH guidelines and NICE guidance reflect the uncertainties about establishing a bleeding tendency but also agree that a perioperative coagulation screen in most instances should not be performed routinely. Although one could make a better case for routine testing in patients awaiting surgery with a high bleeding risk, the arguments regarding poor sensitivity and specificity of these tests remain. In conclusion, we do not claim that history taking will entirely solve the problem of preoperative coagulation status but that it is more rational than relying on routine coagulation testing in unselected patients.
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عنوان ژورنال:
- British journal of anaesthesia
دوره 106 4 شماره
صفحات -
تاریخ انتشار 2011