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The composition of the fluid used to prime cardiopulmonary bypass (CPB) circuits has been a source of great interest and debate ever since the inception of cardiopulmonary bypass in 1953. There has been significant progress in our understanding, but the ideal priming solution has still to be agreed upon and practice continues to vary widely between cardiac units. Circuits must be carefully de-aired with a compatible priming solution in order to prevent gas emboli from passing into the patient’s circulation at the commencement of CPB. Crystalloid and colloid priming solutions are now commonplace.
This chapter discusses the diagnosis, evaluation and management of rhabdomyolysis. Physical examination of a patient with rhabdomyolysis may reveal muscle swelling and tenderness, with occasional skin changes including discoloration, induration, and blistering. It is possible for rhabdomyolysis to present without any of these signs or symptoms, making serum markers essential to the diagnosis. Severe cases may present with hypovolemic shock, acute kidney injury (AKI), metabolic acidosis, disseminated intravascular coagulation (DIC), compartment syndrome, hyperkalemia, and cardiac arrhythmias. Compartment syndrome occurs due to swelling and edema of the injured muscle: classic physical examination findings include pain, paresthesias, paralysis, pallor, and pulselessness. The cornerstone of management includes discontinuation of inciting factors and aggressive management of fluid and electrolyte abnormalities. Intravenous fluids enhance renal perfusion and increase urinary flow in order to prevent AKI and increase potassium excretion.
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