isotonic dehydrationoccurs when the fluid lost is isotonic with serum, as in sweating, simple enteritis, nephrosis. There are therefore no errors of electrolyte balance likely to result.The concentration of sodium is in the normal range.hypotonic dehydrationoccurs when there is loss of both sodium and fluid .The serum sodium level falls below 135mmol/L and the osmotic pressure of extracellular fluid is lower than normal. hypertonic dehydrationA condition caused by the excessive loss of water from the body，which there is less electrolyte loss than water.The serum sodium level is over 135mmol/L and the osmotic pressure of extracellular fluid is lower than normal.water intoxication/dilutional hyponatremia an increase in the volume of free water in the body. Common causes are excessive ingestion of water, increased infusions of hypotonic IV solutions, or excess secretions of antidiuretic hormone(ADH). Clinical manifestations are abdominal cramps, nausea, vomiting, lethargy, and dizziness. It can potentially lead to convulsions and coma.hypokalemiaan abnormally low serum potassium level(<3.5mmol/L). Hypokalemia may occur in metabolic alkalosis, chronic diarrhea, Cushing syndrome, primary aldosteronism, and excessive use of cortisone, or ACTH. hyperkalemiaabnormally high potassium concentration in the blood(above 5.5mmol/L), most often due to defective renal excretion, as in kidney disease, severe and extensive burns, intestinal obstruction, diabetes mellitus, acute renal failure and hypoadrenocorticism.metabolic acidosisDecreased pH(below 7.35) and bicarbonate concentration of the body fluids caused either by the accumulation of excess acids stronger than carbonic acid or by abnormal losses of bicarbonate from the body.metabolic alkalosisAn increase in the alkalinity of body fluids due to an increase in alkali intake or a decrease in acid concentration, as from vomiting. pH is over 7.45.respiratory acidosisAcidosis that is caused by retention of carbon dioxide, due to inadequate pulmonary ventilation or hypoventilation, and that results in a decrease in blood pH unless compensated for by renal retention of bicarbonate. respiratory alkalosisan abnormal condition characterized by a high plasma pH(over 7.45) resulting from increased alveolar ventilation. The consequent acceleration of carbon dioxide excretion lowers the plasma level of carbonic acid, thus raising plasma pH. The hyperventilation may be caused by pulmonary and nonpulmonary problems. Some pulmonary causes are acute asthma, pulmonary vascular disease, and pneumonia. Some nonpulmonary causes are aspirin toxicity, anxiety, fever etc.acepsisthe exclusion of all microorganisms before they can enter an open surgical wound or contaminate a sterile field during surgery sterilizationthe process of destroying all microorganisms and their pathogenic products. It is accomplished by heat (wet steam or dry heat ) or by bactericidal chemical compounds. disinfectionThe process or act of destroying pathogenic microorganisms. However, certain bacterial spores may survive and germinate which could lead to contamination.blood transfusionthe administration of whole blood or a component, such as packed red cells, to replace blood lost through trauma, surgery, or disease,in order to supplement blood volume, improve circulatory function and oxygen-carrying ability, increase the plasma protein and enhance immunity and coagulation function.hematocrit HCTa measure of the packed cell volume of red cells, expressed as a percentage of the total blood volume. The normal range is between 43% and 49% in men and between 37% and 43% in women.tansfusion reactiona group of clinical signs due to antibody in the recipient's blood reacting with the transfused red blood cells when blood for transfusion is incorrectly matched, or when the recipient has an adverse reaction to some element of the donor blood.SIRSan inflammatory state affecting the whole body, frequently a response of the immune system to infection, but not necessarily so. It is related to sepsis, a condition in which individuals both meet criteria for SIRS and have a known or highly suspected infection. Temperature < 36oC or > 38oCHeart rate > 90 beats/minRespiratory rate pCO2 < 32 mm Hg or > 20 breaths/minWBC count < 4 x 109 or > 12 x 109 or , or the presence of > 0.10 immature neutrophils transfusion-related acute lung injury TRALIa syndrome seen in persons receiving transfusions, characterized by pulmonary edema, dyspnea, hypoxemia, hypotension, and fever; it is thought to be a reaction to antibodies or other components of the donor blood product. Patients need oxygen support, and in some cases the syndrome can be fatal. transfusion associated graft versus host diseaseis a rare complication of blood transfusion, in which the donor T lymphocytes mount an immune response against the recipient's lymphoid tissue. Donor lymphocytes are usually identified as foreign and destroyed by the recipient's immune system. However, in situations where the recipient is immunocompromised, or when the donor is homozygous and the recipient is heterozygous for an HLA haplotype , the recipient's immune system is not able to destroy the donor lymphocytes. This can result in graft versus host disease.autologous blood transfusion/autotransfusionInfusion of blood or blood products into the individual from whom they were originally withdrawn.fresh frozen plasma FFPan unconcentrated form of blood plasma containing all of the clotting factors except platelets. It can be used to supplement red blood cells when whole blood is not available for exchange transfusion or to correct ableeding problem of unknown cause. It is also used to correct disseminated intravascular coagulation.fresh plasma FPa form of blood plasma which is obtained after FFP is melted at 4℃and cryoprecipitate is removed.cryoprecipitate CryoA product derived from a unit of whole blood, which has a volume of 15 ml and provides 80 units of factor VIII:C procoagulant–for hemophilia A, factor VIII:vWF–von Willebrand's disease, factor XIII, fibronectin, fibrinogen–for DIC, dysfibrinogenemia.It is the unmelted element of FFP under 4℃. plasma substitute/plasma volume expander a substance that can be transfused to maintain fluid volume of the blood in event of great necessity, supplemental to the use of whole blood and plasma. Called also artificial plasma extender.shockShock is a medical emergency in which the organs and tissues of the body are not receiving an adequate flow of blood. This deprives the organs and tissues of oxygen (carried in the blood) and allows the buildup of waste products.Causal factors include hemorrhage, vomiting, diarrhea, inadequate fluid intake, or excessive fluid loss, resulting in hypovolemia. Shock can result in serious damage or even death.hypovolemic shockThis is a common type that happens when blood or plasma is lost in such quantities that the remaining blood cannot fill the circulatory system despite constriction of the blood vessels. The blood loss may be external, as when a vessel is severed by an injury, or the blood may be “lost” into spaces inside the body where it is no longer accessible to the circulatory system, as in severe gastrointestinal bleeding from ulcers, fractures of large bones with hemorrhage into surrounding tissues, or major burns that attract large quantities of blood fluids to the burn site outside blood vessels and capillaries. hemorrhagic shockHypovolemic shock resulting from acute hemorrhage and characterized by hypotension, tachycardia, oliguria, and by pale, cold, and clammy skin.traumatic shockrefers to shock following physical trauma, with hemorrhage, peripheral blood vessel dilation, and changes in capillary permeability. septic shockshock associated with overwhelming infection, usually by gram-negative bacteria, although it may be produced by other bacteria, viruses, fungi, and protozoa. It is thought to result from the action of endotoxins or other products of the infectious agent.warm shockreferring to a stage in early septic shock, which is characterised by increased cardiac output, arterial and arteriolar dilatation, decreased peripheral arterial resistance, increased peripheral perfusion, no fluid losses and third spacing and minimal catecholamine effectMODSthe presence of altered organ function in acutely ill patients such that homeostasis cannot be maintained without intervention. It usually involves two or more organ systems. CVP the pressure of blood in the right atrium. Measurement of central venous pressure is made possible by the insertion of a catheter through the median cubital vein to the superior vena cava.The normal range for CVP is 0 to 5 mm H2O. A reading of 15 to 20 mm usually indicates inability of the right atrium to accommodate the current blood volume PCWPAn indirect indication of left atrial pressure obtained by wedging a catheter into a small pulmonary artery tightly enough to block flow from behind and thus to sample the pressure beyond.CO cardiac outputthe effective volume of blood expelled by either ventricle of the heart per unit of time (usually per minute).It is equal to the stroke volume multiplied by the heart rate. Normal values are 4 to 6 liters per minute.CI cardiac indexcardiac output per unit time divided by body surface area.Its normal range in a healthy adult is 2.5 to 3.5 L/min/m2.CAISa complex pattern of immunologic responses to severe infection or injury. CARS is a global deactivation of the immune system tasked with restoring homeostasis.ARF acute renal failurerenal failure of sudden onset, such as from physical trauma, infection, inflammation, or toxicity. Symptoms include uremia and usually oliguria or anuria, with hyperkalemia and pulmonary edema. Three types are distinguished: prerenal, intrarenal, and postrenal.ARDS acute respiratory ditress syndrome is a lung condition that leads to low oxygen levels in the blood. ARDS can be life threatening. This is because body's organs, such as the kidneys and brain, need oxygen-rich blood to work properly.ARDS usually occurs in people who are very ill with another disease or who have major injuries. acute gastrointestinal dysfunctionis an acute gastrointestinal pathological condition with gastrointestinal mucosa damage, motor and barrier dysfunction.See in trauma, burn, shock etc.oliguriaa diminished capacity to form and pass urine-less than 400 mL in every 24 hours-so that the end products of metabolism cannot be excreted efficiently. It is usually caused by imbalances in body fluids and electrolytes, renal lesions, or urinary tract obstruction. anuriathe absence of urine production or a urinary output of less than 100 mL per day. Anuria may be caused by a failure or kidney dysfunction, a decline in blood pressure below that required to maintain filtration pressure in the kidney, or an obstruction in the urinary passages.azotemiaretention of excessive amounts of nitrogenous compounds in the blood. This toxic condition is caused by failure of the kidneys to remove urea from the blood and is characteristic of uremia.uremiathe presence of excessive amounts of urea and other nitrogenous waste products in the blood, as occurs in renal failure.Manifestations include weakness, headache, confusion, vomiting, and coma, and in terminal chronicrenal disease, purpura and epistaxis may be present. Uremia is caused by insufficient urinary excretion for any reason.VILL ventilator-induced lung injury Ventilator induced lung injury occurs when the lung is directly damaged by the action of mechanical ventilation, mainly volutrauma. AHF acute hepatic failurethe appearance of severe complications rapidly after the first signs of liver disease (such as jaundice), and indicates that the liver has sustained severe damage (loss of function of 80-90% of liver cells). The complications are hepatic encephalopathy and impaired protein synthesis.stress ulcerStress ulcers are single or multiple mucosal defects which can become complicated by upper gastrointestinal bleeding during the physiologic stress of serious illness. stress ulcers are found commonly in fundic mucosa and can be located anywhere within the stomach and proximal duodenum. anesthesiathe condition of having sensation (including the feeling of pain) blocked or temporarily taken away. It is a pharmacologically induced and reversible state of amnesia, analgesia, loss of responsiveness, loss of skeletal muscle reflexes or decreased stress response, or all simultaneously. This allows patients to undergo surgery and other procedures without the distress and pain they would otherwise experience.inhalation anestheticsAn inhalational anaesthetic is a chemical compound possessing general anaesthetic properties that can be delivered via inhalation. Agents of significant contemporary clinical interest include volatile anaesthetic agents such as isoflurane, sevoflurane and desflurane, as well as certain anaesthetic gases such as nitrous oxide.MAC minimum alveolar concentrationThe MAC is the concentration of the vapour (measured as a percentage at 1 atmosphere, i.e the partial pressure) that prevents the reaction to a standard surgical stimulus (traditionally a set depth and width of skin incisions) in 50% of subjects. This measurement is done at steady state (assuming a constant alveolar concentration for 15 minutes), under the assumption that this allows for an equilibration between the gasses in the alveoli, the blood and the brain. MAC is accepted as a valid measure of potency of inhalational general anaesthetics because it remains fairly constant for a given species even under varying conditions.blood/gas partition coefficientthe ratio of concentrations of anesthetics in the blood and gas at equilibrium. it is used to discribe the dissolved quantity of one anesthetics in unit volume of blood. intravenous anestheticsAn agent that produces anesthesia when injected into the bloodstream via venipuncture. Very often, this term is used to refer to general anesthesia, frequently required during surgery to promote total unconsciousness of a patient. muscle relaxantsSkeletal muscle relaxants are drugs that relax striated muscles (those that control the skeleton). They are a separate class of drugs from the muscle relaxant drugs used during intubations and surgery to reduce the need for anesthesia and facilitate intubation. combined anesthesia/balanced anesthesiaa highly variable technique of general anesthesia using narcotic analgesics, muscle relaxation, and minimal inhalation agent and nitrous oxide to render the patient unconscious.this can summate the advantages but not the disadvantages of the individual components of the mixture.local anesthesiaLocal or regional anesthesia involves the injection or application of an anesthetic drug to a specific area of the body, as opposed to the entire body and brain as occurs during general anesthesia.hypersusceptibilitya condition of abnormal susceptibility to poisons, infective agents, or agents that are entirely innocuous in the normal individual surface anesthesialoss of feeling or sensation. Artificial anesthesia may be produced by a number of agents capable of bringing about partial or complete loss of sensation. It is induced to permit the performance of surgery or other painful procedures.nerve blockregional anesthesia by injection of anesthetics close to the appropriate nerve.spinal blockregional anesthesia by injection of a local anesthetic into the subarachnoid space around the spinal cord.epidural blockthat produced by injection of the anesthetic into the extradural space, either between the vertebral spines or into the sacral hiatustotal spinal anesthesiaspinal anesthesia extensive enough to produce loss of sensation in all extracranial sensory roots.caudal blockanesthesia by injection of local anesthetic into the caudal or sacral canal.controlled hypotensionThe deliberate acute reduction of arterial blood pressure to reduce blood loss during surgery, either by pharmacological means or by presurgical withdrawal of blood which is returned to the circulation postsurgically hypothermiaa potentially fatal condition, occurs when body temperature falls below 95°F (35°C). EEC extracorporeal circulation or CPB cardiopulmonary bypassa technique that temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the body.intensive care unit (ICU)a hospital unit in which is concentrated special equipment and specially trained personnel for the care of seriously ill patients requiring immediate and continuous attention . resuscitationrevival methods that maintain vital signs for a person in cardiac or respiratory failure. Cardiac massage and artificial respiration techniques are employed, and fluid and acid-base imbalances are corrected. Cardiopulmonary cerebral resuscitation (CPCR),a basic emergency procedure for life support, consisting of artificial respiration and manual external cardiac massage. It is used in cases of cardiac arrest to establish effective circulation and ventilation in order to prevent irreversible cerebral damage resulting from anoxia andreestablish of heart and lung action.basic life support (BLS),fundamental emergency treatment consisting of cardiopulmonary resuscitation (CPR) or emergency cardiac care (ECC) that is provided until more precise medical treatment can begin.advanced life support (ALS),a higher level of emergency medical care, usually provided by EMT-intermediates or paramedics. Typically ALS includes invasive techniques such as IV therapy, intubation, and/or drug administration.cerebral resuscitationtreatment to counteract the cerebral edema resulting from low cerebral blood flow and hypoxia that occurs during cardiopulmonary resuscitationcardiopulmonary resuscitation (CPR)the reestablishing of heart and lung action after cardiac arrest or apparent sudden death resulting from electric shock, drowning, respiratory arrest, and other causes. The two major components of CPR are artificial ventilation and closed chest cardiac massage. electro-mechanical dissociation Persistence of electrical activity in the heart without an associated mechanical contraction; it is often a sign of cardiac rupture.oxygen therapysupplemental oxygen administered for the purpose of relieving hypoxemia and preventing damage to the tissue cells as a result of oxygen lack (hypoxia). perioperative periodrelating to the period of time surrounding a surgical procedure, including the preoperative, intraoperative, and postoperative periods. emergency surgeryA surgical procedure that cannot be delayed, for which there is no alternative therapy or surgeon, and for which a delay could result in death or permanent impairment of health Examples extensive burns, urinary obstruction, intestinal obstructionlimited surgeryis the time to operate surgery is not urgent, but limited to a certain extent.such as tumor radical surgery.seromaA seroma is a pocket of clear serous fluid that sometimes develops in the body after surgery. selective/elective surgeryis surgery that is scheduled in advance because it does not involve a medical emergency.such as cosmetic surgery. Surgical infectionThe infection which needs surgical treatment ,including the infection caused by the complications of trauma ,burn,et.enteral nutrition ENthe provision of nutrients through the GI tract when the client cannot ingest, chew, or swallow food but can digest and absorb nutrients.parenteral nutrition,a technique for meeting a patient's nutritional needs by means of intravenous feedings.The parenteral fluid usually consists of physiologic saline with glucose, amino acids, electrolytes, vitamins, and medications, which are not nutritionally complete but maintain fluid and electrolyte balance.TPN total parenteral nutrition intravenous administration, via a central venous catheter, of the total nutrient requirements of a patient with gastrointestinal dysfunction.bacteria translocation BTIn some cases, the bacteria in the digestive tract, called the intestinal flora, can cause a severe infection if they move into the bloodstream. This process, called bacterial translocation, is most likely to occur during surgery on the digestive tract.conditionally essential amino acidsome of the NEAAs have a low efficiency of synthesis, so it sometimes needs extra supplement to meet a large demand.such as Gln.surgical infection;enterogenic infection; enterogenous infection;gut original infectionduring sever burns, there is often gastrointestinal mucosa damage, motor and barrier dysfunction, thus intestinal pathogenic bacteria and its endotoxin have chance to cause systemic infection through bacteria translocation.hospital-acquired infection/nosocomial infectionsis usually one that first appears three days after a patient is admitted to a hospital or other health care facility. Hospital-acquired infections can be caused by bacteria, viruses, fungi, or parasites. These microorganisms may already be present in the patient's body or may come from the environment, contaminated hospital equipment, health care workers, or other patients.opportunistic infectionis an infection caused by pathogens (bacterial, viral, fungal or protozoan) that usually do not cause disease in a healthy host, i.e. one with a healthy immune system. A compromised immune system, however, presents an "opportunity" for the pathogen to infect. furunclea painful nodule formed in the skin by circumscribed inflammation of the dermis and subcutaneous tissue, enclosing a central slough or “core”; due to staphylococci entering the skin through hair follicles. SepsisSepsis refers to a bacterial infection in the bloodstream or body tissues. This is a very broad term covering the presence of many types of microscopic disease-causing organisms.BacteremiaBacteremia is an invasion of the bloodstream by bacteria.traumaany physical or emotional injury due to sudden or violent action, exposure to dangerous toxins or profound shock.burninjury to tissues caused by the contact with heat, flame, chemicals, electricity, or radiation. First degree burns show redness; second degree burns show vesication; third degree burns show necrosis through the entire skin. Burns of the first and second degree are partial-thickness burns, those of the third degree are full-thickness burns.inhalation injurydamage to the pulmonary parenchyma caused by inhalation of substances such as very hot air, toxic gas, asbestos, and chemical products of plastic manufacture.cold injuryany of several abnormal and often serious physical conditions caused by exposure to low ambient temperatures.TumorAn abnormal growth of tissue resulting from uncontrolled, progressive multiplication of cellsborderline tumoris a kind of tumor without a clear diagnosis of benign or malignant, namely its histology manifestation and biology behavior lie between benign and maligancy. transplantationthe transfer of living organs or tissue from one part of the body to another or from one individual to another.microsurgerySurgery on minute body structures or cells performed with the aid of a microscope and other specialized instruments, such as a micromanipulator.。