Acute Liver Failure

28
Acute liver Failure David Anderson Advanced Trainee in Intensive Care Medicine Advanced Trainee in Palliative Medicine

description

Presentation on Acute Liver Failure from Bedside Critical Care conference, Cairns 2013.

Transcript of Acute Liver Failure

Page 1: Acute Liver Failure

Acuteliver

Failure

David AndersonAdvanced Trainee in Intensive Care MedicineAdvanced Trainee in Palliative Medicine

Page 2: Acute Liver Failure
Page 5: Acute Liver Failure
Page 7: Acute Liver Failure

Case

Page 8: Acute Liver Failure
Page 9: Acute Liver Failure

Jaundice

DefinitionEncephalopat

hy

A short time after the onset of

Coagulopathyhttp://www.capitalpath.com.au/about-us/laboratory-

information.aspx

http://patient.co.uk

Encephalopathy

Page 10: Acute Liver Failure

?Aetiology

http://herron.com.auhttp://giantmicrobes.comhttp://onlinepillspro.comhttp://en.wikipedia.orghttp://indyprops.com

Page 11: Acute Liver Failure

Call for Help

http://8774e4voip.com/blog/polycom-soundpoint-ip-bat-phone/

Page 12: Acute Liver Failure

Full Blood Count

Biochemistry

LFTs

Coags (incl fibrinogen)

Group and Screen

Blood Gas (with Lactate)

Paracetamol Level

Viral Hepatitis Serologybeta HCG*

Ammonia

Autoimmune Screen

HIV

Amylase/Lipase

Send Labs

http://www.npsg.uwaterloo.ca/people/daniel/rendering/

Page 13: Acute Liver Failure

Give NAC

http://nutralife.com

Page 14: Acute Liver Failure

ICU Housekeeping

http://allposters.com.au

http://mooselicker.wordpress.com/2012/09/24/continuations/

Page 15: Acute Liver Failure

Early Vascular Access

http://medgadget.com

Page 16: Acute Liver Failure

Haemodynamics

http://lcars47.comhttp://

transfusion.com.auhttp://hospira.com

http://indiamart.comhttp://healthfirst.com

Page 17: Acute Liver Failure

Encephalopathy

http://www.urmc.rochester.edu/hslt/courses/neuroslides/lab2a/slide063.cfm

Page 18: Acute Liver Failure

Encephalopathy

?http://valleyvet.com

http://nursingcrib.comhttp://hexal-elements.de

Page 19: Acute Liver Failure

Start CRRT Early

http://gambro.com

Page 20: Acute Liver Failure

Ammonia

http://www.luckymojo.com/ammonia.html

Page 21: Acute Liver Failure

Coagulation

http://varnerlab.org

Page 22: Acute Liver Failure

TEG

Patton et al, 2012http://www.aacc.org/publications/cln/2011/April/Pages/PlateletFunction.aspx

Page 23: Acute Liver Failure

Microbiology

http://giantmicrobes.com

Page 24: Acute Liver Failure

Transplant

http://liverfoundation.org.au

Page 25: Acute Liver Failure

Cholongitas et al, 2012

Prognosis

Page 26: Acute Liver Failure

Palliative Care

Page 27: Acute Liver Failure

Extracorporeal Support?

Page 28: Acute Liver Failure

Summary

@expensivecarehttp://expensivecare.com/2013/08/25/alf