481

Chapter 9

Post-operative care

Post-operative treatment of injuries 482

Physiotherapy 486Rehabilitation 488The future 490

Chapter 10Chapter 11

Post-operative care

482

Post-operative treatmentof injuries

Upper limb

Elevation of the limb either by a 'roller towel' or on pillowsfor at least 3 days post-operatively. Outpatients should havethe arm elevated in a sling. The patient should move thefingers, elbow and shoulder as much as possible. Check the fingers regularly for appearance, warmth,movement, ability to straighten the fingers, swelling andsensation, disturbing the patient if necessary. The plastershould be checked for pressure. If the circulation is in doubt, the plaster should be split orloosened immediately. In supracondylar fractures the elbowshould be extended and the patient treated as an emergency(see pages 243 and 324).

Lower limb

Elevation of the limb in major cases, either by bed blocks,or pillows, for at least 1 - 3 days post-operatively. The patientshould move the toes frequently. In acute cases, plasters should be either well padded andsplit, or a padded plaster slab and bandage used instead of acomplete plaster. On the evening of operation, it is important to checkswelling, colour, warmth, sensation and movement of toes,disturbing the patient if necessary. Plaster should be trimmedif rough areas are causing pressure. If there is any doubt as to the circulation the plaster shouldbe split and loosened down to the skin for its whole lengthand opened out.

483

Post-operative careObservation of circulation and patient

} 1/2Hourly Appearance, warmth and pulsesMovement and sensationSwelling and plaster pressure{} Carefulobservation{ChestAbdomenShock and haemorrrhage

Split plaster(if in doubt)

After splitting plaster, put wool ingap and crepe bandage

Split whole lengthdown to skin itself Open out well

Increase elevation Encouragemovements

of fingers and toes

Post-operative care

Patient'sgeneralcondition

Fingersandtoes

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484

Instructions for patients inplaster

If your arm is in plaster Move your shoulder and fingers several times every hourduring the day. Keep the plaster dry and away from water. Carry the arm in a sling during the first 3 days if your handor fingers are at all swollen.

If your leg is in plaster Do not bear weight on it unless the plaster has a foot pieceor you have been given an overboot. Move the toes several times every hour during the day. Raise your foot on a chair when sitting, especially duringthe first week.

If your fingers or toes become swollen or cannot be feltproperly, go to the nearest hospital, or inform your owndoctor immediately.

Instructions after the plasterhas been removed

If your arm was injured Move your fingers, wrist, elbow and shoulder several timesevery hour during the day. Use your arm and hand more and more each day.

If your leg was injured Move your toes, ankle, knee and hip as much as possibleeach day. If your foot swells, raise it on a chair while sitting andwear a crepe bandage, elastic support or stocking. Walk more and more each day. If your fingers or toes become swollen or cannot be feltproperly, go to the nearest hospital, or inform your owndoctor immediately.

485

ExercisesUpper limb

Shoulder

Elbow Wrist

Lower Limb

Hip AnkleKnee

Continuous passive movement machine

Post-operative care

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486

PhysiotherapyPhysiotherapy can be divided into three main categories:

Thermal and cryotherapyRadiant or superficial heat is suitable for patients who areunfit to travel to a physiotherapy department or who havean implanted prosthesis. Sometimes ice packs are used ifthere is considerable bruising immediately after injury. Deep heat, such as short wave diathermy or ultrasound,can be used in cases where there is NO implanted prosthesisor plates, nails or screws.

MassageMassage in its various forms is soothing to the patient buthas a limited place.

ExercisesExercises may be active or passive. Active exercises These are where the patient exercisesthe joint, and are by far the most valuable. They increase thepower of muscles and actively move the joints, oftenincreasing both the range of joint movement and jointlubrication. Passive exercises These are where the physiotherapistmoves the joints. They may be necessary where the limb isparalysed, or where the patient is reluctant to move the limb.They have a place, but are of much less value than activeexercises. They are useful, however, in preventingcontractures across joints, particularly in the shoulder, handand knee. CPM machine In addition to passive exercises performedby the physiotherapist, continuous passive motion (CPM)machines are now in use. These machines are powered by anelectric motor and are used mainly on the lower limb andoccasionally on the upper limb. Limbs are moved through avariable range of movements at a predetermined speed. Themachines are invaluable for patients recovering from severeknee or hip operations (and occasionally the upper limb), andhelp prevent the joints from becoming stiff post-operatively. It has also been shown that constant movement by thesemachines markedly improves the nutrition of the jointcartilage and often accelerates the recovery of joint mobility.

487Post-operative care

Transcutaneous electrical nervestimulation (TENS)In chronic pain, particularly low back pain and sciatica,transcutaneous nerve stimulation with a battery poweredmachine worn by the patient may relieve pain. A small pad,placed over the site of maximum tenderness on the skin, canelectrically stimulate the underlying cutaneous nerves indiffering amplitudes and duration.

Bed supportsThese include special cushions to support a patients back,supports and cushions under the sacrum and under the heels,to prevent pressure sores in bed. Pillows can also be usedunder the legs to elevate the feet or to keep the knee flexedafter a hip operation. Sheepskin covers under pressure areassuch as the lower back, hips, and heels can also help preventpressure sores.

Boots and innersolesIn the case of a short leg, a contracted knee or an equinusankle, a raise on a boot, either on the heel alone, or on boththe sole and the heel, may be necessary. Many other supports are in common use, includinginnersoles in shoes to support fallen arches and soft plasticinserts to relieve pressure areas on the sole of the foot,particularly the heel (plantar fasciitis) and forefoot (anteriormetatarsalgia).

Walking aidsA variety of crutches is available. Some allow the patient tobear weight mainly on the shoulders and hands. In additionthere are short elbow crutches and walking frames. Walking sticks vary from those with a broad base and 4prongs, called quadrapods, to single walking sticks whichare used in the opposite hand to the affected leg.

Wheelchairs and motorised vehiclesVarious types of wheelchairs are available, from chairs wherethe patient is self propelled, to electric or petrol drivenwheelchairs which allow patients to drive on the road. Specialadaptations to cars including hand controls will allowdisabled patients to drive cars, even if both legs arecompletely paralysed.

Other supportsThese are discussed on pages 262-265 (orthopaedic splints).

488

Rehabilitation Physiotherapy Adequate early physiotherapy willminimise late stiffness of joints and weakness of muscles,in nearly all injuries, and early rehabilitation is important inall severe trauma. All patients with fractures and dislocations must be shownearly movements of the relevant joints of the upper and lowerlimbs or back as illustrated. Post-operative After removal of plaster and skelecasts,a crepe bandage and wool for a few days, with energeticactive exercises, either at home or in a physiotherapydepartment, is essential. The injured limb should also beelevated to prevent oedema. Swimming is particularlyvaluable for mobilising joints and strengthening muscles.Walking on soft sand in bare feet is good for foot, ankle andknee joint injuries, while cycling on a static machine or actualbicycle is indicated for hip, knee, ankle and back injuries. Amputations and paralysis The long-term managementof patients with amputations, residual paralysis, or residualdeformities, requires a team approach with surgeons,physicians, social workers, or physiotherapists, occupationaltherapists, orthotists or prosthetists, rehabilitation doctors andothers, as already discussed earlier in this book under Spinalinjuries (see page 378). Daily living and employment The final aim should beto rehabilitate the patient, not only to the activities of dailyliving, but also wherever possible to return to someemployment. This may mean retraining and adjustments tothe place of work and to the home, such as ramps, supportingrails and low benches, together with adjustments andattachments to machines. It should also be a legal requirement for all large companiesto recruit a minimum of possibly 3% of its workforce fromthose with a significant disability. The needs of paraplegicand other severely disabled workers also include ramps inpublic buildings, special lavatories with easy access, andsupporting rails geared to the needs of the physicallydisabled.

489

Rehabilitation

Daily living

Washing andtoilet

Housing

Nelson knife(combined

knife and fork)

Combs andsponges with

handles Towels

with loops Bath with seat Lavatory rails

Ordinary and motorised

Wheel chairs Cars

Low benches Adjusted controls for

machines Safety guards if

necessary

Industry

Transport

Adjustment to premises if necessary

Post-operative care

Eating

Public transport Improved access

Improved accommodation

Special hand controls Automatic gears

Space for wheelchair

Ramps for wheel chairs Suitable canteens

Wider bathroom doors

Ground flooraccommodation Ramps andsuitable doors Low basinsand stovesRubber handle

on spoon

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The future

Safe roads

Safe people

Safe vehicles

Centre and sidecrash barriers all

highways

convertibles

Ban alcohol and certain drugs Random breath testing Heavier penalties

Compulsory seat belts plus air bags Child safety seats and capsules Safer passenger compartment Head restraints all seats Stronger seat backs Secured luggage

Safe: Steering Tyres Brakes Daytime running lights Anti-lock brakes Safe coaches and heavy vehicles

for all Roll-over bars

Surface roads non-skid All roads reflectors or lighted Speed, alcohol and drug infringement penalties strictly enforced Helicopter and police highway patrols increased

Safe pedestrians- Education More underpasses and footbridges More cycleways Helmets for all cyclists and motorcyclists

Fatigue Driving skills Medical fitness First aid training

Separate paths for cyclists

491Post-operative care

The futurePublic education

Safe workSafe travel Safe homes

Safefactories and

offices

Hospitals

Regionalisation of accident services

Trauma and resuscitation training

Air Sea Land

Mobileaccidentteams

Emergencyfacilities fully

staffed

improvedaccidentand

intensivecare

departments

Safe electricity Safe kitchens

Safe bathrooms Non-skid floors

General hospitals:

Accidentkits

for all Homes Cars

Offices

Surgeons Doctors

Medical students Nurses

Ambulance officers Police

Fire officers

First aid and resuscitation

training: All commercial

drivers In future

all motorists and general

public

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493Emergency equipment and procedures

Chapter 10

Emergency equipment andprocedures

Emergency equipment for vehicles 494 Emergency procedures

Oropharyngeal airway 496 Nasopharyngeal airway 496 Bag and mask resuscitator 496 Adult orotracheal intubation 496 Needle cricothyroidotomy 496 Open cricothyroidotomy 497 Intravenous cannulation 497 Venous cutdown 498 Femoral venepuncture 498 Subclavian and internal jugular venepuncture 498 Intraosseous transfusion 498 Needle thoracocentesis 499 Open thoracocentesis 499 Pericardiocentesis 500 Diagnostic peritoneal lavage 500

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494

Emergency equipment forvehicles

First aid kit for general useReflective packTorch plus 2 batteries + lightstickWaterproof cape (pocket size)Space blanketLabels (3 red plus 3 green disaster or tie-on luggage labels)Marking pen waterproofScissors all purpose heavy dutyWhistleHandcleaner small tubeBandages triangular 6Plaster wool 15 cm rollCling bandages 10 cm and 15 cm 3Combines (9 x 29 cm) and (15 x 20 cm) 3Adhesive dressings miscellaneous sizesElastic adhesive bandage 2.5 cm rollAirways (disposable) Nos 2 and 3Collapsible face mask (optional)Cervical collar Plastazote or inflatableAnaesthetic creamFirst aid manual

Extra for doctors, nurses andparamedicsStethoscope lightweight paediatricSphygmomanometer lightweightSyringes (10 ml) + needles + alcohol wipes + blood bottles(for samples)Dwellcath needle (12 g for emergencycricothyroidotomy)Long leg pneumatic splint + 2 malleable splints for armsEntonox (nitrous oxide + oxygen) inhaler (optional)Spinal board (lightweight) (optional)Plastic bowl + paper tissuesVelcro tourniquetMini-suction pump and catheter (optional)Auto inflatable bag and mask for artificial ventilation + adultand children's face masksNeedles (14 g) through Heimlich valve, or through surgicalglove for tension pneumothoraxSterile gloves 2 pairs

495Emergency equipment and procedures

Laryngoscope + cuffed endotracheal tubes + connections +lubricant (optional)Oro-nasal tube + syringeUrethral catheter + lignocaine jelly(optional)Hacksaw small (15 cm) for emergency amputations(including 2 sterile blades, 4 artery forceps, 1 scalpel + 2 blades,1 pair scissors, plus suture material dressings + alcohol wipes)Defibrillator + ECG + pads + electrode jelly (optional)Intravenous giving sets x 2

DrugsHaemaccel 500 ml x 2Lignocaine 2% 2 ml x 10Adrenaline injection 1 in 10,000 0.1 mg/ml 10 ml x 2Dexamethasone 4 mg/ml x 5Naloxone 400 g x 5Atropine sulphate 600 g x 2Morphine sulphate 10 mg x 2 (dilute in 10 ml

saline for i.v. administration)Aminophylline injection 25 mg/ml 10 ml x 2Salbutamol sulphate 5 mg/ml 10 mlSodium chloride 0.9% 10 ml x 5Sodium bicarbonate 8.4% 50 ml x 2Calcium chloride 10% 10 ml x 2Frusemide 10 mg/ml 2 ml x 5 (optional)Flumazenil 0.1 mg/ml 5 ml x 2 (optional)Verapamil HCl 2.5 mg/ml 2 ml x 5 (optional)Anaesthetic drugs (optional)Sodium versenate 2 ml (dilute in 100 ml water

for alkali eye injuries)Antibiotics (optional)Tetanus toxoid and TIG (optional)

General car equipmentFour-way indicator flasherFlashing torch (red with white non-flashing beam)Reflective number platesReflective danger triangles 2Fire extinguisherSeat belts, head restraints and airbagsMapCar tools jack, screwdriver, pliers, adjustable spanner, tyrelevers, hammer and plastic insulating tapeContainer of water 2 litres minimum + small towelsPenknife multi-purpose with scissors

496

Emergency proceduresThe following summary of emergency procedures is givenonly as a guide for those who cannot obtain more skilledassistance in an emergency.

Oropharyngeal airway Procedure Clear the airway and lift the jaw forward.Insert the correct size airway (one that extends from teeth tothe angle of the jaw) with the concavity of the airway facingthe palate. Rotate the airway 180 at the back of the tongue.Lift chin and apply a face mask such that the concavity nowlies on the tongue. Children In young children depress the tongue with aspatula, and insert the airway, the correct way down underdirect vision, i.e. no rotation required.

Nasopharyngeal airway Indications This should only be used when there is nonasal obstruction or suspected fracture of the base of theskull. Procedure Lubricate the airway or use tap water, andpass the airway gently with a slight twisting action for its fulllength. Apply a face mask and oxygen.

Bag and mask resuscitator Procedure Apply the correct size mask to the patient'sface, with the oxygen flow at approximately 15 litres perminute. Use only if trained in the procedure. Ventilate 12times a minute (every 5 seconds). Do not overventilate.Observe and auscultate for the adequacy of ventilation usingparameters such as equality of chest movements and air entry.Always consider the possibility of an associated tensionpneumothorax.

Adult orotracheal intubation Indications See Accident site emergency management(see page 76).

Needle cricothyroidotomy Indications This is indicated in an emergency if the doctorcannot intubate. Procedure A 12- or 14- gauge cannula about 5 cm longconnected to a 10 or 20 ml syringe. Palpate the cricothyroidmembrane anteriorly between the cricoid and thyroidcartilages and stabilise the trachea.

497Emergency equipment and procedures

Puncture the skin in the midline and direct the needlecaudally at 45 aspirating as it is advanced carefully.Withdraw the trochar when air is aspirated, and advance thecannula sheath fully over the trochar and remove the latter.Attach the cannula sheath if possible to an oxygen supplyunder pressure at 2 to 4 litres per minute. Note Use only as a temporary emergency measure asadequate oxygenation can usually only be maintained forabout 30-60 minutes as CO2 elimination may be limited.

Open cricothyroidotomy Indications This is indicated in patients over the age of12 where the patient cannot be intubated. In youngerchildren, a needle cricothyroidotomy is preferable as anemergency procedure. Procedure The cricothyroid membrane is palpatedbetween the cricoid and thyroid cartilages (see page 76) andlocal anaesthetic injected in the conscious patient. Atransverse skin incision is made and continued through thelower half of the cricothyroid membrane. Do not damage the cricoid or thyroid cartilages. Open upthe incision with artery forceps and insert a cuffedtracheostomy or endotracheal tube distally into the trachea.Inflate the cuff and ventilate the patient with oxygen aftersecuring the tube. Check by auscultation and chest X-ray forthe adequacy of tube placement and air entry on both sides.

Intravenous cannulation Indications These are given on page 18. In all severecases at least two l4- or 16- gauge intravenous lines shouldbe inserted. Technique Wear gloves and apply a venous tourniquet.Clean skin with an alcohol wipe and allow to dry. Use a localanaesthetic if possible. Insert a 14- or 16- gauge cannula.Remove the trochar after blood is aspirated and send forhaematological and biochemical investigations if necessary.Advance the cannula into the vein and remove the trochar.Attach the cannula to the drip. In severe trauma or hypovolaemic shock at least 2 veinsshould be cannulated. The best veins for closed cannulation are the veins over theradial side of the forearm or the basilic at the elbow. Otherveins used in an emergency include the femoral at the groinand the internal jugular and subclavian.

498

Venous cutdown Technique The saphenous vein at the ankle, oralternatively the basilic at the elbow, 2.5 cm (1 in) lateral tothe medial epicondyle, are the veins usually used. Saphenous vein

The skin 2.5 cm (1 inch) anterior andproximal to the medial malleolus is cleaned and draped andanaesthetised with 1% or 2% lignocaine. The skin is incisedwith a small blade and the vein mobilised carefully for about2.5 cm (1 inch). A suture is tied as distal as possible and leftuncut for traction. A small transverse incision is madecarefully in the anterior surface of the vein and a large plasticcannula inserted for at least 3 cm up the vein. The skin isclosed and the cannula secured to the skin and attached tothe drip.

Femoral venepuncture Technique After cleaning and draping the skin the veinis identified immediately medial to the femoral artery. Theskin is infiltrated with 1% or 2% lignocaine. A cannulathrough a needle attached to a 5 or 10 ml syringe with 2 ml ofsaline is then inserted towards the patient's head in the femoralvein. The vein should again be located during insertion ofthe needle by using a finger palpating the femoral artery as alandmark. The needle is advanced until free blood appearsin the syringe. The cannula is advanced and the needle isremoved. The catheter is then attached to the intravenous drip.

Subclavian and internal jugularvenepunctureThese procedures should be left to a skilled operator, and arenot usually the first portal of access for the hypovolaemicshocked patient for fluid replacement (see page 91).

Intraosseous transfusion Indications Although this is usually only recommendedfor children under the age of 6, older children or even adultscan benefit in an emergency if other venous infusion sites areinaccessible. It should be ceased as soon as other sites forinfusion become available. Procedure The knee should be slightly flexed over apillow with the patient supine. The subcutaneous surface ofthe tibia is punctured about 2.5 cm (1 inch) below and medialto the tibial tubercle after cleaning and anaesthetising the skin.The special intraosseous needle with stylet is inserted distallyat about 30 to the skin by a twisting motion into the medullary

499Emergency equipment and procedures

cavity. The stylet is removed and a 5 or 10 ml syringe withabout 5 ml of saline attached and the saline injected into thebone marrow. It should flow easily. The needle is thenattached to the intravenous infusion.

Needle thoracocentesis Indications As an emergency for a tensionpneumothorax. There is a 10% risk of lung damage.Definitive drainage should by blunt insertion of a drain, inthe 5th intercostal space (nipple level) in the mid axillary line. Procedure Infiltrate the 2nd intercostal space in the midclavicular line with local anaesthetic and sterilise the skin onlyif time allows. If there is no hypotension or suspected spinalinjury the patient should be sitting up. A cannulaapproximately 5-8 cm long over a needle and attached to a 20ml syringe is inserted into the pleura, aiming just superior tothe insertion point. Air is aspirated to relieve the immediatedistress, and the sheath attached to a Heimlich valve, or putthrough the finger of a glove to form a one-way valve (seepage 93-97). In an emergency use any large bore needle andaspirate air. As soon as possible insert a chest drain in the 5thintercostal space in the mid axillary line (see below).

Open thoracocentesis Indications This is a much safer procedure than by usinga cannula. It is illustrated on page 95, with insertion of agloved finger through an open wound. It should be used forboth a tension pneumothorax and haemothorax. It issometimes indicated as a prophylactic measure whenintubation and positive pressure ventilation is used inpatients with a risk of a pneumothorax. Procedure The site should be in the 5th intercostal space(nipple line) in the mid axillary line. It is important toanaesthetise the skin, and particularly the pleura andmuscles, with at least 30-40 ml of 0.5% or 1% lignocaine andallow this anaesthetic time to work. A 3 cm incision is madein the line of the 5th intercostal space and the subcutaneoustissues are opened with tissue forceps. The pleura is carefully penetrated with the forceps andreplaced immediately after penetration with a gloved finger(see page 95). The finger is used to separate any adhesionsaround the insertion site. Forceps clamped to the end of thethoracotomy tube are then used to insert the intercostal tubefor about 3-6 cm in a caudal direction. A Seldinger technique is also available with a 20-gaugeneedle, guide wire, dilator and 7 FG catheter.

500

The tube is sutured in place and the wound closed withinterrupted sutures (not purse string), and a vaseline gauzedressing applied. An underwater drain, with low suction ifnecessary, is used, and a post-insertion chest X-ray taken.Check that the tube does not become kinked or blocked, andthat the drainage bottle is never lifted above the level of thechest without first being clamped.

Pericardiocentesis Indications and assessment Pericardial tamponade mayproduce muffled heart sounds, increased pericardialdullness on percussion, elevated jugular venous pressure anddiminished pulse pressure (see page 100). Assess the patient for mediastinal shift and also apply ECGleads if time allows. Procedure Anaesthetise the puncture site with 1%lignocaine. A 16- or 18- gauge cannula over a needle isattached to a 3-way stopcock. The skin is punctured about 1cm below the left xiphichondral junction, and at 45 to theskin. The needle and catheter are slowly advanced, aimingfor the tip of the left scapula. As soon as the needle tip entersthe blood filled pericardium the cannula sheath should beadvanced over the needle before the needle is removed. Thepericardium is then aspirated. The catheter is strapped inplace and the stopcock is closed. ECG changes such as ST segment elevation or frequentventricular ectopic beats as the needle is advanced indicateirritation of the myocardium, and the catheter should bewithdrawn slightly. This may also occur as thehaemopericardium is aspirated, and the heart comes in contactwith the catheter which can then be slightly withdrawn. Repeated aspirations of the pericardium may be necessary.A clotted haemopericardium may occasionally require openoperation.

Diagnostic peritoneal lavage Indications These are discussed on page 108. Do notwaste time performing this if there is an open wound, or if aCT scan or ultrasound indicate the need for an urgentlaparotomy. In children CT scan or ultrasound is indicatedinstead of peritoneal lavage. Laparotomy may be needed for injuries to the diaphragmor for retroperitoneal injuries when peritoneal lavage isnegative. If in doubt a laparotomy should always be carriedout. This is discussed in detail on page 108 under abdominalinjuries. Always insert a gastric tube and urinary catheter.

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Chapter 11

Reference material

Reference books 502Haematology 503Clinical chemistry 504

Chapter 9Chapter 10

502

Reference booksAdams J C Hamblen D L Outline of Fractures. ChurchillLivingstone

Adams J C Standard Orthopaedic Operations. ChurchillLivingstone

Apley A Solomon L Apley's System of Orthopaedics andFractures. Butterworth

Benson M et al Childrens Orthopaedics and Fractures.Churchill Livingstone

Chapman M et al Operative Orthopaedics. Lippincott

Cross M J Crichton K J Clinical Examination of the InjuredKnee. Gower

Dandy D Essentials of Orthopaedics & Trauma. ChurchillLivingstone

Evans T R et al ABC of Resuscitation. British Medical Journal

Huckstep R L A Simple Guide to Orthopaedics. ChurchillLivingstone

Huckstep R L Sherry E Colour Guide Picture Tests Orthopaedics and Trauma. Churchill Livingstone

McLatchie G Lennox M E Soft Tissues Trauma and SportsInjuries. Butterworth

McRae R Practical Fracture Treatment. Churchill Livingstone

Mollan R A B Rowlands B J Modern Trauma Management.Butterworth

Rowley D Skeletal Trauma in Old Age. Chapman & Hall

Skinner D et al ABC of Major Trauma. British MedicalJournal

Teddy P Head Injuries Pocket Picture Guide. Gower

Watson N Hand Injuries & Infections Picture Guide.Gower

Wedel D J Orthopaedic Anaesthesia. Churchill Livingstone

503Reference material

Haematology

Reference intervals

The following reference intervals are intended as a guide only.Results should be assessed using the reference intervals

provided by the laboratory that performs the testing. If there isany doubt the results should be discussed with the particularlaboratory involved.

Red and white cell counts

Haemoglobin (Hb) adult male 13.0-18.0 g/dl adult female 11.5-16.5 g/dlRed cell count (RCC) adult male 4.6-6.5x10l2/L adult female 3.8-5.8x10l2/LMean cell volume (MCV) 80-100 fLWhite cell count (WCC) 4.0-11.0x109/LLeucocyte differential count

neutrophils 2.0-7.5x109/L lymphocytes 1.5 -4.0x109/L monocytes 0.2 -0.8x109/L eosinophils 0.04 -0.4x109/L basophils

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Clinical Chemistry

Electrolytes, urea and creatinine (EUC's)

Sodium 135-145 mmol/LPotassium (serum) 3.8-4.9 mmol/LChloride 95-110 mmol/LBicarbonate (total CO2) 24-32 mmol/LCalcium (total) 2.10-2.55 mmol/LPhosphate 0.70-1.50 mmol/LMagnesium 0.8-1.0 mmol/LCopper 13-22 mol/LZinc 12-20 mol/LUrea 3.0-8.0 mmol/LCreatinine 0.05-0.12 mmol/L

Liver function tests (LFTs)

Bilirubin (total) 2-20 mol/LAlkaline phosphatase (ALP) 25-100 U/LGamma glutamyl transpeptidase(GGT)

males

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