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Renal physiology: Function and anatomy

The kidneys have a number of diverse functions. The main roles are as follows: Filtration and elimination of metabolic waste products Maintenance of fluid and electrolyte homeostasis Control of acid–base status Production of erythropoietin to stimulate red cell synthesis Hydroxylation of circulating calcifediol (25-hydroxyvitamin D3) to calcitriol (1,25-dihydroxyvitamin D3), the active form of vitamin D, for calcium homeostasis Blood pressure maintenance and control of sodium and…

Respiratory system

Control of breathing Breathing is primarily concerned with the homeostasis of blood O 2 and CO 2 to ensure that both remain at appropriate concentrations despite wide variations in the body's metabolic needs. Breathing control is also vital for speaking and singing; it must also be modified to allow protective reflexes such as coughing, sneezing and vomiting. Unusually for such a fundamental function, breathing can be…

Cardiovascular system

The autonomic nervous system The term autonomic nervous system (ANS) refers to the nervous and humoral mechanisms that modify the function of the autonomous or automatic organs. These include heart rate (HR) and force of contraction; calibre of blood vessels; contraction and relaxation of smooth muscle in gut, bladder, bronchi; visual accommodation and pupillary size. Other functions include regulation of secretion from exocrine and other glands…

Muscle function and neuromuscular blockade

In the last 70 years, neuromuscular blocking drugs have become an established part of anaesthetic practice. They were first administered during abdominal surgery in 1942, when Griffith and Johnson in Montreal used Intocostrin, a biologically standardised mixture of the alkaloids of the Indian rubber plant chondrodendron tomentosum to facilitate muscle relaxation during cyclopropane anaesthesia. Previously, only inhalational agents had been used during general anaesthesia, making surgical…

Postoperative nausea and vomiting

It is estimated that up to 80% of patients experience postoperative nausea and vomiting (PONV) within the first 24 h after surgery. If risk factors are identified and acted upon, PONV can be easily managed, but for a small, high-risk cohort of patients, symptoms can be extremely distressing and disabling. Fortunately, the aetiology of PONV is multifactorial; therefore a variety of different treatments and interventions can be…

Physiology and pharmacology of pain

The International Association for the Study of Pain (IASP) defines pain as ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage’. It is clear from this definition that the degree of tissue damage and perception of pain are not necessarily correlated. Pain perception is a complex phenomenon, involving sensory, emotional and cognitive processes. Thus, although…

Local anaesthetic agents

Local anaesthetics are analgesic drugs that suppress action potentials by blocking voltage-activated sodium ion (Na + ) channels (VASCs) in excitable tissues. Examples include the amides (e.g. lidocaine, bupivacaine, levobupivacaine, ropivacaine) and esters (e.g. cocaine and procaine) ( Table 5.1 ). Other drugs that can inhibit VASCs, such as diphenhydramine (a first-generation histamine H 1 receptor antagonist) and amitriptyline (a tricyclic antidepressant), also have local anaesthetic…

Intravenous anaesthetic agents and sedatives

A wide variety of therapeutic and non-therapeutic substances will obtund cerebral function and produce a continuum of cognitive states from almost fully awake to unexpected death ( Table 4.1 ). The clinically useful part of this spectrum is characterised by the American Society of Anaesthesiologists as levels of sedation and general anaesthesia ( Table 4.2 ). Any centrally acting depressant agent may produce sedation or general…

anaesthetic agents and medical gases

Inhalational and volatile anaesthetic agents are used widely for the induction and maintenance of general anaesthesia throughout the world. Since the famous demonstration of an ether anaesthetic by William Morton in 1846, the development of volatile anaesthetic agents paved the way for the introduction of modern surgical practices, procedures and techniques. Early agents such as diethyl ether, chloroform, ethyl chloride, cyclopropane and trichloroethylene, although effective, were…

Data, statistics and clinical trials

Statistics is the science of learning from data – from collection and organisation through to analysis, presentation and dissemination. Like all sciences, it has its own vocabulary and can sometimes appear somewhat impenetrable to the uninitiated. This chapter gives an overview of statistical processes and methods, but readers are advised to consult more detailed texts on medical statistics for further information. Whenever data are collected, in…

General principles of pharmacology

Basic principles A drug is a molecule or particle that produces a therapeutic effect by modifying how a biological system responds to a physical or chemical stimulus. This effect can occur locally at the site of administration or after absorption and delivery to a more distant site of action through carriers or mass transit. Most drugs undergo passive or active transport across membranes as part of…

Acute Leg Pain in a Patient With Cellulitis

Case Study A rapid response was initiated by the bedside nurse (RN) for a patient with severe leg pain. Upon the arrival of the rapid response team, the patient was a 48-year-old male with a known history of type 2 diabetes mellitus with insulin dependence, stage III chronic kidney disease, and chronic hypertension. The patient had been admitted two days earlier for lower extremity cellulitis, for…

Acute Foot Discoloration in a Patient With Peripheral Vascular Disease

Case Study A rapid response event was initiated by the bedside nurse after the patient had symptoms of sudden pain in his left foot. Prior to calling the condition, the nurse assessed the patient’s pulse in the affected foot, and she did not feel it. On prompt arrival of the rapid response team, a quick chart review suggested that the patient was a 55-year-old male with…

Muscle Spasms in a Patient With a History of Thyroidectomy

Case Study A rapid response was initiated by the bedside registered nurse for uncontrollable spasms in the hands and feet. Upon the arrival of the rapid response team, the patient was a 72-year-old gentleman with a known history of coronary artery disease, diabetes, hypothyroidism, and morbid obesity. The patient had been admitted earlier for viral gastroenteritis associated with intractable nausea and vomiting. The patient had been…

Transgender athlete sport inclusion polices: the current state

Sport participation policy Sport participation policies influence who has access to sport and competition, which in turn shapes our idea of who is an athlete. While inclusion policies can be based on age, school attendance, or geography, they are frequently also based on gender. Rules about gender classifications affect access to sport for transgender athletes. This chapter will – cover a brief history of athletic participation…

The history of transgender athletes in sport

Introduction The discussion of gender in sports is not new in the world of professional, amateur, and even high school athletic events. This chapter starts by exploring historic definitions of gender within the context of sport and then outlines some of the challenges that remain with the current methods used to determine gender in competition. Conversations regarding the fairness in athletic competition have been ongoing in…

Gender affirmation surgery

Introduction The purpose of gender-affirming surgery is to help alleviate distress associated with anatomical structures which (1) cannot be altered or eliminated by medical treatment, (2) have not changed enough with medical treatment, or (3) require the patient to take additional medication to maintain their body in congruence with their gender. Not all individuals who identify as transgender (or gender diverse) want or need surgery. However,…