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Extra resources for Emergency Medicine - An International Perspective
The passage of nasal feeding tubes should be avoided in patients with facial injuries and basal skull fracture. Instate oragastric replacement should be used. Diarrhoea also may be seen during enteral feeding and may resolve with using a different formula of feed. But persistent diarrhoea should be thought infection with Clostridium difficile , particularly in patients receiving multiple antibiotics. A specimen should always be sent for microbiological culture. Total parenteral nutrision (TPN) is prefered especialy enteral nutrision is imposible(80).
The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 2002; 166:1338-1344  Riker RR, Picard JT, Fraser GL. Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients. Crit Care Med 1999; 27:1325-29  Ely EW, Truman B, Shintani A, et al. Monitoring sedation status over time in ICU patients-reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA 2003; 289:2983-91.
The particle size of the emulsion is similar to a chylomicron, and the lipidis handled in a similar manner. The energy yield from fat is 9 cal/g, but the presence of the egg phosphatides increase the caloric value of intralipid to 11 cal/g. The lipid load should be decreased in the presence of sedation with propofol, severe jaundice ,severe hypoxamia, thrombocytopaenia and hypothermia . Carbohydrate should be consist of two-thirds of the energy requirement and is in the form of glucose having 4cal/g energy.