Emergency medicine clinics of North America
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Fairs, concerts, parades, and rallies are some of the many events that cause large numbers of people to gather in one place. Whether the event lasts a day or a week, it is evident that the people attending may require organized medical care. Most of the medical needs are minor, but cardiac arrests and other serious medical problems, including trauma, must be dealt with by the medical team. Careful planning and integration of emergency physician efforts with local hospitals and the emergency medical services system allow for an optimal delivery of health care, from the routine incident to a mass-casualty event.
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Emerg. Med. Clin. North Am. · May 1996
ReviewDisaster planning, Part I. Overview of hospital and emergency department planning for internal and external disasters.
The definition and causes for internal and external disasters are discussed in this article. Features of a hospital disaster plan are outlined with special reference to the role of the emergency department. Examples of previous disasters involving hospitals are presented to demonstrate problems that disaster planners should anticipate.
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Emerg. Med. Clin. North Am. · May 1996
ReviewHazardous materials. Disaster medical planning and response.
Hazardous materials offer a variety of unique challenges to emergency personnel. These agents have immense economic impact, but when mishandled, they become notorious for turning contained accidents into disasters involving the entire community. During a hazmat accident, the victims often ignore the rules of the disaster plan by seeking out the nearest hospital for medical care, regardless of that institution's capabilities. ⋯ As a result, emergency physicians must work with their hospital to implement a hazmat decontamination program in order to appropriately care for these individuals. The appendix to this article presents a list of recommendations for hospital hazmat preparedness. It is modeled after existing CDC and OSHA guidelines.
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Traumatic brain injury (TBI) contributes significantly to the mortality and morbidity rates of traumatized patients. This article presents current concepts in the pathophysiology of TBI, including mechanisms of injury, biomolecular mediators of injury, and the occurrence of secondary injury. Emergency management, monitoring, and imaging of TBI also are reviewed.
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Emerg. Med. Clin. North Am. · Feb 1996
ReviewTriage of critically ill patients: an overview of interventions.
The recognition of tissue hypoxia or cumulative oxygen debt is of fundamental importance for triage and resuscitation of critically ill patients during the ¿golden hour¿ in the emergency department (ED). The measurement of central venous blood oxygen saturation, plasma lactate concentration, cardiac output, systemic oxygen transport and use, and non-vital organ oxygenation and function can enhance the detection of systemic and regional hypoperfusion and tissue hypoxia. Systemic and organ-specific oxygenation indices may guide the choice of therapy to optimize resuscitation of the macrocirculation and microcirculation in critically ill ED patients.