Resuscitation
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Sophisticated care of the head injury patient in the emergency department does not demand sophisticated knowledge of neurosurgery. Instead it depends upon: (1) Meticulous attention to the fundamental principles of resuscitation; (B) Prevention of secondary cardiopulmonary abnormalities which can further injure the traumatized brain; (C) Performance of serial neurologic examinations. (In the case of acute head injury, a simple neurologic examination performed repeatedly usually provides the physician with more useful information than a more elaborate examination performed only once). (D) Consultation with the neurosurgeon. ⋯ This can only be achieved through persons dedicated to training emergency medical technicians, nurses and physicians in the optimal care that can be afforded these patients. If advances are to be made in decreasing the morbidity and mortality of the CNS trauma patient, those actively involved in emergency medicine are going to have to take an active role in training programs, seminars and clinical practice for physicians, emergency department nurses, and emergency medical technicians.
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The treatment of head and spinal cord injuries must be directed towards prevention of secondary insults which will increase the extent of permanent disability. Improved extrication techniques at the scene of the accident, earlier recognition and treatment of complications and improved transfer management have all reduced the acute morbidity and mortality of injuries to the central nervous system. At the University of Virginia we have implemented a comprehensive training program in the acute care of the head and spinal cord injured patient for Emergency Medical Technicians (EMT), nurse, community referring physicians, and house staff within the medical center. ⋯ The greatest emphasis is placed on the history and physical examinations, which documentation of the extent of neurologic deficit, including the Glasgow coma scale. Data on 900 pre-hospital calls by volunteer EMTs demonstrate a 90% compliance in basic life support skills outlined in the educational program. A similar compliance has been achieved with referring physicians and house staff in the medical center, in the acute management of the CNS injured patient, due primarily to this educational program and increase in the optimal care of these patients has resulted.
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A combination of three cardiokinetics - adrenaline, isoprenaline, and noradrenaline, ("AIN") - have been rather widely used in certain hospitals of the People's Republic of China since the beginning of the 1970s. "AIN" was initially used by intracardiac injection in an attempt to restart the asystolic heart when other therapies failed. Fifty-nine cases of restoration of the heart action with various therapies were analyzed. It was concluded that "AIN" could be recommended as first-aid drugs in the restoration of difficult cases with asystolic hearts, but not under any condition or in every case. In the patients with potential arrhythmias, such as may occur in myocardial infarction, "AIN" may induce refractory ventricular fibrillation.