Critical care : the official journal of the Critical Care Forum
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On 7 December 1988, a severe earthquake hit in Armenia, a former republic of the Soviet Union (USSR); on 11 September 2001, a manmade attack of similar impact hit New York City. These events share similar implications for the role of the uninjured survivor. With basic training, the uninjured survivors could save lives without tools or resuscitation equipment. This article makes the case for teaching life-supporting first aid to the public in the hope that one day, should another such incident occur, they would be able to preserve injured victims until formal rescue occurs.
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Review
The World Trade Center attack. Disaster preparedness: health care is ready, but is the bureaucracy?
When a disaster occurs, it is for governments to provide the leadership, civil defense, security, evacuation, and public welfare. The medical aspects of a disaster account for less than 10% of resource and personnel expenditure. Hospitals and health care provider teams respond to unexpected occurrences such as explosions, earthquakes, floods, fires, war, or the outbreak of an infectious epidemic. ⋯ In other locations, disaster drills become pro forma and have no similarity to real or even projected and predicted disasters. The World Trade Center disaster on 11 September 2001 provides new information, and points out new threats, new information systems, new communication opportunities, and new detection methodologies. It is time for leaders of medicine to re-examine their approaches to disaster preparedness.
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The use of low-dose dobutamine to maintain hemodynamic stability in pulmonary hypertension may have a detrimental effect on gas exchange. The aim of this study was to investigate whether inhaled nitric oxide (INO), dobutamine and a combination of the two have beneficial effects in patients with end-stage airway lung disease and pulmonary hypertension. ⋯ Dobutamine and INO have complementary effects on pulmonary circulation. Their association may be beneficial in the treatment of patients with mild to moderate pulmonary hypertension.
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At the 2001 Toronto Critical Care Medicine Symposium, exciting new research results were presented, including a randomized trial of peri-operative pulmonary-artery catheter use and evidence-based guidelines for the prevention of ventilator-acquired pneumonia. Presenters reviewed other important recent critical care developments such as (1) activated protein C and low-dose steroids in sepsis, (2) prone positioning and long-term outcomes in patients with adult respiratory distress syndrome, and (3) medical errors in the critical care unit. ⋯ Furthermore, additional study is needed for an understanding of how physicians implement new research findings. Successful methods of enhancing the widespread adoption of new research require further study.
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The plasma colloid osmotic pressure (COP) plays a major role in transcapillary fluid balance. There is no information on plasma COP of healthy infants beyond the first post-natal week. The normal COP in healthy adult subjects (25 mmHg) is currently also applied as a reference value for healthy infants. This study was designed to test whether plasma COP values in healthy infants are the same as those in normal adults. ⋯ The data accept the null hypothesis that the COP range in infants younger than 1 year old is similar to those observed in adult subjects. Our observations, compared with previously reported neonatal COP values, suggest that there is a sharp increase in COP within the first months after birth.