Nederlands tijdschrift voor geneeskunde
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Mortality due to trauma in pregnancy is not very common in the Netherlands. More often a pregnant woman presents herself for examination after trauma. Blunt trauma is more common in the third trimester. ⋯ Maternal mortality after penetrating trauma is low because of the protection of vital organs by the uterus. With good treatment the mortality in pregnant trauma patients will not be higher than in nonpregnant patients. A rapid and effective resuscitation of the mother will give the foetus the best chance of survival.
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Ned Tijdschr Geneeskd · May 1999
Comment Review[Sedation by non-anesthesiologists should be centralized for considerations of safety].
Sedation and analgesia for diagnostic or therapeutic procedures outside the operating room by non-anaesthesiologist physicians is becoming more frequent. In reaction to sedation casualties a multidisciplinary committee organized by the National Organization for Quality Assurance in Hospitals (CBO) has developed guidelines for sedation and analgesia by non-anaesthesiologists for psychologically or physically distressing diagnostic and therapeutic procedures. ⋯ It may be expected that with these guidelines sedation and analgesia by non-anaesthesiologists will increase further. With a view to the safety of the patient diagnostic and therapeutic procedures which require sedation for psychological or physical reasons should be concentrated in a diagnostic/therapeutic complex, connected to the operating complex, where it is possible to consult the expertise of an anaesthesiologist.
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Ned Tijdschr Geneeskd · May 1999
Practice Guideline Guideline[Guideline for administration of sedatives and analgesics by physicians who are not anesthesiologists. National Organization for Quality Assurance in Hospitals].
A consensus text for sedation or analgesia in diagnostic or therapeutic procedures has been developed for application by non-anaesthetist physicians. The final consensus text has the support of 17 scientific societies in the Netherlands. There is not enough medical manpower for direct, personal, specialist-based supervision of level 3 sedation procedures (the patient is relaxed, with eyes closed, but promptly reacts to verbal commands) for significant number of patients in the Netherlands. ⋯ The consensus party favours titrated administration of small doses of short acting sedative or analgetic drugs. Combining sedative and analgesic drugs increases risk. Sedation and analgesia in children and patients with mental handicaps is acceptable in terms of quality, but requires special expertise, because of the greater psychic and physical vulnerability of these categories of patients.