Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2009
Practice Guideline[Practice guideline 'Pharmaceutical pain treatment during labour'; the woman's request is sufficient indication].
The basic principle of the practice guideline 'Pharmaceutical pain treatment during labour' is that during labour every woman can have adequate pain treatment at her request. Most women experience severe pain during labour, but retrospective satisfaction also depends on the support of care-givers and on the extent to which the woman was involved in decisions relating to her situation. A number of medical indications require good pain management. ⋯ Pethidine is far less effective. Recommended organisational changes include structured provision of information on pharmaceutical pain management in the 30th week of pregnancy, to be developed by midwives, obstetricians and anaesthetists. Other recommended changes include referral to another hospital for the treatment of choice, development of local protocols across primary and secondary care with agreements about out-patient referral to the anaesthetist, structured daily contact between obstetricians and anaesthetists, the time lapse between the request for pain treatment and the administration of the treatment, and the site of administration and monitoring.
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A 12-year-old boy fell off his bicycle, hitting his neck on the handle-bars. He sustained a tracheal rupture, which required surgical treatment. ⋯ Both were treated conservatively, the 2-year-old boy needed endotracheal intubation and mechanical ventilation. Blunt neck trauma can cause life-threatening complications, which are difficult to diagnose.