Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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Tidsskr. Nor. Laegeforen. · Jun 2000
[Treatment of patients with acute head injury in Vestfold 1987-96].
In Norway, patients with severe head injuries are transported to a regional, neurosurgical department for surgery, but some are operated on by surgeons without neurosurgical training in local hospitals. ⋯ In Norway and countries with a similar hospital system, local hospitals should establish guidelines for safe and swift transport of head injury patients to the nearest neurosurgical department, and should not try to perform neurosurgical decompression in such patients.
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Tidsskr. Nor. Laegeforen. · Jun 2000
[Time delay in the thrombolytic treatment of myocardial infarction].
Thrombolytic treatment is central in the treatment of patients with myocardial infarction. ⋯ In order to reduce time delay, doctors should give better instructions to patients with a previous history of coronary heart disease and conduct regular training programmes for hospital interns and nurses. It is further assumed that prehospital ECG and direct admission to the coronary care unit, or initiation of thrombolysis in the emergency department or in the ambulance, would result in a considerable reduction in time delay.
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Tidsskr. Nor. Laegeforen. · Jun 2000
Review[Troponins and other biochemical cardiac markers--time for a change].
During the last ten years new, more sensitive and specific cardiac markers in blood for detection of acute myocardial injuries have been characterised and clinically evaluated. Of practical importance is also the fact that rapid and robust methods and equipments suitable for emergency service have been developed. ⋯ It is recommended that one of the troponins, either I or T, should be included in the diagnostic regime for detecting acute coronary syndromes in Norwegian hospitals. CKMB, determined as mass and not as activity, ought to be retained, at least until more clinical experience with the troponins have been gained by the hospital. Myoglobin may only be of interest if early exclusion of myocardial injuries has practical consequences. In this connection the transaminases and LDH are no longer of any interest.
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Tidsskr. Nor. Laegeforen. · Jun 2000
Comparative Study[Rewarming of patients with accidental hypothermia with the help of heart-lung machine].
Different techniques have been used for treatment of victims with accidental hypothermia. We have used cardiopulmonary bypass (CPB) for rewarming hypothermic patients with circulatory failure or cardiac arrest. This report summarises our experiences with this patient group. ⋯ Due to lack of safe prognostic predictors, all accidental hypothermic victims with circulatory failure should be rewarmed by cardiopulmonary bypass before further therapeutic decisions are made.
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In order to be able to discuss the issue of whether or not terminal sedation is, or may be conceived of as, a form of help in dying, one needs to be very clear as to the meaning of the terms "help in dying" and "terminal sedation". In this article, we suggest what we take to be detailed and precise definitions of the two forms of voluntary help in dying--euthanasia and physician-assisted suicide. Our definitions (interpretations) basically draw on the Dutch experience and understanding. ⋯ Furthermore, we discuss on what grounds this treatment strategy may be induced, including a presentation of criteria and guidelines that must be met; the issue of documentation of the strategy; palliative sedation in the light of the ethical principle of double effect; and in what way euthanasia could be concealed as palliative sedation. In closing, we comment briefly on the phenomenon of large differences between published cohorts with regard to the frequency of use of palliative sedation. This treatment strategy is open to be challenged both clinically and ethically, and all parties would benefit from a continuous debate over the legitimacy of, and the clinical need for, palliative sedation.