Harefuah
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The phenomenon of "ischemic preconditioning" has been well known for nearly two decades. In this phenomenon, a brief period of ischemia prior to a more prolonged one improves myocardial function and reduces infarction. ⋯ The mechanism of late preconditioning is well described and is different from its early phase. Fully understanding the mechanism of this amazing phenomenon promises to be a novel discovery as for developing preconditioning mimetic agents and, thereby, using preconditioning as a therapeutic tool or as a preventive factor in cardiovascular diseases.
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In a patient, admitted for cerebral stroke with right side hemiparesis, an acute episode of dyspnea has developed 6 hours after admission. Based on a finding of fine rales on auscultation and a chest radiogram showing congestion, a diagnosis of pulmonary edema was made. The electrocardiogram and cardiac enzymes were normal. ⋯ Neurogenic pulmonary edema may be a result of a vast range of neurological lesions or conditions, including status epilepticus, head trauma, subdural and subarachnoid hemorrhage, brain tumors, meningitis, multiple sclerosis and ischemic stroke. This condition is probably mediated by the sympathetic system outflow, leading eventually to an increase of left atrial pressure, or to an increase in pulmonary vessel permeability. It is treated conventionally, with diuretics and after-load reduction.
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Paramedics are a critical national resource. The paramedic workforce is dynamic and has never been studied, thereby limiting the possibility of appropriate planning. ⋯ These findings may provide a better basis for long-term planning for training, recruitment, and employment of paramedics and may serve as an example for workforce planning for other health professions.