Harefuah
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Mechanical ventilation is one of the most important technologies used in critically ill patients. In many patients, the use of mechanical ventialtion and weaning from mechanical ventialtion may be complicated by occurence of positive end expiratory pressure (PEEP) which is created by the mechanical and physiological properties of the pulmonary system and the mechanical ventilator. In order to minimize the detrimental effects of spontaneous PEEP, which is also termed intrinsic PEEP (PEEPi) or autoPEEP, clinicians should be aware of the mechanisms leading to PEEPi, and the possible ways of diminishing it. This review will present some aspects of PEEPi including the most common ways of reducing it and it's deleterious effects.
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Abdominal pain is a frequent complaint. In this report, a woman who presented with abdominal pain was found to have a contained rupture of the abdominal aorta that extended into the retroperitoneum. ⋯ The patient described, however, did not have an aneurysm, as illustrated by the abdominal CT scan and surgical findings. Therefore, abdominal or back pain may be caused by a rupture of the aorta, even in the absence of an aortic aneurysm.
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Each year, many children suffer from injuries caused by bicycles, scooters, skateboards, and roller skates accidents. Head injury is the most common cause of death and serious disability in bicycle-related crashes. In various studies the use of bicycle helmets has been proven to be the most effective measure in preventing head injury: the use of bicycle helmets reduced the risk of head and brain injury by 85-88%. Legislation that mandates the use of helmets has been shown to effectively increase helmet use and, therefore, significantly decrease head injuries among riders. COST-BENEFIT: Legislation requiring helmets will save $44.2 million (direct benefit) to society over a 5-year period, and save approximately 57 lives, 2,544 hospitalizations, and 13,355 emergency room visits. BICYCLE-RELATED DEATHS AND INJURIES IN ISRAEL: Data from trauma registry of 10 hospitals of the Israeli Center for Trauma and Emergency Medicine research indicate that 649 children ages 17 years and under were injured in a bicycle-related accidents (58-serious, 77-medium injury). Bicycle-related injuries accounted for approximately 33% of motor vehicle accidents among children ages 17 years and under. ⋯ Many countries have legislation requiring helmets for riders. In Israel, there is no law requiring helmets. On a telephone survey, conducted by 'Beterem', a high support rate for a law requiring bicycle helmets (89%) was found among parents to children up to 15 years of age. Based on the evidence of the effectiveness of helmets as a means for reducing head injuries in cyclists, and the importance of a law to this effect, the medical community in Israel should act to promote the legislation requiring helmets for children on bicycles, scooters, skateboards, roller skates, and rollerblades.
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Although humans spend as much as a third of their life sleeping, many schools of medicine around the world do not provide sufficient knowledge about the physiology and pathology of sleep to their students, as if diseases fall asleep at night. People suffering from impaired sleep are often unaware of the problem. ⋯ The latter type is associated with several sleep disorders, among which are: obstructive sleep apnea, periodic limb movement in sleep, narcolepsy, idiopathic hypersomnia and circadian rhythm sleep disorders. To provide accurate diagnosis and appropriate treatment, medical education programs should offer the students a deeper knowledge of sleep medicine.
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Saving life demands only two hands and some basic knowledge. A qualified person can open airways, resuscitate, massage a heart and call for help. A person with cardio-pulmonary resuscitation (CPR) training can sustain an ailing person's heart and brain for a short time. However, knowledge of CPR guidelines and skills is not enough; medical and nursing practitioners must practice and train regularly to hone those skills. Western Galilee Hospital has developed simulator programs for surprise CPR training exercises in all hospital departments and units. ⋯ It is our belief that surprise resuscitation drills are the key to improve functioning during actual emergency resuscitation, both on a departmental and a general hospital level.