Nordisk medicin
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Norway has ten bases for helicopters manned by aeromedical doctors, five for fixed-wing aircraft, and five for search-and-rescue helicopters. In 1992 there were 4,197 helicopter missions and 4,078 patients were transported by plane, figures representing 20 and 30 per cent increases, respectively, as compared with 1988. In addition, the teams used motor transport to cater to 1,699 patients at locations close to the helicopter bases. Utilisation of aero-medical services was correlated to geographic availability, and can be seen as compensating for the uneven distribution of advanced emergency medical resources.
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Mortality is high among patients developing post-traumatic brain oedema and increased intracranial pressure following severe head injury. Although routine treatment varies from one centre to another it often includes one or more of such measures as hyperventilation, high-dose barbiturate therapy, osmotherapy or the drainage of cerebrospinal fluid. The preservation of high cerebral perfusion pressure is fundamental to traditional treatment, often combined with inotropic support, as ischemia is considered to be a crucial factor with regard to the development of secondary injuries and oedema in the brain. ⋯ Colloid osmotic pressure is preserved with albumin infusion. Normovolemia is attained despite manifest fluid balance. With this therapy both mortality and morbidity have been reduced significantly, as compared to retrospective figures for a comparable control group.
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An emergency facility was provided at the Midtfyn Rock Music Festival in 1990 (comprising 7,000 musicians and ancillaries and an overall public attendance of 60,000). A total of 329 patients were treated at the facility during the four and a half days that the festival lasted. ⋯ In terms of staff costs and the saving in patient transport costs alone, the economic gain to the community was estimated to be about 25,000 DKR. Thus, the provision of an emergency facility was cost-effective, and is recommended at such mass outdoor gatherings as cultural and sports events.
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The pathophysiology of spinal stenosis and segmental instability is discussed. The critical magnitude of the cross-sectional area of the cauda equina in the lower part of the vertebral canal is related to the dynamic loading of the spine, nerve impulse conduction and nerve root nutrition. Present knowledge of segmental instability is discussed, and an account is given of findings obtained during dynamic measurements with an intervertebral motion device (IMD), which indicate pathological motion patterns to differ from one pair of vertebrae to another.