Articles: patients.
-
'Suspended animation for delayed resuscitation' is a new concept for attempting resuscitation from cardiac arrest of patients who currently (totally or temporarily) cannot be resuscitated, such as traumatic exsanguination cardiac arrest. Suspended animation means preservation of the viability of brain and organism during cardiac arrest, until restoration of stable spontaneous circulation or prolonged artificial circulation is possible. Suspended animation for exsanguination cardiac arrest of trauma victims would have to be induced within the critical first 5 min after the start of cardiac arrest no-flow, to buy time for transport and resuscitative surgery (hemostasis) performed during no-flow. ⋯ In the 1990s, the Pittsburgh group achieved survival without brain damage in dogs after cardiac arrest of up to 90 min no-flow at brain (tympanic) temperature of 10 degrees C, with functionally and histologically normal brains. These studies used emergency cardiopulmonary bypass with heat exchanger or a single hypothermic saline flush into the aorta, which proved superior to pharmacologic strategies. For the large number of normovolemic sudden cardiac death victims, which currently cannot be resuscitated, more research in large animals is needed.
-
Primary emergency medicine systems in developed countries are well organized. Besides this primary system a secondary interhospital transport system has been developed in the past decade. ⋯ This article outlines the current status of these secondary interhospital transfer systems, their components, possibilities, advantages or disadvantages, and the actual literature. Surprisingly, the available scientific data on these cost-intensive and highly developed systems are quite insufficient.
-
Cervical spine injuries occur in 2-5% of blunt trauma patients, and 1-5% of these injuries are initially missed. Data from the large National Emergency X-Radiography Utilisation Study have helped to define the problem in some detail. There is a consensus on how to clear the cervical spine in patients who are alert, but in patients with altered mental status the choice of strategy for spinal clearance is more controversial. ⋯ As long as manual in-line neck stabilization is applied, rapid sequence induction of anaesthesia, followed by direct laryngoscopy and oral intubation appears to be safe in the patient with a cervical spine injury. If intubation is not urgent, an awake fibreoptic technique is a useful option. If intubation of the patient with a potential cervical spine injury fails, or appropriate experienced personnel are unavailable, the laryngeal mask airway or one of its various modifications are useful alternatives.
-
Many commissions and groups throughout the world have proposed clinical guidelines on the management of low back pain, spinal pain, and chronic pain. Practice guidelines are systematically developed statements to assist the practitioner and patient decisions about appropriate healthcare for specific clinical circumstances. The American Society of Interventional Pain Physicians developed practice guidelines for interventional techniques which are professional practice recommendations for practices for prevention, diagnosis and treatment of acute and chronic painful disorders, and in some cases, disability management. ⋯ The results consistently showed decrease in number of visits from 1999 to 2000 and 2001 with 5.5 +/- 0.18, 5.1 +/- 0.17, and 4.3 +/- 0.15 respectively. The average expenditure also decreased from per visit of $872 in 1999 to $891 in 2000, to $810 to 2001. further, the average expenditure per year also decreased as expected due to decrease in frequency of visits, as well as the average expenditure per visit from $4751 +/- $231 in 1999 to $4505 +/- $214 in 2000 and to $3514 +/- $193 in 2001 even without consideration of inflation. Thus, it is concluded that guidelines describing the interventional techniques in the management of chronic pain are effective in reducing the cost and frequency of visits with improvement or at least maintenance of similar outcomes, physician decision making abilities, and patient preferences.
-
Caudal epidural administration of corticosteroids is one of the commonly used interventions in managing chronic low back pain. Reports of the effectiveness of all types of epidural steroids have varied from 18% to 90%. Sicard, a radiologist, was the first to describe injection of dilute solutions of cocaine through the sacral hiatus into the epidural space in 1901, to treat patients suffering from severe, intractable sciatic pain or lumbago. ⋯ The clinical effectiveness evaluations fill the literature with various types of reports including randomized clinical trials, prospective trials, retrospective studies, case reports, and meta-analyses. Evidence from all types of evaluations with regards to the clinical and cost-effectiveness of caudal epidural injections is encouraging. This review discusses various aspects of the role of caudal epidural injections in the management of chronic low back pain, including pathophysiology of low back pain, indications, clinical effectiveness and complications.