Articles: emergency-medical-services.
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To describe the planning and implementation of health care provision at a mass gathering, and to describe the conditions treated at such an event. ⋯ Solutions to recurrent problems experienced by medical personnel involved with mass gatherings or disasters are suggested. The lack of practice in implementing a multiple casualty or disaster plan may be remedied by organised responses to mass events.
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Fire victims are exposed to the triple threat of thermal injury (skin and lungs), smoke toxicity (toxic or irritant gases and soots) and even trauma whose occurrences are somewhat independent one from the other but whose addition does sharply increase the probability of death of the victims. As the different victims of the same fire may not suffer from the same injuries, this triple threat must be looked for in each fire victim.
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Hepato Gastroenterol · Dec 1992
Randomized Controlled Trial Clinical TrialProtecting against the acid aspiration syndrome in adult patients undergoing emergency surgery.
This paper has studied the effect of i.v. cimetidine and ranitidine, given 1 h prior to anesthesia, on gastric volume and pH in three homogeneous groups undergoing emergency surgery. Group I (10 patients) received placebo, group II (20 patients) cimetidine 400 mg in saline solution, and group III (20 patients) ranitidine 150 mg in saline. Standardised premedication was administered and anesthesia induced. ⋯ There were no significant differences in gastric volume among the three groups. However, treated patients had significantly elevated pH as compared with the control group and the number of patients at risk (pH < 2.5 and volume > 25 ml) was significantly smaller at 20% and 15%, respectively, than in the control group (40%). It is concluded that cimetidine 400 mg, and ranitidine 150 mg i. v., given about 70 min. prior to induction of anesthesia may decrease the risk of the acid aspiration syndrome in emergency operations.
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Pediatric emergency care · Dec 1992
Aeromedical transport services accepting pediatric patients and their abidance by published guidelines.
The number of aeromedical transport services accepting pediatric patients (ATSP) in the United States has increased greatly over the past decade. Most aeromedical transport services are primarily designed for adults but will also transport children. ⋯ This survey of 65 ATSP and their abidance by the major AAP guidelines showed that two thirds of the ATSP were based at facilities with pediatric tertiary care capabilities; most ATSP were not directed by pediatric critical care (PCC) or pediatric emergency care (PEC) specialists; most transport team personnel were not trained in PCC or PEC; most ATSP had specific protocols for different clinical situations; most ATSP had separate equipment appropriate for pediatric patients; and there was little variation in transport team composition based on different clinical situations. In summary, all ATS surveyed transported children, but few were aware of the AAP guidelines, and only one in 65 was in complete abidance with the recommendations.
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Successful emergency airway intervention incorporates the anaesthetist's basic skills in airway management with the knowledge of the special nature of the clinical problems that arise outside the operating room. While a thorough but rapid evaluation of the key anatomical and physiological factors of an individual patient may result in an obvious choice for optimal management, clinical problems often arise in which there is not an evident "best approach." In these less clear-cut situations, the anaesthetist may do well to employ those techniques with which she/he has the greatest skills and experience. At times, however, some degree of creative improvisation is required to care for an especially difficult problem.