Articles: emergency-medical-services.
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Vasoactive (vasodilating and vasoconstricting) and inotropic drugs are widely used in intensive therapy. Major progress in their use in recent years has been due to a greater understanding of the physiological derangements of the critically ill. ⋯ An understanding of the basic anatomy and physiology of the cardiovascular system (CVS) is essential to an understanding of the methods used for monitoring and measurement (1). Logical therapeutic interventions follow from consideration of these measured and derived parameters.
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The measurement of tissue oxygen saturation with a pulse oximeter is of proved value in the hospital setting. The development of a portable oximeter has allowed this investigation to be performed during the prehospital phase of a patient's care. ⋯ There were no practical difficulties associated with the use of the instrument either at the roadside or in a moving ambulance. The portable pulse oximeter is a valuable aid in the prehospital monitoring of patients with trauma.
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We conducted a retrospective study of the interventions performed by physicians in 191 transfers by our pediatric critical care transport team. Currently, the team always includes a pediatrician or pediatric resident, a pediatric emergency department nurse, and a pediatric respiratory therapist. Procedures performed during transport were divided into those done only by physicians in our institution and those also performed by nurses or respiratory therapists. ⋯ In 91% of the transports, no procedures were performed that required a physician. In 66%, no medications were used that required physician presence. In at least 46%, the physician believed his expertise was not required for the transport's success.(ABSTRACT TRUNCATED AT 250 WORDS)