Emergency medicine clinics of North America
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In summary, I have examined the questions of why have a trauma care system and whether trauma care systems improve trauma care. I believe the evidence is overwhelming that trauma care systems are worthwhile and that they improve trauma care. ⋯ Trauma care systems should also be integral to the regional disaster plans and to the education of the public and should be a focus for research activities in trauma care. All trauma centers should provide access to rehabilitation services so that the patient who recovers from acute injuries can return to a productive life.
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Injury to the chest accounts directly or indirectly for up to 50 per cent of deaths secondary to trauma. Eighty-five per cent of patients with chest injury may be managed by minor procedures available to the emergency physician. The indications for surgery in the remaining 15 per cent of patients with chest injury must be understood.
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This discussion focuses on the several pressure-related syndromes that are peculiar to diving and that are collectively known as dysbarism. These include barotrauma of descent, barotrauma of ascent, and air embolism. Also considered are nitrogen narcosis and decompression sickness.
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Of the three phases of disaster response, the primary phase (immediate postincident to six hours thereafter) represents the core of the EMS-augmented response to save lives. Activities during this phase include triage, victim control and stabilization, communications, and transportation. To cope successfully with the mass casualties of an actual disaster, special emergency forces must be trained (and rehearsed) to act together as a team to treat the critically ill and injured.
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Cold injuries, hypothermia, and frostbite are discussed, including the pathophysiology, clinical presentation, and modern management.