Articles: emergency-medical-services.
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Because of the need for rapid diagnosis and management of patients acutely stricken by either injury or illness, critical care delivery cannot be limited to intensive care units. Instead, it must span the continuum from the scene of injury or illness to the patient's eventual arrival at the intensive care unit. University Hospital in Ghent, Belgium, has developed a comprehensive system that involves prehospital and in-hospital critical care, as well as a rapid and efficient interhospital and intrahospital transportation system. ⋯ The emergency department and its staff are available 24 hours a day to ensure uninterrupted delivery of critical care, including when patients are transported between various hospital departments. In addition, critical care specialists with at least 2 years' intensive care experience are available 24 hours a day. They also serve as coordinators for disaster planning for the hospital and the city of Ghent and its province.
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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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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.
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To examine the ability of a unified metropolitan paramedic system to provide IV access in children when indicated. ⋯ Although paramedics had an 84% success rate at establishing IV lines in children in the field, half the children younger than 6 years who required intravascular access did not receive an IV line in the prehospital setting. Multiple IV line attempts should be discouraged because additional attempts yield little benefit and may prolong transport times.
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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.