Articles: emergency-medical-services.
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The authors discuss the indications for emergency carotid endarterectomy, based on their experience between 1956 and 1975 when 15 patients with completed stroke and internal carotid occlusion (Group I) underwent this operation, and after 1975 when emergency revascularization was performed in 22 patients with unstable neurological deficit (Group II) and 21 patients with TIA's associated with preocclusive internal carotid stenosis (Group III). The good early and late results show that surgery was indicated in these cases. An attempt to identify the patients at high risk of acute ischemia on the basis of clinical or anatomical findings is made to ascertain the physiopathologic patterns of cerebral ischemia.
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Out-of-hospital cardiac arrests constitute 350,000 cases yearly in the United States and 60,000 in the United Kingdom. Prompt resuscitation (CPR) by lay persons and fast defibrillation by paramedics have had epidemiologic consequences on both sides of the Atlantic. In Seattle there are 20.6 and in Brighton 10.0 long-term life-saves yearly per 100,000 persons. ⋯ Diagnostic procedures like electro-provocation identify high-risk patients. Changes of behavior and diet, new drugs, new operations, and external and implantable automated devices reduce sudden deaths. In the future, automated defibrillation by first responders and trained lay persons (including members of families of high-risk patients) should increase the number of early survivors who become candidates for long-term therapy with drugs, operations, and devices.
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Emerg. Med. Clin. North Am. · May 1984
ReviewPrinciples of prehospital care of musculoskeletal injuries.
Prehospital management of musculoskeletal injuries in the traumatized patient is based on the application of a few basic principles in an orderly but expeditious manner. The patient must be assessed for immediate life-threatening conditions involving airway, respiratory, and circulatory functions while the cervical spine is protected. Resuscitative efforts to reestablish and preserve an adequate circulating volume of oxygenated blood must follow, using airways, oxygen therapy, and fluid replacement through MAST trousers and intravenous fluids. ⋯ In the multiply traumatized patient with severe injuries to several organ systems, prehospital care may need to be expedited to provide this patient the in-hospital care required to save his or her life. Appropriate treatment in such life-threatening trauma situations will consist of a rapid primary assessment, airway and cervical spine control, appropriate respiratory and cardiovascular assistance, gross whole body fracture immobilization using a backboard, and immediate transport. For less severely injured patients, primary assessment, resuscitation, stabilization, full secondary assessment, initial definitive care, and immobilization should be completed before transport begins.