Long-term oxygen therapy (LTOT) usually represents the final step in the management of severe chronic respiratory diseases: a large proportion of patients suffering from these conditions is involved and the corresponding impact for the Health Institutions and the Society is dramatically increasing. Although LTOT is well known and widely used since long ago in most modern countries, it still represents a challenging topic due to the huge amount of variables which can affect both its efficacy and effectiveness. Unfortunately, patients, doctors, care-givers, together with health institutions and political decision makers frequently have different visions on LTOT, thus highly contributing to obtain uneven results and changing outcomes. The focus of this volume is on new insights and novel perspectives of LTOT. Starting from consolidated experiences, it's aim is also to emphasize the strategic value of developing technologies and innovative organizational models uniquely to find out even more opportunities and advantages for the management of chronic respiratory patients needing long-term oxygen treatment.

Dysfunction of the gastrointestinal tract in critically ill patients has recently become a focus of intensive research. This book, the first one on this topic, is a comprehensive overview of what is currently known about the role of the gut in patients requiring intensive care. The definitions and pathogenesis of intestinal dysfunction are critically evaluated. Currently available and potential new ways to monitor intestinal function in the intensive care setting are presented. Emphasis has been placed on the evaluation of therapeutic strategies in the prevention and treatment of gut dysfunction. Options for monitoring and treating gut dysfunction in critically ill patients are rapidly evolving. This volume provides state-of-the-art information for both clinicians and clinical researchers.

The 80 rules you need to prepare for action in a medical disaster

Here are 80 disaster management rules to reflect on, remember and follow in the immediate aftermath of an incident involving mass casualties. Each rule is a single-page long, providing the essential information to inform the most common critical decisions you will have to make in either a civilian or military environment.

Written by clinicians with deep clinical and operational experience, these rules are concise evidence-based guidelines for all medical personnel dealing with disasters at the scene or in hospital. Based on the Major Incident Medical Management and Support system widely adopted in the UK, mainland Europe, Australasia and NATO, they are both authoritative and effective.

The World Federation of Societies of Intensive and Critical Care Medicine (WFSIC- CM) has reached the age of maturity. Physicians, nurses, and many others associated with the field of Intensive and Critical Care Medicine will be coming from all corners of the world to Florence, Italy in August, 2009 to celebrate the 10th quadrennial congress. Every 4 years for the last 36 years, congresses in the magnificent venues of London (1973), Paris (1977), Washington (1981), Jerusalem (1985), Kyoto (1989), Madrid (1993), Ottawa (1997), Sydney (2001), and Buenos Aires (2005) have sig- fied an ever-developing process which has resulted in the four pillars of the field of Intensive and Critical Care Medicine, namely partnership, ethics, professionalism, and competence. The first pillar is based on a stronger interdisciplinary collaboration and a mul- professional partnership in the field of Intensive and Critical Care Medicine. In recent decades, professional activity in medicine has been regulated by well-defined, universal principles, such as the welfare of the patient, autonomy, social justice, and the patient-physician relationship. The second pillar, ethics, has offered welcomed assistance to all these principles in establishing an ethics curriculum.

This book has been written by established Orthopedic Surgeons who have become dedicated specialists within their particular subspecialty. They have contributed by writing highly detailed chapters that educate the reader with the basic science, accepted fundamentals and most recent trends within the full range of trauma management in orthopedics. It is intended that this well illustrated and highly informative text book to provide orthopedic surgeons in training with comprehensive and relevant core knowledge on all aspects of trauma management orthopedics, and will become an essential guide for surgeons in training, providing step by step approaches to performing initial diagnosis, surgical procedures and post operative management.

Completely revised and updated, Nutrition Support for the Critically Ill Patient: A Guide to Practice, Second Edition presents an unbiased, evidence-based examination of critical nutrition across the life cycle. Taking a multidisciplinary approach, each chapter has been carefully designed to provide a comprehensive review of the literature and a detailed exploration of the practical application of this information. With chapters written by experts, you get the most pertinent and current knowledge available, bolstered by tables, figures, and case studies that make the information accessible. New Coverage in the Second Edition: Gut microbiota support Short bowel syndrome Chronic critically ill phenomenon Professional nutrition practice guidelines and protocols Ethical considerations Quality and performance improvement Many challenges remain when providing optimal nutrition to all patients under all conditions at all times. Divided into eight sections, the book covers metabolic issues, nutrients for critically ill patients, delivery of nutrition therapy, nutrition therapy throughout the life cycle, special interest groups, specific organ system failure, general systemic failures, and professional issues in the field. It keeps you informed and aware of the continuous accrual of knowledge needed to craft and provide optimal nutrition therapy for the critically ill patient.

In the past, many tropical and parasitic infections were confined to tropical areas of the world located between the Tropic of Cancer and the Tropic of Capricorn. However, with the increase in air travel and tourism and the changing patterns of immigration, an increasing number of individuals are coming into contact with these infectious agents and transmission across the world has been enhanced. Tropical and Parasitic Infections in the Intensive Care Unit provides an international perspective on this topic and an overview of those infections that may cause critical illness.

An Atlas of Radioscopic Catheter Placement is unique, and has been conceived as a handy reference guide for students, interventional cardiologists, nurses and electrophysiology technicians. It includes plenty of schemes and X-ray images, and every EP correct catheter positioning is explained step by step through detailed descriptions of the necessary manoeuvres, including some "trucks" brought about by the experience.

Ability to learn from errors is an essential aspect of the quest to improve treatment quality and patient safety. This book consists of 33 cases in anesthesiology that is based on real life situations and illuminate avoidable complications and mishaps. The cases are presented in a novel manner in that they are embedded within narratives. The reader comes to each case "cold", without any clue as to the content, and each case comprises a narrative and a factual component that are interwoven. The narrative parts provide the reader with information and tips regarding the clinical problems and tasks that the protagonist must face and try to solve. The idea is to engage the reader emotionally while reading and to entertain him or her while learning. All cases conclude with short debriefing sections which include possible strategies to prevent similar errors or mishaps.

Owing to their frequency and possible consequences and considering the fact they frequently affect young people, trauma tic lesions of the thoraco lumbar spine represent a special point of interest within the field of Neurotraumatology. Traffic accidents are the commonest cause, which accounts for the high peak of occurrence between 15 and 24 years of age. It is also worth noting that according to published series nearly 50% ofthe cases affect the thoraco-lumbar junction. From an anatomical point of view, we must note the severity of thoracic spinal cord lesions especially of the thoraco-lumbar junction and of the lumbar region and be able to associate injuries ofthe conus medullaris and of the ca uda equina where there is a possibility of neurological recovery. Clinical evaluation is not always easy, but remains the basis for diagnosis and prognosis. The neurological classification proposed by FRANKEL et al. in 1969 and used at STOKE MANDEVILLE Hospital seems to retain its value. A more sophisticated study of medullary evoked potentials, as described by TsUBOKAWA can allow a more precise localisation and appreciation of the extent ofthe lesion as well as a better evaluation ofthe prognosis and ofthe evaluation of treatment in the acute phase. The neuro-radiological study should include standard views ofthe whole of the spine with antero-posterior and lateral tomograms of the fractured or luxated area. At present, the unquestionable contribution of the CT.

This eighth edition of Dr Reichel's formative text remains the go-to guide for practicing physicians and allied health staff confronted with the unique problems of an increasing elderly population. Fully updated and revised, it provides a practical guide for all health specialists, emphasizing the clinical management of the elderly patient with simple to complex problems. Featuring four new chapters and the incorporation of geriatric emergency medicine into chapters. The book begins with a general approach to the management of older adults, followed by a review of common geriatric syndromes, and proceeding to an organ-based review of care. The final section addresses principles of care, including care in special situations, psychosocial aspects of our aging society, and organization of care. Particular emphasis is placed on cost-effective, patient-centered care, including a discussion of the Choosing Wisely campaign. A must-read for all practitioners seeking practical and relevant information in a comprehensive format.

Over the last two decades, the increasing use of noninvasive ventilation (NIV) has reduced the need for endotracheal ventilation, thus decreasing the rate of ventilation-induced complications. Thus, NIV has decreased both intubation rates and mortality rates in specific subsets of patients with acute respiratory failure (for example, patients with hypercapnia, cardiogenic pulmonary edema, immune deficiencies, or post-transplantation acute respiratory failure). Despite the increased use of NIV in clinical practice, there is still a need for more educational tools to improve clinicians knowledge of the indications and contraindications for NIV, the factors that predict failure or success, and also what should be considered when starting NIV. This book has the dual function of being a "classical" text where the major findings in the literature are discussed and highlighted, as well as a practical manual on the tricks and pitfalls to consider in NIV application by both beginners and experts. For example, setting the ventilatory parameters; choosing the interfaces, circuits, and humidification systems; monitoring; and the "right" environment for the "right" patient will be discussed to help clinicians in their choices."

This book is a concise guide to ordering radiology tests for diagnosis and treatment and provides best practice guidelines for patients whose management depends on a clinical question that is best approached through imaging. Organized primarily by organ system, it outlines considerations in selecting the most efficacious imaging studies based on the clinical history, laboratory values, and physical findings to arrive cost-effectively at a correct diagnosis. It also explores the current limitations of each imaging modality and presents evidence-based information to insure that patient safety considerations are observed when ordering potentially dangerous examinations. Clinician's Guide to Diagnostic Imaging is a valuable resource for all physicians who regularly order imaging studies, including primary care physicians, family practitioners, internists, and surgeons alike. Further, this volume serves as an invaluable reference for medical students who are exposed to medical imaging for their first time or who are rotating through a radiology elective in medical school.

This book is the first of four books on the core principles of acute neurology. This book is a primer - and a great deal more - on how to clinically recognize acute brain injury and to treat its consequences. Acute brain injury often changes the dynamics of cerebral blood flow, cerebrospinal fluid mechanics and eventually intracranial pressure. And furthermore, acute brain and spine injury impacts on heart function, blood pressure control, breathing regulation and even gastric and bladder function. It is necessary to not only understand these fundamentals but also how certain measures could influence or correct these manifestations. Major concepts are illustrated to facilitate understanding. Each chapter concludes with a section that explains its relevance to clinical practice.The book truly combines basic neuroscience with practical know- how in an easy to read prose useful for both the novice and expert.

In any acute neurologic condition situations come up which generate questions about management. In a deteriorating patient there is a strain in decision making and many acute problems are hard calls. Handling Difficult Situations includes solutions for these reoccurring dilemmas. Each topic is carefully chosen and reflects clinical practice. The book addresses how to recognize treatable coma, how to judge the severity of traumatic brain and spine injury, and discusses how to recognize neurosurgical emergencies. Handling Difficult Situations also includes recognition and management of acute respiratory neuromuscular failure. A separate chapter discusses errors in CT scan evaluation of acute neurologic conditions.

A compelling true story of one woman's battle with the aftermath of childhood trauma, which gives a gripping account of the often controversial and misunderstood condition of dissociative identity disorder (DID), formerly known as multiple personality disorder (MPD). This emotional but ultimately uplifting journey details the unforeseen twists and turns of the effects of therapy and how it can help in coming to terms with the past and its unsettling echoes in the present. Heartwarming and lucid, it's an inspiring tale for all to read. Through its clinical rigour, professional therapists will also gain insight into the various treatment options for DID, including the innovative use of energy therapy. The book contains 32 colour illustrations, including 24 drawings by The Girls. The star of this book is an extraordinary, bright-spirited, and entertaining six-year-old girl, called Little Vivvi, who experienced shocking abuse from members of her family. Yet Little Vivvi lives within Vivian, a middle-aged woman who has struggled with DID for many years. The challenging process of psychotherapy is laid bare, as Little Vivvi wrestles with overwhelming memories of childhood abuse. Alongside talking therapy, energy treatment, which she calls Wooshing, is utilised to astonishing effect, becoming the enigmatic ingredient that finally enables Little Vivvi to find relief from the distress and fear that had dominated her existence. As therapy seems to draw to a close, Izzy appears. A very sensitive, thoughtful and mature eight-year-old, Izzy too needs love, support and treatment to speak about her trauma. After overcoming her understandable distrust, Izzy enables an exceptional ending to the therapeutic journey, far beyond anything Vivian and her therapist, Gill, could have dreamed. Little Vivvi and Izzy will make you want to laugh out loud as well as cry. Their story teaches so much about suffering, dissociation and survival. Their aim is to enlighten, inspire and offer hope to others through reading their incredible tales, which reveal the astonishing power of The Girls within.

This is an introduction to the patient monitoring technologies that are used in today's acute care environments, including the operating room, recovery room, emergency department, intensive care unit, and telemetry floor. To a significant extent, day-to-day medical decision-making relies on the information provided by these technologies, yet how they actually work is not always addressed during education and training. The editors and contributors are world-renowned experts who specialize in developing, refining, and testing the technology that makes modern-day clinical monitoring possible. Their aim in creating the book is to bridge the gap between clinical training and clinical practice with an easy to use and up-to-date guide. * How monitoring works in a variety of acute care settings * For any healthcare professional working in an acute care environment * How to apply theoretical knowledge to real patient situations * Hemodynamic, respiratory, neuro-, metabolic, and other forms of monitoring * Information technologies in the acute care setting * New and future technologies

G. SERRATRICE This book is new and original. For some decades mitochondriopathies have been extensively studied: morphology, biochemistry, genetics. However these studies mainly concerned encephalopathies and myopathies related to mito- chondrial disorders. In this book the field of mitochondrial cytopathies is largely extended to "Mitochondrial Medicine". Very new data are gathered. A new step is jumped. Many medical specialities are concerned. Part I is devoted to mitochondrial biology: the mitochondrial machinery, the dysfunction of mitochondrial in elderly: cell decline, deleterious effects of oxidative stress in ageing, especially dysfunction of cardiac mitochondria, as well mitochondrial involvement in neurodegeneration. An attractive chapter concerns the implication of apoptosis, the programmed cell death, linked to cytochrome oxidase defect. Iatrogenic mitochondrial diseases are studied in Part II either due to a sen- sitivity to some drug or especially induced by antiretroviral drugs. Several drugs lead to a mitochondrial toxicity: antiepileptic treatment, anticancer drugs. Mitochondrial damage involving mainly the mitochondrial DNA is frequent in patients treated for several years by antiretroviral drugs, with absolute deple- tion of mitochondrial DNA. Some patients with severe lactic acidosis and mul- tiple organ failures may be improved by carnitine. Special problemes arise in newborn and in perinatal exposure to antiretroviral drugs. In case of treated mother a mitochondrial disease could occur in non infested newborn.

Hans von Holst Royal Institute of Technology, WHO Collaborating Center, Sweden Ake Nygren Karolinska Institute, WHO Collaborating Center, Sweden Ake E. Andersson Institute for Futures Studies, Sweden n a recent study initiated by Harvard University, World Bank and I World Health Organization it was concluded that road injuries will be ranked from number 9 today to number 3 within the next two to three decades if authorities all over the world do not pay more attention to this significant problem. Injuries in traffic do not only concern the patient himself but also the relatives from an emotional point of view and the society from a socio economic point. Both emerging markets and industrial countries have significant experi ence of the events following a traffic accident. Much effort has been directed towards transportation of the victim from the scene of the accident to intensive care unit in the hospital. Simultaneously, the awareness of our knowledge about how these injuries should be prevented is striking. The focus of this second book of transportation, traffic safety and health is to further present some of the latest aspects in the area of mobility and its rela tion to planning of an optimal traffic safety with respect to our present knowl edge in the field. The volume contains a collection of contributions presented of scientists, clinicians and administrators at The Second International Conference on Transportation, Traffic Safety and Health, held in Brussels, Belgium, 1996."

Contrary to popular belief, death is not a moment in time, such as when the heart stops beating, respiration ceases, or the brain stops functioning. Death, rather, is a process--a process that can be interrupted well after it has begun. Innovative techniques, such as drastically reducing the patient's body temperature, have proven to be effective in revitalizing both the body and mind, but studies show they are only employed in approximately half of the hospitals throughout the United States and Europe.

In Erasing Death, Dr. Sam Parnia presents cutting-edge research from the front line of critical care and resuscitation medicine that has enabled modern doctors to routinely reverse death, while also shedding light on the ultimate mystery: what happens to human consciousness during and after death. Parnia reveals how medical discoveries focused on saving lives have also inadvertently raised the possibility that some form of "afterlife" may be uniquely ours, as evidenced by the continuation of the human mind and psyche in the first few hours after death. Questions about the "self" and the "soul" that were once relegated to theology, philosophy, or even science fiction are now being examined afresh according to rigorous scientific research.

With physicians such as Parnia at the forefront, we are on the verge of discovering a new universal science of consciousness that reveals the nature of the mind and a future where death is not the final defeat, but is in fact reversible.

Modern society is, to a great extent, characterised by a tremendous growth in transportation -- the freedom to travel is a central and fundamental human value. As mobility has increased so have health problems. The number of fatalities and serious injuries caused by road traffic is unacceptable, and, while a downward trend is visible in most countries, there still remains a lot to be done. This collection of contributions by scientists and administrators presents some of the latest findings in the area of mobility and its relation to medical treatment, rehabilitation, public health and prevention.

A large number of cardiovascular diseases are accompanied by inflammation. This volume on the molecular basis of microcirculatory disorders gives a comprehensive summary of key steps in the inflammatory cascade. Leading investigators present a state-of-the-art analysis of the molecular determinants of leukocyte-endothelial cell adhesion, mechanotransduction in endothelial and inflammatory cells, mechanisms of cell activation, microvascular apoptosis with applications to ischemia-reperfusion in the brain, the heart and in venous disease, diabetes and hypertension. The book provides the latest thinking in these important cardiovascular problems, with the most contemporary literature and a look at the increasingly complex events during inflammation. Molecular biology tools, microvascular and modern bioengineering analysis are seamlessly integrated into the analysis of clinical problems. The book helps not only newcomers to gain entry into the interesting problems associated with microvascular disorders, but lays the foundation for the design of new therapeutic interventions.

This core textbook defines the pathophysiologic mechanisms underlying the disease states commonly encountered by pre-hospital care providers. The chapters are short, clinically focused and specific to the diseases, disorders, and traumatic conditions of critical interest to the EMT and pre-hospital environment. Each chapter identifies the appropriate drugs and management guidelines to be used. Designed to bridge the gap between EMT and the Physician in all emergent or acute conditions, the book includes management cautions and tips are highlighted throughout the presentation. The book is tailored specifically to the curriculum for EMT training.

Trauma surgery has increasingly become a specialized field inspired by different principles and philosophy. A good trauma surgeon is a surgeon who knows how to perform abdominal, vascular, thoracic, urologic, gynecologic, and orthopaedic procedures and is able to repair multiple traumatic injuries in the best sequence possible. In this second volume the focus is exclusively on thoracic and abdominal trauma, with coverage of injuries to all regions. The surgical techniques employed in managing such trauma are carefully described with the aid of high-quality illustrations. Exploratory surgery (via either laparotomy or laparoscopy), damage control surgery, and definitive surgery are all fully covered, and attention is drawn to important technical tips and tricks. The volume will be a handy pocket guide for trainee surgeons who are beginning to deal with severe multiple trauma patients, as well as for all general or specialty surgeons and professionals (including scrub nurses and theatre staff) who are involved in trauma care and wish to keep abreast of developments in this complex field. Also available: Trauma Surgery Vol. 1: Trauma Management, Trauma Critical Care, Orthopaedic Trauma and Neuro-Trauma

Trauma surgery has increasingly become a specialized field inspired by different principles and philosophy. A good trauma surgeon is a surgeon who knows how to perform abdominal vascular, thoracic, urologic, gynecologic, and orthopaedic procedures and is able to repair multiple traumatic injuries in the best sequence possible. In this first volume, practical, up-to-date guidance is provided on the optimal critical care and ICU management of trauma patients. In addition, individual chapters focus on specific injuries in orthopaedic trauma (and especially spinal trauma) and neurotrauma, with the aim of providing a fresh view of the surgical approach and practical suggestions for improving the skills of treating surgeons. Educational issues and the organization of a trauma center are also covered.

The volume will be a handy pocket guide for trainee surgeons and any surgeon, physician, or nurse who treats trauma patients. It will be particularly relevant for emergency department physicians, critical care and ICU doctors, orthopaedic surgeons, neurosurgeons, and professionals responsible for trauma care and decision making, programs of trauma education, or organization of a trauma center.

Also available: "Trauma Surgery" Vol. 2: Thoracic and Abdominal Trauma