This book describes how the integrated approach offered by health services research can improve the quality of care provided to critically ill patients. By focusing on the needs of the patient, health services research links conventional scientific disciplines, systems research, education, and management, with the aim of translating developments in knowledge into sustained change in culture and practice. Intensive care has much to offer in this respect, as it can both benefit from and contribute to the collaborative methodology of health services research. Although the contributions are directed at critical care, the content is relevant to all health care disciplines, including health services administration.

Critical care medicine is a relatively new specialty. Over the past few decades, we have seen an enormous growth in the number of inten sive care units (ICUs) worldwide. Medical students, residents, fellows, attending physicians, critical care nurses, pharmacists, respiratory ther apists, and other health-care providers (irrespective of their ultimate field of practice) will spend several months or years of their profes sional lives taking care of critically ill or severely injured patients. These clinicians must have special training, experience, and compe tence in managing complex problems in their patients. In addition, they must interpret the data obtained by many kinds of monitoring devices, and they must integrate this information with their knowl edge of the pathophysiology of disease. This handbook was written for every practitioner engaged in criti cal care medicine. We have attempted to present basic and generally accepted clinical information and some important formulas as well as laboratory values and tables that we feel will be useful to the practi tioner of critical care medicine. Chapter 1 provides an introduction to the ICU. Chapters 2 through 18 follow an outline format and are divided by organ system (i. e. , neurologic disorders, cardiovascular dis orders), as well as special topics (i. e. , environmental disorders, trauma, toxicology). In addition, many of these chapters review some useful facts and formulas systematically. Finally, Chapters 19 and 20 supply lists of pharmacologic agents and dosages commonly used in the ICU and laboratory values relevant to the ICU.

Eine echte Enzyklop die der Notfallmedizin, bedarfsgerecht im praktischen Taschenbuch-Format, umfassend, kompakt, bersichtlich.
Blitzschnell kompetente Entscheidungshilfen:
-> rund 2000 klar strukturierte Eintr ge in griffiger Didaktik mit anschaulichen Abbildungen und Tabellen
-> notfallmedizinische und feuerwehrtechnische Begriffe, ber 150 Notfallmedikamente mit Dosierungen und Therapie-Strategien
-> aktuelle Empfehlungen und Algorithmen der internationalen Fachgesellschaften
Das Wissen f r Ihre Sicherheit im Beruf und in der Ausbildung.

Qualitatsmanagement im Gesundheitswesen ist in aller Munde. Auch fur den Rettungsdienst ist es ein aktuelles Thema, das an Bedeutung weiter zunimmt. Zahlreiche Rettungsdienstorganisationen in Deutschland, Osterreich und der Schweiz sind bereits zertifiziert und besitzen damit ein Qualitatsmanagementsystem.

Das vorliegende Werk gibt erstmalig einen zusammenfassenden Uberblick uber die verschiedenen Aspekte des Qualitatsmanagement und dessen Bedeutung fur den Rettungsdienst. Es soll Hilfestellung bei der Implementierung und Umsetzung eines Qualitatsmanagementsystems bieten bzw. einen Uberblick uber die verschiedenen Moglichkeiten und Aspekte liefern. Das Werk richtet sich an alle Verantwortlichen im Rettungsdienst, Qualitatsmanager im Rettungsdienst, Rettungsdienstleiter, arztliche Leiter Rettungsdienst, Berater im Qualitatsmanagement und Rettungsdienstmitarbeiter.

Alle Inhalte besitzen fur Deutschland, Osterreich und die Schweiz Gultigkeit bzw. auf Unterschiede in diesen Landern wird explizit hingewiesen."

A unique textbook in cardiovascular emergencies Cardiovascular Problems in Emergency Medicine takes you on rounds with the leading teachers of emergency medicine. Transcripts of in-depth telephone conferences on 27 real-life cardiovascular cases provide a unique and fascinating insight into the way complex cases are diagnosed and managed by some of the most experienced and respected practitioners in the field. Each chapter is then complemented by an authoritative, fully-referenced review of the current literature on the topic. With its unique approach, and the range of cases covered, Cardiovascular Problems in Emergency Medicine is an invaluable source of information for all emergency physicians, both qualified and in training.

Over two decades an abundance of knowledge has been accumulated focus ing on the understanding of the molecular and cellular pathomechanisms of stressful conditions like systemic inflammation and sepsis. We have learned that there is a clear correlation between the magnitude of the inciting traumatic event and the degree of inflammatory dysbalance. The immunoinflammatory disintegration comprises a simultaneous col lapse of the otherwise very smoothly balanced pro- and antiinflammatory vectors of cytokine regulation. Most recently, we understood that it is predominantly the dysregulation of antiinflammatory mediators that plays a pivotal role for the phenomenon of trauma-induced depression or paralysis of cell-mediated immune responses. The substantial intellectual and logistic investments of numerous investi gators towards understanding the biology of sepsis inevitably lead us towards a rewarding status in terms of reaching spheres of clinical relevance. From the evolutionary collection of a multitude of ex-vivo and in-vivo immuno mechanistic parameters, some were found to represent most significant bio logical markers to support the clinician to characterize better the severity of inflammatory illness and to predict outcome. Chapter one of this book, authored by G. Grass and E.A.M. Neugebauer, analyses elegantly our current knowledge on the assessment of the immuno logical status in terms of risk and prognosis of sepsis.

Infections contracted by patients constitute an important factor in the manage- ment of any hospital unit. For patients with weakened resistance due to trauma, after surgery and in intensive care, infection-related complications have a nega- tive impact on care quality indicators, specifically in terms of protracted hospi- talisation time, increased costs from complications and extended hospitalisation, and increased mortality rate. Effective strategies to prevent and treat infections are a priority in optimising the cost-effectiveness of care. Infection control, diag- nostics and targeted antibiotic therapy require an integrated epidemiological, microbiological and clinical approach. This is indispensable for critically ill patients, especially when the processes of infection and sepsis are supported by micro-organisms which are multidrug-resistant and difficult to root out. The importance of this subject has been demonstrated by a European obser- vational study on the prevalence of hospital infections in patients under intensive care. In this study, the prevalence of infections contracted in a "high-risk" envi- ronment was 21 %, while other studies have observed that the incidence of pneu- monia in patients undergoing artificial ventilation varied between 8% and 54%, with a median of 24%. These figures alone are enough to show the clinical impor- tance of the infective process and the need for continuous interdisciplinary updating and exchanges of experience.

The interest of researchers, clinicians, practitioners and surgeons in critical care medicine is growing. Clinical pharmacology and new technologies now allow more appropriate therapies, and the commitment of all those involved in this field is of fundamental importance for reaching high interventional standards, in both the prevention and treatment of critical conditions, but also for satisfying the concept of cost-effectiveness in critical care. In this volume advances in critical care medicine are described, including the application of new technologies in the clinical setting, the full integration of computers and informatics, and the continual training of physicians and technicians.

Trauma in the Creative and Embodied Therapies is a cross-professional book looking at current approaches to working therapeutically and socially with trauma in a creative and embodied way. The book pays attention to different kinds of trauma - environmental, sociopolitical, early relational, abuse in its many forms, and the trauma of illness - with contributions from international experts, drawn from the fields of the arts therapies, the embodied psychotherapies, as well as nature-based therapy and Playback Theatre. The book is divided into three sections: the first section takes into consideration the wider sociopolitical perspective of trauma and the power of community engagement. In the second section, there are numerous clinical approaches to working with trauma, whether with individuals or groups, highlighting the importance of creative and embodied approaches. In the third section, the focus shifts from client work to the impact of trauma on the practitioner, team, and supervisor, and the importance of creative self-care and reflection in managing this challenging field. This book will be useful for all those working in the field of trauma, whether as clinicians, artists, or social workers.

This accessible guide explores how our brains react to stress and offers a fresh perspective on how we define "trauma." Probing how the words we use can influence our understanding of distress, this text focuses on expanding awareness of excess stress and reducing judgment of its potential impact on relationships and day-to-day life. Helpfully split into three parts, the book introduces the terms "cortisprinkled," "cortisaturated," and "cortisoaked" and provides a rationale for why these states of brain occur. The role of culture and society are highlighted, and an in-depth focus on coping and offering support to others is presented. Whether caused by sexual assault, social rejection, abuse, the taboo of sexuality, disadvantaged status, or other difficulties, chapters detail specific coping skills and step-by-step strategies to deal with a variety of stress responses. Advice is offered on reconnecting with sexuality, phrasing difficult questions, and ways to offer validation, with concrete recommendations on incorporating healthier practices into everyday life. Both metaphor and real-world vignettes are interwoven throughout, making Redefining Trauma an essential and understandable resource for therapists and their clients, parents and support givers, and anyone looking to develop practical, informed methods for dealing with stress and trauma and reclaim life with intention.

An experienced physician knows how to recognize a patient suffering from sepsis, but cannot accurately determine whether the patient will survive. Cardinal elements of the treatment for sepsis include specific antibiotic and vasoactive drugs, enteral and parenteral nutrition, artificial respiration, and optimization of the oxygen transport to tissues. Nonetheless, with a certain frequency, these techniques are insufficient to ensure the recovery of a critically ill patient, especially when it is necessary to overcome functional alterations subsequent to organ and vital-system overload. The key elements in the progression of the sepsis-MODS syndrome are tied to numerous factors. These include: the severity and location of the lesion; the patient's age; the remaining functional reserve; the presence of mediatory which may be stimulatory, inhibitory or both.

Soon after losing her own daughter in a tragic accident, Hon returns to her childhood home in the Korean countryside after many years away. Her father, a cattle farmer, is elderly and requires her care. He is withdrawn, kind but awkward around his own daughter. As time passes however, Hon realises that her father is far more complex than she ever realised. The discovery of a chest of letters and conversations with his family and friends help Hon piece together the tumultuous story of his life. She learns of her father's experiences during the Korean War and the violence of the 19th April Revolution; of a love affair and involvement in a religious sect; of his sacrifice and heroism and of the phantoms that haunt him. As she unravels secret after secret, Hon grows closer to her father, realising that his lifelong kindness belies a past wrought in both private and national trauma. More than just the portrait of one man, I Went to See My Father opens a window onto humankind, family, loss and war. It asks us to look at the ones we love, uncover the secrets they keep, and finally see who they really are. Flawlessly rendered by award-winning translator Anton Hur, Kyung-Sook Shin has crafted a novel both affectionate and epic, joyous and lasting.

Trauma, Abandonment and Privilege discusses how ex-boarders can be amongst the most challenging clients for therapists; even experienced therapists may unwittingly struggle to skilfully address the needs of this client group. It looks at the effect on adults of being sent away to board in childhood and the problems associated with boarding, which have only recently been acknowledged by mainstream mental health professionals. This practice-based book is illustrated by case studies, diagrams and exercises and is divided into three parts: 'Recognition; Acceptance; Change'. It aims to help readers understand the emotional processes of boarding and the psychological aspects of survival, outlining the steps toward recovery and the repercussions of survival. The book also explores how ex-boarders frequently struggle with intimate relationships with spouses and partners and offers interventions and strategies for those working with ex-boarder clients. Trauma, Abandonment and Privilege will be of interest to therapists, counsellors and mental health workers across the UK. It will also be relevant to those who are well acquainted with boarding schools based on the UK model, for example in Canada, Australia, New Zealand and India.

This practical and accessible handbook introduces the non-specialist surgeon to vital aspects of injuries to the neck. The author familiarises the reader with the regional pathology and related clinical facts for almost every conceivable injury to the neck. The book has been written in such a way that it presents an easy format for quick reference. Over 100 of the author's hand-drawn diagrams support the text. As these are based on his own direct observations, the accuracy is unfailing, allowing precision in surgical diagnoses and management. Filled with practical advice, this comprehensive yet accessible source of information is invaluable for non-specialist surgeons experiencing neck injuries firsthand. This book provides also provides comprehensive inter-speciality information for clinical medical students and surgical trainees.

TRUE LIFE-AND-DEATH DRAMA

In taut, thrilling prose, Peter Canning has written a book that captures the rarely seen real world of emergency medicine. A seasoned paramedic who fights under enormous pressure to save lives, Canning trains new paramedics for the rigors of a nonstop, action-packed battle. From a four-month-old baby who has stopped breathing to a sixty-seven-year-old woman with a strange abdominal mass that threatens to explode--these are gripping true stories from the "ER on the streets." An exciting, often moving account, Canning tells a powerful story of camaraderie, selflessness, and courage as paramedics try to stand tall and human through both defeat and victory.

This diagnosis and management guide opens up a new frontier both for medical specialists and physical therapists dealing with vertigo sufferers. It presents a new original approach to diagnosis and rehabilitative treatment of vertigo and dizziness based on an innovative model of the vestibular system. It includes a detailed introduction to the MCS method, and a treatment program that involves mechanic, cybernetic, and synergetic aspects. Additionally, it provides a brief outline of the modern neurophysiological concepts behind the methodology.

The anesthesia and intensive care in infants and children have assumed positions of primary importance in contemporary medicine. In these delicate sectors of medicine, clinical research activities must be continually supported by interdisciplinary collaborations. Neonatal and pediatric intensive care requires that all involved physicians, including the surgeon and anesthesiologist, be willing to work together as a team. However, coordination of the various pathophysiological and clinical aspects of neonatal and pediatric critical medicine is highly complex. A complete and current review of the anaethesia and intensive care of infants and children must include discussions of morbidity rates, so as to guide the clincians in choosing the diagnostic approach, as well as of monotoring techniques appropriate to support the therapeutic decision. Recent progress in intensive care medicine for infants and children has been significant.

The critically ill patient in intensive care may present with serious metabolic alterations caused directly by the illness or secondarily by complications (e.g. infections, organ failure or sepsis) developing within a few hours of hospitaliza tion or in the following days. Among the situations which maintain and further trigger rapidly evolving altered metabolism are complex hormonal reactions, particularly those of the hypothalamus-hypophysis-adrenal axis, and abnormal stimulation of the autonomic nervous system. In fact, the sympathetic nervous system is known to cause significant metabolic alterations. For example, a surgery patient afflicted by septic complications may become hypercatabolic and experience significant nitrogen loss; the altered protein metabolism may in turn heavily influence carbohydrate and lipid metabolism as well. Thus, it is apparent that for optimal care of patients with altered metabolic functions, further knowledge is necessary regarding the physiopathology of metabolism and the physiopathological mechanisms, which alter the consump tion of principal energy substrates. Many experimental and clinical studies have investigated the metabolic aspects of individual organs or organ systems. However, for a correct evaluation of such metabolic events, in addition to studying the roles of metabolic enzymes, active metabolites, and the glutathione system, it is interesting to consider the use of indirect calorimetry as a valid and important investigative technique. The critically ill patient with major alterations in nutritional status may require artificial nutritive support administered through either parenteral or enteral routes."

The management of the critically ill patients has been in the past few years a discipline at the forefront of development which continues to make progress with the support of basic and clinical research. This work is a collection of material that deals with the management of critically ill patients, published on the occasion of the 13th APICE congress in November 1998, which celebrated 40 years of Critical Care Medicine.

Management of the intensive care patient afflicted by respiratory insufficiency requires knowledge of the pathophysiological basis for altered functions. The etiology and therapy of pulmonary diseases, such as acute respiratory distress syndrome (ARDS) and chronic obstructive pulmonary disease (COPD) are highly complex. While physiologists and pathophysiologists work prevalently with theoretical modes, clinicians employ sophisticated ventilation support technologies in the attempt to understand the pathophysiological mechanisms of the pulmonary diseases which can present with varying grades of severity. Despite the availability of advanced technologies it is common to personalize the treatment protocol according to the patient's physiologic structure.Given the complexity and difficulties of treating respiratory disease, a strong collaboration between clinicians and physiologists is of fundamtental importance.

Trauma has assumed a prominent role in contemporary medicine as an event that can significantly influence clinical variables such as morbidity, functional deficits and consequential disability, and mortality. Trauma is the principal cause of death in the population below 40 years of age in industrialized coun tries. Therefore, there is great interest in studying traumatic events from both the clinical and epidemiological viewpoints. The importance of trauma is exem plified by the fact that in many countries the trauma patient is first treated in specialized "trauma centers," in which the diagnostic and treatment processes are facilitated by the 24-hour presence of personnel having interdisciplinary competencies. Trauma in this context consists of any acute, often unexpected, condition. Many of the medical difficulties associated with trauma occur in a relatively brief period that spans from the first call for help to the initiation of first aid measures. A correct approach depends on the availability of experienced personnel. The first measures of aid must guarantee, above all, the patient's survival. The most critical, initial phases of care to trauma patients are represented by the triad: first aid, triage, and transport. Specific morbidity indices, whether anatomical, func tional or mixed, are indispensable elements for monitoring a patient's clinical evolution. The immediate availability of "essential" drugs is imperative to con front the clinical situations that often present in the acute post-traumatic phase."

Real-life case studies are used in delivering practical advice and information on specific aspects of care delivery and risk management. The experience of the patient is the main focus, making this an invaluable text for all those involved in the trauma and recovery process.An essential text providing a team-based structure for the delivery of optimum trauma care Offers advice on how to get the best out of staff working in the unpredictable, often stressful environment of the trauma unit Features real-life case studies focusing on the experience of the patient

Since the 1980s, ankle arthroplasty has been considered a dubious treatment for painful and degenerated joints. Many of the concerns that existed previously have been solved today. Prosthetic replacement of other joints also took a long time before reaching their present successful status. This is the first book to deal with ankle arthroplasty. International experts have given their opinion on (i) the kinematics of the ankle; (ii) the basics of replacing the ankle joint; and (iii) the current status of several modern ankle-prosthesis designs. A better understanding of the ankle kinematics, alignment techniques and biological stabilisation and the results of newer designs have changed the former attitude worldwide. The content of this book bears evidence for this change in opinion.

Sepsis represents a life threatening condition to ICU patients. The evolution of sepsis to severe sepsis or septic shock may occur in an unpredictable way. In the coming millennium the prevention and management of sepsis and organ dysfunction will present a real challenge for researchers and clinicians.

This major reference work is the most comprehensive resource on oncologic critical care. The text reviews all significant aspects of oncologic ICU practices, with a particular focus on challenges encountered in the diagnosis and management of the critically ill cancer patient population. Comprised of over 140 chapters, the text explores such topics as the organization and management of an oncologic ICU, diseases and complications encountered in the oncologic ICU, multidisciplinary care, surgical care, transfusion medicine, special patient populations, critical care procedures, ethics, pain management, and palliative care. Written by worldwide experts in the field, Oncologic Critical Care is a valuable resource for intensivists, advance practice providers, nurses, and other healthcare providers, that will help close significant knowledge and educational gaps within the realm of medical care for critically ill cancer patients.