The acute abdomen often perplexes the expert as well as the young physician. There are few areas in medicine in which Hippocrates' aphorism-the art is long, life is short, decision difficult, and delay perilous-is more applicable than here. Too often the harried physician fails to listen to the patient who is trying desperately to suggest the diagnosis. The significance of various types and location of pain often are neglected by the doctor. Physical findings are influenced by experience; the presence or absence of tenderness or a mass may be answered in entirely different ways by various observers. Because solid facts frequently are lacking, attempts to resolve diagnostic dilemmas by computer analysis or by algorithms are not likely to be successful. Fortunately, in the great majority of cases, unusual and difficult diagnostic procedures are not necessary for the identification of the acute abdomen and of the major disease. Astute clinical judgment must be based primarily upon careful attention to the pa tient's words and detailed observation."

The Police Emergency Unit concept for our Community has proven to be unique and highly practical. Highly skilled teams of college trained, physician- supervised Police Offi cers render emergency care for trauma and illness with remarkable expertise. The roving, constantly on duty concept has distinct merits. It does provide a low cost system to en sure the delivery of emergency medical care to a community with a minimum of confu sion and a maximum of efficiency. Special acknowledgement is noted herewith for Mrs. Candace Otte, R. N., Dr. Frede rick A. Doornbos, Dr. Ramon B. Lang, Dr. Lee R. Pool, Dr. John R. Wilson, and P. Rode rick Smithson, the E. M. T. County Coordinator. Emergency Unit Calls for Metropolitan Grand Rapids and Kent County Grand Rapids (2 Units E-1 and E-2) January 1973 thru December 1973 P. 1. Accidents 1237 Cardiac 410 Disregarded 76 Others 805 D. O. A. 's 114 Code K's 30 Total: 2672 Average Per Day 7. 3 Kent County (3 Units E-66, E-67, E-68) August 1973 thru April 1974 P. I. Accidents 553 Cardiac 202 Disregarded Others 241 Not Applicable D. O. A. 's l3 Code K's 3 Total: 1017 Average Per Day 4. 1 Wyoming (1 Unit E-50) February 18, 1974 thru May 8, 1974 P. I. Accidents 57 Cardiac 50 Disregarded Others 135 Not Applicable D. O. A. 's Code K's Total: 242 Average Per Day 3. 0 Kentwood (1 Unit E-35) P. I."

Re-Circuiting Trauma Pathways in Adults, Parents, and Children presents the evidence-informed and substantiated Intergenerational Trauma Treatment Model (ITTM), with an emphasis on up-to-date trauma theory, the development of specialized clinical skills, and the replicability of methods. Grounded in original research, experiential practice, and mathematical principles of logic, the ITTM targets and treats both the child's and the caregiver's complex trauma, providing the content and the process for supplying an effective, and brief, caregiver-first treatment option. It delivers an innovative, multigenerational approach to complex trauma treatment that strengthens the caregiver-child relationship by motivating and teaching caregivers to help their children cope with the effects of trauma.

Die Behandlung der aktuten respiratorischen Insuffizienz steht hiiufig im Mittelpunkt therapeutischer Bemiihungen warnend der postoperativen Phase sowie in der Intensivmedizin. Entsprechend lag und liegt das wissenschaftliche Hauptinteresse zahlreicher Arbeitsgruppen verschiedenster medizinischer Fachrichtunge- von der Physiologie liber die Pathologie, Rontgenologie, Chirurgie, Innere Medizin bis hin zur Aniisthesiologie und Intensivmedizi- im Bemiihen, den Pathomechanismus der akuten respiratorischen Insuffizienz aufzukliiren und hieraus therapeutische Konsequenzen zu entwickeln. Das vorliegende Heft beinhaltet Vortriige, die auf einem inter- nationalen Symposium, veranstaltet yom Institut flir Aniisthesiolo- gie der Universitiit MUnchen, gehalten worden sind. Die themati- sche Palette reicht von der Darstellung der normalen Lungenfunk- tion bis hin zur Diskussion detaillierter Fragen der Beeinflussung von PEEP auf die Hamodynamik. Es wird die pathologische Anato- mie der akuten respiratorischen Insuffizienz dargestellt, das rontge- nologische Substrat bei dieser Erkrankung diskutiert und die ver- schiedensten therapeutischen Verfahren werden angesprochen. Von besonderem Interesse wird flir Experten die Diskussion der Frage nach der Bedeutung des !lerzens, insbesondere des rechten Ven- trikels unter den Bedingungen der respiratorischen Insuffizienz sein. Es ist das liel der Zusammenstellung der verschiedenen Sympo- siumsbeitrlige, fdr Studenten wie auch fUr Arzte, die an Fragen der Intensivmedizin interessiert sind, eine lesenswerte Arbeitsgrundlage zu schaffen. Mein Dank gilt deshalb den Autoren sowie dem Springer-Verlag.

F.A. Bauhofer, Geneva In disaster situations, the particular concern of WHO is not so much to offer immediate relief and assistance for affected communities, but to have ready prepared plans for the provision of primary medical care as well as for resuscitation and casualty services. Disast ers are characterized by a need for rapid assistance and by the inability of affected communities to cope with the large scale mortality, morbidity, and damage to essential installations and homes. In some highly elaborate and centralized societies even small scale events may assume the proportion of a disaster, if they result in the serious break down of vital services. The Executive Board of the World Health Organization has defmed disasters or "emergencies," as situations where there are unforeseen, serious, and immediate threats to public health. Particularly severe disasters may be classified as catastrophes; such -occurrences, whether natural or man-made, disturb or overthrow the existing order. For planning purposes, it is important to distinguish between different types of catastrophes since they require special relief measures. In the past, medical assistance was primarily needed in epidemics of, for example, plague, cholera, and smallpox. Today, health authorities face emergency problems brought about by major accidents and outbreaks of chemical pollution and poisoning, which may have long-term effects. The role of health services may differ quite extenSively in different types of cata strophes, and an attempt must be made to draw up specific plans to deal with them."

This volume contains the results of the 7th International Symposium on Acute Care, held in Rio de Janeiro from 21st to 24th November 1977. I would like to thank all the participants for their wonderful cooperation which made this Symposium a real success. I am especially grateful to the excellent speakers from all special ist fields and from all nations: I assure you, we all learned a great deal I would also like to thank the members of the organizing and scientific committees whose combined efforts ensured the smooth running of the Symposium, a meeting with a high-level discussion of scientific and philosophic problems as its goal. But first and foremost, we should like to express profound gratitude to the man whose idea it was to hold an annual conference in Rio: Dr. Brenildo Tavares, the Director of the Rio Symposia on Acute Care. He is one of the great pioneers of intensive, critical, acute, and emergency care, not only in.south America, but allover the world. The secret of the success of his symposia lies in his interdisciplinary and international approach. The symposia have brought together a great number of people who have since become close friends and continue to meet throughout the world. We all congratulate and thank him and wish him much success in the future."

The backbone of in-patient care is the hospital ward, and I believe that this will remain so in the future. Shortcomings in the staffing, organization and layout of the conventional ward have been recog nized for a long time, but there have been few changes and not all these have benefited the patient. The evolution of specialized treat ment centres for poliomyelitis, thoracic surgery, burns and so on, showed the need for a new staffing structure-a re-organization of patient care and of secondary importance, new forms of accom modation. These regional or referral centres serve large populations or areas and are collectively known as specialized intensive care (or therapy) units. The idea of using similar principles of staffing, organ ization and facilities to serve each large district hospital came much later (1959) and was first applied in the United States. Thus, the general intensive care unit was born, a unit which would treat critically ill patients irrespective of the nature of their disease, in sharp contrast to the specialized intensive care unit. The staffing structure and technologies of the two are however similar. Special ized intensive care consists of a single speciality or two specialities, for example thoracic surgery and thoracic anaesthesia. General intensive care cannot be a speciality because it embraces the whole of acute medicine, acute surgery, accident surgery, toxicology and many more individual specialities. This very diversity makes it difficult to organize, but interesting to perform.

Global and national confidential inquiry reports show that 60 to 80% of maternal and neonatal morbidity and mortality are due to avoidable errors. This comprehensive and illustrated second edition offers a practical guide to the management of obstetric, medical, surgical, anaesthetic and newborn emergencies in addition to organisational and training issues. The book is divided conveniently into nine sections and updated throughout in line with modern research and practice. Several new chapters cover setting up skills and drills training in maternity services to reduce avoidable harm, managing obstetric emergencies during 'home births' and in low-risk midwifery units, and minimizing maternal and fetal morbidity in failed operative vaginal delivery. Each chapter includes a practical algorithm for quick reference, the scientific basis for proposed actions, a case-based practical exercise and useful learning tools such as 'Key Pearls' and 'Key Pitfalls'. An invaluable resource for obstetricians, neonatologists, midwives, medical students, anesthesiologists and the wider perinatal team.

This scenario-based text provides answers to urgent and emergent questions in acute, emergency, and critical care situations focusing on the electrocardiogram in patient care management. The text is arranged in traditional topics areas such as ACS, dysrhythmia, etc yet each chapter is essentially a question with several cases illustrating the clinical dilemma - the chapter itself is a specific answer to the question.

This is a unique format among textbooks with an ECG focus. The clinical scenarios cover the issues involved in detecting and managing major cardiovascular conditions. Focused, structured discussion then solves these problems in a clinically relevant, rapid, and easy to read fashion.

This novel approach to ECG instruction is ideal for practicing critical care and emergency physicians, specialist nurses, cardiologists, as well as students and trainees with a special interest in the ECG.

Diagnostik und Therapie sind die Pfeiler, auf denen die Medizin ruht. Beide wurden in der letzten Zeit wesentlich erweitert und vertieft - teils zum Nutzen der Patienten, teils aber auch zu deren Nachteil. Betroffen sind alle Fachgebiete der nicht-operativen Medizin inklusive der Pneumologie. Im Bereich der Pharmakotherapie von Lungenerkrankungen fehlte bisher ein Nachschlagewerk im deutschen Sprachraum. Meistens wird das Thema lediglich kursorisch in Lehrbuchern der Inneren Medizin und Pneumologie abgehandelt: Wenig vertieft bzw. kritisch abgehandelt mit Therapieempfehlungen ohne wissenschaftliche Evidenz. Erstmalig im deutschen Sprachraum liegt nun dieses fachbezogene Lehrbuch mit neuesten Erkenntnissen der Pharmakotherapie vor. Es wendet sich vor allem an Internisten und Pneumologen, ist aber auch fur Padiater, Thoraxchirurgen und Allgemeinarzte von grossem Interesse.

Traditional Doctor / Nurse boundaries are being eroded with nurses expanding their sphere of practice to encompass assessment skills and enable them to manage total episodes of patient care with true autonomy (DOH 2000). More recently we have seen the emergence of Nurse Practitioners undertaking this advanced level of health assessment in the acute medical arena. This book will support the decision-making process and treatment that can be offered by these individuals.

"Acute Medicine - A Handbook for Nurse Practitioners"is an up-to-date, practical and comprehensive guide, offering invaluable information and advice on the management of acute medical conditions. Key features include:

Assessment, investigation, diagnosis and management of the most acute medical conditions A guide through the management of the patient and identification of priorities for treatment Legal, professional and ethical issues faced by nurses working at an advanced level Role development The development of protocols and prescribing Examples of Clinical Management Plans for the supplementary prescriber and Patient Group Directions to support practice

Written by an experienced Consultant Nurse in Acute Medicine, this engaging book will serve as a text from which the busy and highly skilled nurse can refer to for information on assessment, diagnosis and management of acute medical conditions.

This book aims to challenge and change unhelpful attitudes to those who suffer traumatic reactions, to show that they are not signs of weakness or a personality disorder and that there is understanding and help available for those who suffer. It draws on personal and professional experience. The author has worked as a counsellor, practising the psychological debriefing he describes in detail, dealing with many different kinds of traumatic events. He describes theories and methods used for understanding traumatic stress and outlines the history of treatments offered, up to the present. There are also descriptions of the coping strategies used by professionals in the Emergency and Social Services, which are also found in civilian organisations and in society in general.The author describes personal experience, counselling and psychological debriefing. (Prison Riots, armed robberies, traffic accidents, rape, aid agency personnel, bomb-disposal, military families held hostage, Army War Graves' Registration Team).The diagnostic criteria and symptoms of Post-Traumatic Stress and Post-Traumatic Stress Disorder are outlined in detail, with examples. Although Post-Traumatic Stress and Post-Traumatic-Stress-Disorder cannot be understood without reference to the military experience of war and combat, examples are given from both military and civilian experiences of trauma.Helpful resources are listed: organisations offering help & support to those who suffer and their families; and key books.

Emergency care is improving throughout the world and thousands of lives are being saved each year. However, there are still too many patients who die before help reaches them in the form of advanced rescue and definitive emergency care techniques. In an effort to improve emergency care throughout the world, the International Committee of Emergency and Disaster Medicine meets bi annually. This meeting takes place in Mainz, Germany in September in order to discuss issues, exchange information, and establish re commendations designed to improve emergency care. The group is in dependent of political, national, racial, religious, or commercial influences and, in this sense, similar to the Club of Rome which attempts advances in sociology, biology and natural sciences. There fore, the organization could be called the "Club of Mainz" for the field of emergency and disaster medicine. The following book contains the proceedings of the International Symposiom on "Mobile Intensive Care Units and Advanced Emergency Care Units" at Mainz from September 24-27, 1973, and the discussions evoked by the first activities of the "Club of Mainz" and the inter nationally acknowledged "Recommendations." At this time we also announce the next meeting and International Symposium on Disaster Medicine, open to the public, organized by the "Club of Mainz" (October 1 - 2, 1977)."

Group Treatment for Post Traumatic Stress Disorders is a collection written by renowned PTSD experts who provide group treatment to trauma survivors. The book reviews the state-of-the-art applications of group therapy for survivors of trauma such as: rape victims, combat veterans, adult survivors of childhood abuse, motor vehicle accident survivors, trauma survivors with co-morbid substance abuse, survivors of disaster, families of trauma survivors, homicide witnesses and survivors, and disaster relief workers. This book a unique contribution to the field. Each chapter provides a detailed and comprehensive description of state-of-the-art group treatment and artfully combines scholarly review with a step-by-step summary of treatment rationale and methods. Furthermore, the book covers a wide scope, typically found only in large, multi-volume compendia. Group Treatment for Post TraumaticStress Disorders is ideal for clinicians, aspiring clinicians, researchers and educators. It provides a unique and eminently readable summary of group therapy applied to increasingly recognized clinical populations.

Comparatively little is known about the risk of sudden death associated with exercise in young competitive athletes, and whether the benefits of sports activity outweigh the hazards of exercise-related fatal events is a clinical dilemma. This is only a small part of the story, however, as there are considerable effects of exercise whether it be at a competitive level or on a leisure level on patients of all ages. This in itself is of massive importance to the cardiac patient population as exercise is a key component of effective recovery and recommended as central in the prevention of much cardiac disease."

Children and infants comprise up to 20% of emergency department visits, and emergency physicians must be knowledgeable in choosing the most appropriate imaging modality to arrive at an accurate diagnosis and provide optimal patient care. Written specifically for the non-specialist and those with limited pediatric training, Pediatric Imaging for the Emergency Provider provides expert guidance in this challenging area. Abundant high-quality imaging examples cover the full range of pediatric disorders you're likely to see, including trauma, musculoskeletal, pulmonary, ENT, cardiac, genitourinary, gastroenterology, neurological, and neonatal patients. Presents more than 80 common and important rare cases, supported with 450+ images across relevant modalities including ultrasound, radiography, CT, and MRI. Identifies key radiographic findings for various pediatric conditions including congenital heart lesions, surgical entities, infectious disease processes, and traumatic injuries. Accompanies images with clear, concise text that makes it easy to grasp the most clinically significant points of each case. Provides expert guidance on best practices in important areas of pediatric imaging such as sedation, ionizing radiation exposure reduction, and imaging modality selection. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.

What is posttraumatic stress disorder (PTSD), and who experiences it? Why do some people develop PTSD after a traumatic event, while others do not? What are the unique impacts of trauma on children? Are there effective treatments for traumatic stress disorders? PTSD: What Everyone Needs to Know is a scientifically-supported yet accessible resource on a disorder that affects up to 7% of adults during their lifetime. Utilizing a reader-friendly Q&A format, the book demystifies and defines PTSD, explaining that, despite popular opinion and countless media portrayals, this is not simply a disorder for combat veterans. Instead, survivors of any life-threatening event can experience PTSD. Beginning with an overview of common types of trauma, internationally-renowned experts on traumatic stress Barbara Rothbaum and Sheila Rauch then go on to describe the effects of PTSD, what can trigger the disorder, and who is likely to experience it. They explain how the most effective treatments work, and guide readers on how to be a source of support and understanding for those who have experienced trauma. Drawing attention to the pervasiveness of traumatic experiences in our lives and in culture and society, PTSD: What Everyone Needs to Know is a must-read for anyone seeking authoritative and current information about this often misunderstood disorder.

Stories of life, death and unforgettable clinical cases A psychiatrist and a patient with supernatural connections. A family man's resilience as he recovers from a life-changing terrorist attack. A rural nurse specialist and his incredible roadside rescue of a woman on the brink of cardiac death. A trauma therapist caught in the aftermath of a violent methamphetamine episode. The Unexpected Patient tells the stories of patients who impacted health carers in unforgettable ways: patients who showed stubborn perseverance on the road to recovery, who clung to hope in the face of unexpected trauma, and who illuminated the indomitable depths of the human spirit. These stories look at the things that lead to bad health outcomes, from the seeds that are set before we are born, to the personal choices we make, and to societal and health sector shortcomings. Yet, ultimately, The Unexpected Patient is about human relationships and the bonds forged between two people: a medic and that one, unforgettable patient.

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.

The Managing Obstetric Emergencies and Trauma (MOET) course teaches the practical skills and procedures needed to save the mother and fetus in life-threatening circumstances. The course includes lectures, skills stations and workshops covering: resuscitation of the mother and newborn, including cardiopulmonary resuscitation, amniotic fluid embolism, pulmonary embolism and airway management; trauma, including shock, spine and spinal cord injuries and musculoskeletal trauma; obstetric emergencies, including pre-eclampsia and eclampsia, shoulder dystocia, umbilical cord prolapse and anaesthetic emergencies; and triage and transfer. The Manual provides readers with a structured preparation and revision system for the course. It provides essential anatomical, physiological and pathological information which the authors use to explain basic logical principles of resuscitation and treatment. Based on sound principles, this comprehensive handbook is easy to read and provides useful practical advice and management plans, and will be of use to all those working in obstetrics as well as to course delegates.

No local, os segundos contam. PHTLS: Suporte de Vida em Trauma Pre-hospitalar ensina e reforca os principios em avaliar rapidamente um paciente de trauma usando uma abordagem ordenada, tratando imediatamente os problemas com risco de vida, a medida que eles sejam identificados, e minimizando quaisquer atrasos em iniciar o transporte a uma destinacao apropriada. Desenvolvido pela Associacao Nacional de Tecnicos de Emergencia Medica (NAEMT) em colaboracao com o Colegio Americano do Comite dos Cirurgioes de Traumas (ASC-COT), o PHTLS, Nona Edicao reflete os conhecimentos e praticas atuais com base em evidencias, e promove o pensamento critico como a base para fornecer cuidados de qualidade. Avaliar rapidamente um paciente de trauma para identificar os cuidados de salvamento constitui o centro da nona edicao do PHTLS. Leva 2 minutos ou menos para um paciente exsanguinante. Nenhuma outra intervencao pre-hospitalar que os prestadores de cuidado realizam e mais importante do que parar esse nivel de sangramento em pacientes de trauma. A fim de refletir isso, o PHTLS, Nona Edicao utiliza a mnemonica XABCDE de avaliacao do paciente para colocar a hemorragia exsanguinante a frente de cada encontro com o paciente. A importancia de XABCDE (hemorragia grave exsanguinante, vias aereas, respiracao, circulacao, incapacidade neurologica e exposicao ao ambiente) e reforcada em cada capitulo clinico. Caracteristicas do PHTLS, Nona Edicao: Informacoes atuais sobre ressuscitacao com fluidos e imobilizacao espinhal a partir de pesquisas com base em evidencias e experientes provedores de cuidados pre-hospitalares que aplicam os principios e as praticas do PHTLS no local Tecnicas atualizadas de tratamento do paciente, incluindo colocacao de torniquete, locais de descompressao com agulha, o uso de ligantes pelvicos, ressuscitacao pediatrica com fluidos e manejo pediatrico das vias aereas Enfase em lesoes evitaveis, desde dirigir distraido ate quedas em adultos idosos, e violencia entre parceiros intimos Foco em ameacas e respostas tacticas civis, desde veiculos como armas de destruicao em massa ate um novo fluxograma de metodologia de avaliacao remota Componentes Dinamicos do Programa O manual do PHTLS, Nona Edicao e o recurso definitivo em cuidados de trauma que detalha as evidencias medicas por tras dos principios e praticas recomendados do curso do PHTLS. Como proximo passo na evolucao do programa do PHTLS, o manual principal sera acompanhado pelo novo manual do curso do PHTLS, que reforca e esclarece os conceitos-chave do curso; apresenta um design envolvente e interativo; e esta escrito de modo que voce sente estar participando de um bate-papo, versus ouvindo a uma aula expositiva.

This workbook addresses the vital questions helpers, responders, and organizations have about self-care and its relationship to resilience and sustained effectiveness in the midst of daily exposure to trauma victims and or situations. Packed with activities, worksheets, and interactive learning tools, the text provides neuro-based and trauma-sensitive recommendations for improving the ways clinicians care for themselves. Each 'session' helps clinicians identify their personal self-care needs and arrive at an effective self-care plan that promotes resilience in the face of daily exposure to trauma-inducing situations and reduces the effects of compassion fatigue and burnout. Reducing Compassion Fatigue, Secondary Traumatic Stress, and Burnout is an essential workbook for any helper or organization looking to enhance compassionate care.

Mapping Trauma and Its Wake is a compilation of autobiographic essays by seventeen of the field's pioneers, each of whom has been recognized for his or her contributions by the International Society for Traumatic Stress Studies. Each author discusses how he or she first got interested in the field, what each feels are his or her greatest achievements, and where the discipline might - and should - go from here. This impressive collection of essays by internationally-renowned specialists is destined to become a classic of traumatology literature. It is a text that will provide future mental health professionals with a window into the early years of this rapidly expanding field.