The yearbook compiles the most recent, widespread developments of experimental and clinical research and practice in one comprehensive reference book. It is an excellent source for all clinical physicians.

Developments in surgery have enabled more ambitious operations to be attempted than ever before, while similar advances in anaesthesia and monitoring have meant that many patients who were previously considered unfit now undergo surgery. It is essential that standards of patient care during surgery are continued post-operatively until the depressant effects of anaesthesia have worn off and it is safe for patients to return to the wards or to their homes. The importance of adequate supervision by well-trained nurs ing staff in properly equipped surroundings has been recognised by the introduction of recovery rooms in most hospitals. Despite this, many patients still emerge from anaesthesia in wards or departments where they are supervised by inexperienced nursing staff in unfamiliar surroundings. Recovery from anaesthesia may be accompanied by a variety of dangerous and potentially fatal complications, many of which can be avoided by the detection of early warning signs and the institution of appropriate therapy before an irreversible situation is allowed to develop. This book describes the major complications liable to be encountered and suggests how they may be avoided by careful monitoring, vigilant nursing and sound organisation. The patient's behaviour at recovery is influenced by his pre-operative condition, by drug therapy pre- and intra-operatively and by the nature of the surgery, and sections have been devoted to these aspects since a basic understanding of them is essential in anticipating events in the recovery room."

In Living and Surviving in Harm's Way, experts investigate the psychological impact of how warriors live and survive in combat duty. They address the combat preparation of servicemen and women, their support systems, and their interpersonal and intrapersonal experiences. The text maintains a focus on cognitive-behavioral interventions for treating various combat-related disorders, and addresses psychological health and adjustment after leaving the battlefield. The text is logically organized for easy reading and reference, and covers often overlooked topics such as preparation and training of service personnel, women in combat, and the indirect effects of combat stress on family. This book is written by clinicians who have in some ways experienced what they write about, and resonates with mental health professionals, servicemen and women, and their families. Any clinician hoping to treat a serviceman or woman effectively cannot afford to overlook this book.

This title introduces and examines a number of current debates in the UK in the accident and emergency speciality. It allows the practitioner to consider modern accident and emergency nursing and its implications for the practitioner and society.;This book should be of interest to qualified accident and emergency nurses, and to student nurses on Accident and Emergency.

A pocket-sized self-test book designed for junior doctors. It features not only multiple choice questions, but also case histories, questions on ECGs, data interpretation, x-ray and picture questions. The range of subjects covered is comprehensive and the answers informative and unambiguous. Designed for junior doctors, Self Assessment in Accident and Emergency Medicine features not only MCQs but also case histories, questions on ECGs, data interpretation, X-ray and picture questions. The range of subjects covered is comprehensive, covering all the common problems encountered in the Accident and Emergency Department. Also included are the rarer conditions which many inexperienced doctors find difficult to diagnose. This entertaining and informative guide provides a convenient way of aquiring information and testing knowledge for all doctors working in A&E. It will also become an indispensible study aid for candidates for the Accident and Emergency Fellowship and the Accident and Emergency Faculty exams.

The management of emergent neuro-ophthalmic conditions can be a life-saving encounter for the general ophthalmologist. This book covers life-threatening scenarios that a general ophthalmologist might encounter, and is designed to help the ophthalmologist make emergency triage decisions for initial evaluation and treatment of potentially vision- or life-threatening conditions. This book is case based, and provides the reader with the invaluable expert views of two neuro-ophthalmologists. One, Dr Lee is an ophthalmology-based neuro-ophthalmologist and the other, Dr Brazis is a neurology-based neuro-ophthalmologist. Dr Mughal and Dr Policeni collected and collated the case vignettes during their fellowship with Dr Lee at the University of Iowa Hospitals and Clinics. This textbook provides a concise, easy to read, and practical guide to the emergent evaluation of neuro-ophthalmic conditions. It is designed to be a quick read and not to be all-inclusive or comprehensive. The reader is directed to longer and more comprehensive neuro-ophthalmic texts for this information. It is also not the aim of the book to provide information on anatomy, pharmacology, physiology, or other basic mechanisms of disease. Instead, this text is meant to be a quick reference and resource for the clinician in the emergency room or in the clinic facing a potentially vision- or life-threatening emergency and to provide immediate guidance for potentially "high stakes" decision making. The case vignettes are based upon real clinical cases but the clinical details of each case have been modified for teaching purposes and represent composite rather than individual histories.

Epidural opioids are widely used in the management of post- operative pain. On the basis of an extensive review of the literature the authors here present their own interpretation of current knowledge of how the distribution and effectiveness of epidurally administered opiods are fundamentally determined. They conclude that all opioids that are currently being used to treat postoperative epidural pain carry the potential risk of severe side effects if the dose regimens are not tailored to the patients individual analgesic need. This book will serve to stimulate new ideas among pain specialistst.

Recent technological innovations - influenced primarily by the development of more sophisticated, faster and cheaper computer systems - permitted also the evolution of more affordable systems for Patient Data Management, so called PDM-Systems. The experience of the authors, on one of the first PDMS installation sites in Europe, shows that the purchase of such a system is not an easy task, since accurate data are not available in a comparable format. Therefore the first part of the book is devoted to a comparison of already installed, commercially distributed bedside based PDMS with regard to their specifications, functions and performance. The methods included a questionnaire with detailed questions for the vendors to answer and a "table of functions" comparing the most important functions which should be included in a PDMS. With that list the different systems (which were all in clinical use) were checked for the availability and the way of use of these functions. To evaluate variations in the systems performance an "information retrieval test" was designed and executed. In the second part the different vendors, whose systems were included in the study, were to describe the systems from their viewpoints. The third part contains papers describing the users' experiences. The fourth and last part shows how to use PDMS-data for scientific and therapeutic purposes including two papers on clinical expert systems. Thus, this book provides valuable information for clinicians and hospital managers who have to decide on the purchase of a Patient Data Management System.

E.MARTIN Acute pain services are now established worldwide and guidelines have been drawn for the management of acute pain resulting from surgical or medical procedures and trauma. However, the treatment of pain after surgery is still inadequate and no progress has been made in recent years in several coun tries, including Germany. There are still innumerable patients who find the is also no early postoperative period to be an unpleasant experience. There doubt that pain plays a role in the pathogenesis of postoperative complica tions that could be avoided with effective pain management. However, concern about side effects and inadequate knowledge of the pharmacokinet ics and -dynamics of drugs is still putting constraints on treatment. An acute pain service should be responsible for adequately treating pain, training medical and nursing staff, and evaluating new and existing methods of treatment. As anesthesiologists deal with pain in the operating theater, it is not surprising that they claim a leading role for themselves in acute pain services choosing from the various postoperative pain treatment options."

The Yearbook compiles the most recent, widespread developments of experimental and clinical research and practice in one comprehensive reference book. It is addressed to everyone involved in internal medicine, anesthesia, surgery, pediatrics, intensive care and emergency medicine.

High quality critical care medicine is a crucial component of advanced health care. Completely revised and updated, Key Topics in Critical Care, Second Edition provides a broad knowledge base in the major areas of critical care, enabling readers to rapidly acquire an understanding of the principles and practice of this area of modern clinical medicine. Expanded to include the latest hot topics, the new edition puts an increased emphasis on recent reviews and contains added references to key landmark papers. Using the trademark Key Topics style, each topic has been written by an expert in the field and includes a succinct overview of the subject with references to current publications for further reading. The book provides a framework for candidates of postgraduate medical examinations such as FRCS, MRCP, and FRCA and a reference that can be consulted in emergency situations. New topics include: Critical illness polyneuromyopathy End of life care Inotropes and vasopressors Medical emergency team (outreach critical care) Status epilepticus Venous thromboembolism

H. KIESEWETTER, J. KosciELNY, and F. JuNG Tbe byperoncotic colloid-osmotic pressure of tbe 10% Haes solution causes an increased intravascular volume because free tissue water flows into the vascular system [206]. Witb a volume expansion effect of about 50% an increase in intravascular volume of 750 ml (500 mi Haes and 250 mi tissue water) is expected immediately after hypervolemic hemodilution, after isovolemic bemodilution only an in crease of 250 mi ( only tissue water due to a pblebotomy of 500 mi). The blood is diluted by overloading the vascular system [245]. After isovolemic bemodilution tbe dilution effect is more marked due to the pblebotomy. Estimated by means of the total protcin concentration (Fig. 67) the dilution of plasma was 22% 1 h after isovolemic hemodilution but only 14% after bypervolemic bemodilution. Tbe plasma dilutions were almost confirmed by the concentration changes of albumin (Fig. 68). Therefore, the mixing ratio is 4. 1 to 1 (plasma to bydroxyetbyl starcb) for bypervolemic infusion of 500 ml Haes-sterillO% (200/0. 5) and 3. 7 to 1 for isovolemic dilution. Consequently, the hydroxyethyl starch concentration after isovolemic hemodilution was signifi- cantly bigher at all measuring times tban after hypervolemic hemodilution (Fig. 61). If tbe infusion was performed quickly so that no renal output of the Haes solution could ensue, a mean bydroxyetbyl starch concentration of 10. 3 g per liter plasma would be expected immediately after isovolemic hemodilution for tbe above mixing ratio, and one of 9. 0 g after hypervolemic bemodilution.

This book is a critical response to a range of problems - some theoretical, others empirical - that shape questions surrounding the lived experience of suffering. It explores how moral and ethical questions of personal suffering are experienced, contested, negotiated and institutionalised. Bodies and Suffering investigates the moral labour and significance invested in actions to care for others, or in failing to do so. It also explores circumstances - personal, political and social - under which that which is perceived as non-moral becomes moral. Drawing on case studies and empirical research, Bodies and Suffering examines the idea of the suffering body across different cultures and contexts and the experience and treatment of these suffering bodies. The book draws on theories of affect, embodiment, the phenomenology of illness and moralities of care, to produce a nuanced understanding of suffering as being located across the assumed borders of time, space, bodies, persons and things. Suitable for bioethicists, medical anthropologists, health sociologists and body studies scholars, Bodies and Suffering will also be of use on health science courses as essential reading on suffering bodies, mental health and morality and ethics issues.

"Avoiding Common Prehospital Errors," will help you develop the deep understanding of common patient presentations necessary to prevent diagnostic and treatment errors and to improve outcomes. Providing effective emergency care in the field is among the most challenging tasks in medicine. You must be able to make clinically vital decisions quickly, and perform a wide range of procedures, often under volatile conditions.

Written specifically for the prehospital emergency team, this essential volume in the "Avoiding Common Errors Series" combines evidence-based practice with well-earned experience and best practices opinion to help you avoid common errors of prehospital care.

"Look inside and discover..."

- Concise descriptions of each error are followed by insightful analysis of the "hows" and "whys" underlying the mistake, and clear descriptions of ways to avoid such errors in the future.

- "Pearls" highlighted in the text offer quick vital tips on error avoidance based on years of clinical and field experience.

- Focused content emphasizes "high impact" areas of prehospital medicine, including airway management, cardiac arrest, and respiratory and traumatic emergencies.

It is often said that we live in a violent world. Traumatic injuries are commonplace; every hospital, large or small, sees scores of such patients daily. Appropriate diagnosis and management of the trauma patient are necessary not only to save lives but also to minimize the morbidity which follows injury. It is not surprising, therefore, that several books covering various aspects of trauma diagnosis and treatment are published annually. They are, however, seldom redundant because of the continuing rapid evolution of knowledge relating to the diagnosis and management of the traumatized patient. This volume, restricted to the consideration of thoracic trauma, represents a comprehensive and authoritative study of chest injury. Dr. Groskin is exceptionally well qualified to discuss his subject, being Board Certified in Internal Medicine, in Pulmonary Diseases, and in Diagnostic Radiology. He has practiced and taught in these disciplines in several prestigious institutions. The author has used his multidisciplinary background to develop a book which is unique among others of its kind. The reader will quickly appreciate that it is unusual in its correlation of clinical information with radiological diagnosis. Unlike any other book on traumatology with which I am familiar, this volume discusses extensively the mechanisms of injury which make both clinical and radiological findings easier to understand and to remember. It also presents a meticulous approach to the diagnosis of the many forms of thoracic trauma in which all clinical and radiological diagnostic modalities are thoughtfully integrated.

Only very few therapeutic modalities are used as extensively as mechanical ventilation in intensive care units, during anaesthesia and in emergency situations. Hence theoretical and practical knowledge in this technique had to be made available to workers in a number of medical specialities. In addition to anaesthetists, who are most familiar with artificial ventilation for historical and practical reasons, surgeons, internists, paediatricians and emergency physicians also need a foundation. Furthermore, the widespread application of this life-supporting method requires that paramedical personnel such as nurses and respiratory therapists be trained to use mechanical ventilation, to understand how it works and to be aware of specific side effects and dangers. This book, edited by Fran ois Lemaire, is a well-designed present ation of a number of the relevant aspects, types and problems of mechanical ventilation which are important for physicians and paramedical personnel who use it. After a description of the technical principles and maintenance of an artificial ventilator, the main part of the book is devoted to the most frequently used types of mechanical respiratory support, with their specific indications, the pathophysiology of their effects on pulmonary gas exchange and the specific choice and regulation ofthe mechanical variables involved. Older and new types of ventilatory support are discussed; there is a good balance of enough specific information for the inexperienced as well as a critical analysis of the indications for more exotic techniques, such as mandatory minute ventilation, independent lung ventilation and airway pressure release."

l. A. STURM In modern society, trauma remains the number one cause of death in people under 50 years, but, despite this, very little attention has been paid to trauma care compared with other diseases such as malignancy or myocardial infarction (Table 1). The efforts that have been made in medical care, however, have showed some success; for example although the frequency of traffic accidents in the Federal Republic of Germany has remained constant over the years, the number of deaths resulting from them has decreased (Fig. 1). The results of improvements in rescue systems, surgical techniques, and intensive care are evident, as shown by a review of the statistics of about 3000 multiple trauma patients treated in the last 15 years at the trauma de partment of Hannover Medical School which reflects the progress that has been made in medical care. After the problem posed by posttraumatic kidney failure had been solved in the 1960s and 1970s, the adult respiratory distress syndrome (ARDS) became the biggest problem in the 1970s and 1980s (Fig. 2). ARDS as a single entity disappeared in the literature in the early 1980s and was replaced by the so-called multiple organ failure (MOF) syndrome. Between 1985 and 1990 35% of the patients in our intensive care unit developed MOF, and 70% of them died. Overall MOF mortality has remained constant since 1985 at about 20% (Fig. 3)."

The Yearbook 1992 continues one part of the tradition established by the publication of updates. The Update Series itself will continue with several volumes being published per year on topical special issues. The Yearbookcompiles the most recent, widespread developments of clinical research and practice in one comprehensive reference book. It is addressed to everyone involved in cardiology, internal medicine, anesthesia, intensive care, surgery, pediatrics and emergency medicine.

Disturbances in peripheral O extraction can be produced in dogs treated with 2 endotoxin and thereby provide an opportunity to test theories for the origin of pathological O supply dependency or to try different treatment modalities. The 2 most serious deficiency in the current animal models is the inability to mimic the increased O demand that is observed in patients at 02 delivery rates in excess of 2 normal. A particular feature of this increased O demand is that it apparently does 2 not stimulate increased 02 extraction, although the limitation in O extraction has 2 not been explored in patients by lowering 02 supply, for obvious reasons. At least two possibilities to account for increased 02 demand could be investigated in animal models, however. The amount of 02 that is utilized in extramitochondrial pathways, which is normally on the order of 10%, may be greatly increased in ARDS and sepsis by O radical formation. There is presently no information 2 concerning how much 02 might be used in this way. Another strong possibility is that mitochondrial injury, perhaps as a result of 02 radical formation, uncouples oxidative phosphorylation. Some evidence presently in the literature supports this idea [19]. Indeed, the association of increased blood lactate levels with higher than expected 02 demands makes uncoupling a very attractive hypothesis that warrants further investigation in animal models using such agents as 2,4-dinitrophenol. References 1.

A comprehensive survey of recent advances is given in this Update. The wide spectrum of experimental and clinical investigations include the pathophysiologic, diagnostic and therapeutic aspects.

This book presents a comprehensive survey in which internationally recognized experts discuss specific topics. Physiological and biophysical foundations of hemodynamics are reviewed and clinical tools to evaluate these newer parameters are described. Monitoring strategies integrating theoretical and practical aspects of hemodynamics in commonly encountered ICU conditions are presented. This "Update" represents the series' continuous effort to combine the most recent developments in one reference source for all those involved in cardiology, internal medicine, pediatrics, anesthesia, intensive care and emergency medicine.

Kristina E. Schellinski uncovers the hidden trauma of the replacement child - born into an atmosphere of grief to substitute for a lost sibling or other person - and helps adult replacement children discover the uniqueness of their self. Schellinski combines Jungian theory with research from over 20 years of clinical practice to demonstrate how adult replacement children who suffer from physical and psychological distress can rediscover the essence of their being in the transformative process of individuation. Theoretical yet practical, the book discusses core concepts of analytical psychology, psychoanalysis and attachment theory, and detailed case studies address grief, guilt, identity formation, relational challenges and shadow aspects. Schellinski explores how Jung's birth after three dead children impacted his search for self and his theory and discloses her own personal experience. On treatment and prevention, she argues that by recognising elements of the condition, clinicians can facilitate acceptance, compassion and healing, and help reduce transgenerational transmission. This book is an indispensable tool for clinicians, analytical psychologists, psychodynamic psychotherapists and those in other medical professions, and will be of great interest to academics and readers interested in Jungian studies and existential questions. It offers adult replacement children and their families hope for a psychological rebirth.

Despite the wide array of services offered to students with learning disabilities, attention-deficit disorder, and a variety of comorbid conditions, large numbers of students are caught in the struggle of surviving school. Unfortunate school experiences may impact their sense of self and the degree of tenacity with which they pursue further training or challenging opportunities in the workplace. These are the people for whom educational therapy provides relief, enlightenment, and the coveted prize of success. The second edition of The Clinical Practice of Educational Therapy, the first textbook in its field, provides a comprehensive perspective of this interdisciplinary profession and practice, reaching out to a more global audience. The book describes the scope and practice of educational therapy from its European roots to its growing presence in the United States, providing readers with case studies and research that illustrate the work of educational therapists across the lifespan in diverse settings. Interdisciplinary Perspective - Other books focus on either educational or therapeutic interventions but rarely discuss the blend and synergy of disciplines (e.g., special education, neuropsychology, assessment, and social work) that are the hallmark of this unique profession. Illustrative Cases - The text draws heavily on case studies as a means of understanding the practice of educational therapy, especially the dynamic relationship that exists between therapist and client. Numerous charts and tables provide visuals for educational therapists as well as allied professionals, parents, and those with learning challenges. Expertise - The editors are both highly visible educational therapists. Chapter authors are either experienced educational therapists or allied professionals who have made scholarly contributions to the profession, such as Trisha Waters, Roslyn Arnold, and George McCloskey. In addition to benefiting educational therapists and students, this book is appropriate for professionals who work in related fields such as special education, regular education, school and educational psychology, neuropsychology, school counseling, psychology, speech and language pathology, art therapy, occupational therapy, and social work, as well as in medicine and psychiatry. NEW TO THE SECOND EDITION The second edition of The Clinical Practice of Educational Therapy: Learning & Functioning with Diversity has revised and updated the chapters from the first edition, and added three new chapters which further define and broaden this field by exploring diverse perspectives: Chapter 10, "Cultivating Character Development: Educational Therapy's Impact on Individuals, Families, Schools, Educational Policy, and Society" by Maxine Ficksman Chapter 12, "Women and Girls Who Are Disenfranchised: A Global and Interdisciplinary Approach to Educational Therapy" by Jane Utley Adelizzi Chapter 17, "Examining the Efficacy of Graduate Programs in Educational Therapy at California State University, Northridge (CSUN): Educational Therapy Intern, Graduate and Parent Perspectives" by Marcy Dann, Nancy Burstein, Tamarah Ashton, and Sue Sears. These additional chapters, supported by brain-based research, characterize the shifts and changes experienced in a range of settings. Through the treatment alliance, educational therapists address students' and clients' ability to experience a more comprehensive model of learning, dependent upon the psychological, social, emotional, cultural and academic environments. The three new chapters range in focus from formal research and graduate training in the field of educational therapy to students throughout the lifespan whose social and educational experiences require a careful eye to not only the academic task at hand but also to the ways in which they cope and adapt to a range of environments and challenges. Lastly, educational therapy's empathic foundation in practice is exemplified when we consider the global experience of students who strive to learn in situations and settings that threaten their survival and disenfranchisement from society.

This welcome addition to the series Update in Intensive Care and Emergency Medicine emerges from the most recent of a series of meetings organized by Alvar Net and Salvador Benito of Barcelona. This gathering provided a forum for European intensive care specialists to exchange ideas, knowledge and experience on, the measurements feasible in mechanically ventilated patients. The scope was ambitious, ranging from basics like the measurement of airway pressure and blood gases to topics such as CT, MRI and the multiple inert gas elimination technique. The success of the meeting made publication a logical consequence. The book is unique in its breadth. The contributors, from numerous centers in Europe and North America, cover all tech niques employed in intensive care units, describing indications, contraindications, procedures, biases and complications. This volume will be an invaluable source for intensive care specialists and other clinicians. Alongside practical descriptions of procedures they employ routinely (spirometry, measurement of sys temic vascular oxygen pressure, Swan-Ganz catheterization, BOPA etc.), they will find accounts of such sophisticated techniques as on line measurement offunctional residual capacity, isotope determina tion of ventilation/perfusion ratios, diaphragmatic metabolism and peripheral oxygen exchange. I am especially happy to see the book published by Springer-Verlag, which has distinguished itself in the field of intensive care medicine.

Adversity is a part of life and many of us have experienced trauma that has left us feeling distressed, scared or alone. This book draws on Bridie and Sue's background in Clinical Psychology to help you identify what trauma is, the effect it can have on your physical and mental health, and how you can cope. Containing many ideas and strategies to support you with the impact of trauma, including giving yourself a butterfly hug to calm yourself down or sending an email to someone who lives far away to feel more connected, this is a guide that you can dip in and out of, and return to at different stages in your life after trauma. Co-written with two young people who were brave enough to share their own stories, you will find that you are not alone, that nothing stays the same, and that there's always hope.