"GRIPPING."
--Booklist

A crane falls on a hapless mother of two, almost crushing her to death . . . A trauma victim of a helicopter crash desperately clings to life . . . A paralegal aide suffers a violent seizure from a cocaine overdose and gasps for breath . . . Welcome to the ER at Bellevue Hospital, the frontline trenches of medicine where doctors fight around-the-clock to save lives at a frenetic pace of quick decisions and real life-and-death drama.

Some three hundred people slam through these hospital doors every day. Gunshot cops, battered kids, drug addicts, and suicides. Destitute drunks, bag ladies, AIDS sufferers, and accident victims. It's a bizarre parade of humanity looking for help in the one place they know they can find it: the ER.

"Gut-wrenching, heartwarming, and instructive about the exigencies of this branch of medicine as practiced at this legendary institution."
--Publishers Weekly

"From the Paperback edition."

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.

Die Mastze11e mit ihren 500-1000 metachromatischen Granula im Zytoplasma kommt praktisch in allen Bindegewebsstrukturen des Korpers vor [72]. Sie ist bevorzugt entlang der Blut- und Lymphgefaaverlaufe vor a11em im Be- reich der terminalen Strombahn im lockeren Stromagewebe lokalisiert. In den parenchymatosen Organen, die nur wenig Bindegewebe enthalten, wie z.B. der Leber, Niere und im Herzmuskel finden sich die Mastzellen im Bereich der Adventitia der Gefaaverlaufe und im regionaren Bindegewebe. Die Anzahl in diesen parenchymatosen Organen ist damit relativ gering. Die groate Anzahl der Mastzellen wird in den serosen Hauten, wie Pleura, Pericard, Peritoneum sowie in den Meningen gefunden, ferner im Corium der Haut und hier besonders an den Akren. Nahezu 100% des hohen Gewebshist- aminspiegels sind in diesen Zellen deponiert [1,39,46,67,75,78]. Die Gewebsmastze11en zeigen gegenuber den Blutbasophilen wesentliche Unterschiede: Letztere enthalten wesentl ich weniger Granula und zeiger: ! keine positive Naphthol-ASD-Chloracetat-Esterase-Reaktion [49].Die Granula der Gewebsmastzellen beinhalten das Proteoglycan Heparin, die Blutbasophi- len Chondoitin-Sulfat [3]. Die ze11uliire Ausstattung mit Inhaltsstoffen und die Funktion der Mastzellen in den verschiedenen Organen ist ebenfalls unterschiedlich. HERKUNFT, ENTWICKLUNG UND STRUKTUR DER HASTZELLEN Lennert und Parwaresch [49] konnten immunhistochemische Hinweise dafur finden, daa die Mastze11en sich aus der myelomonozytaren Reihe ableiten. Als wichtigste Hinweise fuhren die Autoren folgende Punkte auf: 1. Nachwe i s von Obergangs formen zwi schen Monozyten und Mastze 11 en nach massiver Mastzelldestruktion. 2. Zytolytische Effekte an Mastzellen durch hochspezifische autologe Makrophagenseren. 3. Vorkommen einer KCN-sensitiven Myeloperoxydase in unreifen Rattenmast- zellen.

En el ambiente tactico civil, cada segundo cuenta. TECC: Atencion tactica a victimas en emergencias, segunda edicion ensena a los proveedores de atencion prehospitalaria como responder y atender a pacientes durante una emergencia tactica civil, incluso en tiroteos activos. Este atractivo programa esta disenado para preparar a los proveedores de servicios medicos de emergencia (EMS) para atender pacientes en un entorno tactico. Desarrollada por la Asociacion Nacional de Tecnicos en Emergencias Medicas (National Association of Emergency Medical Technicians, NAEMT) y aprobado por el Colegio Estadounidense de Cirujanos (American College of Surgeons), TECC, segunda edicion aborda los dominios actuales de los Servicios Tacticos de Emergencia Medica (Tactical Emergency Medical Services, TEMS) y es consistente con las pautas actuales del Comite sobre TECC. NAEMT es un socio educativo reconocido del Comite de TECC. Componentes del programa dinamico El manual del curso TECC, segunda edicion refuerza y clarifica los conceptos clave del curso, tiene un diseno atractivo e interactivo, y esta escrito de modo que sienta que esta participando en una conversacion, en lugar de escuchando una leccion. El manual del curso incluye las siguientes caracteristicas clave: * Compruebe sus conocimientos: aplique los conocimientos presentados en la leccion y refuerce sus habilidades de tratamiento de pacientes. * Estaciones de habilidades: revision paso a paso de como utilizar habilidades que salvan vidas en el entorno tactico.

Dieses essential beleuchtet das Thema Integrierte Notfallzentren (INZ). INZ sollen an einem Tresen die Situation des Patienten einschatzen. Ziel ist es diesen einem der jeweiligen Behandlungsdringlichkeit zustandigen Versorgungsbereich (ambulante medizinische Versorgung, arztlicher Bereitschaftsdienst oder klinische Notfallversorgung) zuzuordnen, um u.a. auch einer UEberfullung und UEberlastung der Notaufnahmen entgegenzuwirken. Dieses essential fasst sowohl den aktuellen Forschungsstand als auch heterogene Meinungen zum Thema INZ zusammen.

""This is an excellent text which covers all of the important research methods in the field, including randomised control trials. A strong component of the text is the inclusion of chapters on ethics and the future of paramedic research... The use of paramedic examples throughout the chapters will help students and other budding paramedic researchers connect with the subject matter and help them link theory, evidence and practice."
Professor Peter O'Meara, La Trobe Rural Health School, La Trobe University, Australia"

This practical book provides a no nonsense guide for student and qualified paramedics looking to understand the key elements of research, and what it means for their profession. The authors explain key concepts and methodologies to help you get to grips with the nature of paramedic research and how it works in practice.

By drawing on a wealth of cases and examples, research is placed firmly in the context of clinical practice. The book will enable you to critique research and to engage in small-scale research projects of your own. Emphasising what you need to know, the book includes information on: Knowledge that underpins practice Key elements of qualitative and quantitative research Research ethics and evidence based practice Undertaking a literature review Dissemination of research findings Considerations of the future for paramedic research Written by experienced lecturers, the authors offer practical advice and tips to more advanced researchers on getting work published and giving oral and poster presentations at conferences.

"Contributors Jayne Cutter, Gary Rolfe, Megan Rosser, Julia Williams, Malcolm Woollard

Pediatric patients are a unique subset of emergency patients, making up about one-quarter of all emergency department visits. Textbooks regarding the care of pediatric patients are almost universally organized by organ system, which does not facilitate an efficient diagnosis. Taking a case-based approach, Pediatric Emergency Medicine: Chief Complaints and Differential Diagnosis is arranged by chief complaint, using real patient scenarios to help the reader work through the inductive and deductive reasoning needed to assess, evaluate, treat, and disposition pediatric patients with urgent complaints. Cases are structured in the way in which they are presented during medical care, allowing practitioners to become comfortable with the general structure of case presentations: chief complaint, HPI, PMH, ROS, exam, and ancillary studies. This volume also discusses disease processes and their differentiations, providing in-depth knowledge regarding current standards of diagnosis and care.

UEbersichtlich und kompakt vermittelt Ihnen dieses Lehrbuch die wichtigsten Inhalte aus allen vier AINS-Fachern. Wie intubiere ich einen Patienten? Worauf kommt es bei der Algesiologie an? Hier bekommen Sie das gesamte Wissen, das Sie fur die Prufung brauchen mit einem direkten Praxisbezug.

Das Buch stellt eine gut strukturierte Einfuhrung in die medizinischen Grundlagen und die Geratetechnik fur eine moderne Intensivversorgung dar. In jedem Kapitel werden die zunachst die Grundlagen fur das Verstandnis der jeweiligen Physiologie und der relevanten Krankheiten gelegt. Anschliessend werden die jeweiligen Therapiegerate in ihrer Funktion beschrieben, mit denen die entsprechenden Erkrankungen behandelt werden koennen. Dabei steht die Modellierung der Wechselwirkung zwischen Maschinen und Koerper im Vordergrund. An verschiedenen Stellen wird dies abgerundet durch einen historischen Abriss und einen Blick auf die zukunftige Entwicklung, die in vielen Fallen in Richtung Informationsfusion, Vernetzung und Automatisierung deutet und uns zu Cyber Medical Systems fuhren wird.

Bei der Bluttransfusion handelt es sich um die Transplantation eines fremden flussigen Organs. Blutkomponenten und Plasmaderivate sind dabei verschreibungspflichtige Arzneimittel und durfen nur auf arztliche Anordnung abgegeben werden. Von dem am Patienten tatigen Arzt werden damit grundlegende klinisch-transfusionsmedizinische Kenntnisse fur den differenzierten Umgang mit Blutkomponenten und Plasmaderivaten gefordert. Das vorliegende Werk gibt diese Hilfestellung und vermittelt Basiswissen zu Blutprodukten und Transfusionen fur Nicht-Transfusionsmediziner. Es beschreibt u.a. die Risiken von Bluttransfusionen, die Grundlagen der Blutgruppenserologie und die Zusammensetzung von Blut und Blutprodukten sowie das Management bei Transfusionszwischenfallen; es geht auf das aktuelle Transfusionsgesetz ein und die Richtlinien zur Bluttransfusion sowie auf die Verordnung und Gabe von Blut und Blutprodukten. Das Werk ist praxisnah und ubersichtlich gestaltet mit vielen konkreten Tipps, Flussdiagrammen und Tabellen. Die 2. Auflage erscheint komplett aktualisiert erweitert, u.a. zu juristischen und arzneimittelrechtlichen Aspekten autologer Transfusionsverfahren und zum Effektivitatsvergleich autologer Verfahren wie Eigenblutspende versus Hamodilution versus maschinelle Autotransfusion. Das Werk richtet sich an klinisch tatige AErzte aller Fachdisziplinen, die keine ausgewiesenen Transfusionsmediziner sind.

AMLS: Advanced Medical Life Support is the leading course for prehospital practitioners in advanced medical assessment and treatment of commonly encountered medical conditions. Taught across the globe since 1999, AMLS was the first EMS education program that fully addressed how to best manage patients in medical crises. Created by the National Association of Emergency Medical Technicians (NAEMT) and endorsed by the National Association of EMS Physicians (NAEMSP), AMLS emphasizes the use of the AMLS Assessment Pathway. This essential assessment tool empowers prehospital practitioners to rapidly diagnose medical patients and initiate effective management in the field. AMLS is the only textbook approved for use in NAEMT's Advanced Medical Life Support course. Its medical content is continuously revised and updated to reflect current, evidence-based knowledge and practice. The AMLS philosophy is centered on using critical thinking to assess patients and formulate management plans. A Clear Approach to Assessing a Medical Patient In the field, seconds count. The AMLS Assessment Pathway provides a systematic approach to the assessment of a medical patient that enables prehospital practitioners to diagnose medical patients with urgent accuracy. Dynamic Technology Solutions World-class content joins instructionally sound design with a user-friendly interface to give instructors and students a truly interactive and engaging learning experience with: eBook of the AMLS Course Manual that reinforces key concepts presented in the AMLS course Engaging case-based lectures in the AMLS Online Instructor Toolkit

Hace mas de tres decadas, PHTLS: Soporte Vital de Trauma Prehospitalario transformo la evaluacion y manejo del trauma en el campo. A lo largo de los anos y alrededor del mundo, el curso de PHTLS ha mejorado la calidad de la atencion al paciente de trauma y ha salvado vidas. La novena edicion de este confiable y fidedigno recurso continua con la mision de PHTLS de promover la excelencia en el manejo de pacientes con trauma por parte de los proveedores involucrados en proporcionar la atencion prehospitalaria mediante la educacion global. Este legendario programa fue desarrollado por primera vez por la Asociacion Nacional de Tecnicos en Emergencias Medicas (National Association of Emergency Medical Technicians, NAEMT), a principios de la decada de los ochenta del siglo pasado con la cooperacion del Comite para el Trauma del Colegio Americano de Cirujanos (American College of Surgeons Committee on Trauma, ACS-COT). Su contenido medico se revisa y actualiza en forma continua para reflejar lo ultimo y mas actualizado del conocimiento y la practica con base en la evidencia. El PHTLS promueve el pensamiento critico como fundamento para proporcionar una atencion de calidad. Basandose en la creencia de que los profesionales de los servicios de emergencias medicas toman las mejores decisiones en beneficio de sus pacientes cuando se les proporciona una base solida de conocimiento y principios clave para estimular sus habilidades de pensamiento critico. Un enfoque claro para evaluar al paciente de trauma En el campo, los segundos cuentan. PHTLS: Soporte Vital de Trauma Prehospitalario, novena edicion ensena y refuerza los principios para evaluar con rapidez al paciente con trauma usando un enfoque ordenado, tratando de inmediato los problemas que ponen en riesgo la vida conforme se van identificando y minimizando cualquier retraso para iniciar transporte a un destino adecuado. Soluciones de tecnologia dinamica El contenido de clase mundial se une al diseno instructivo con una interfaz en linea facil de usar para proporcionar a los instructores y estudiantes una medio de realmente interactivo con una atractiva experiencia de aprendizaje con: * E-book del Manual del curso PHTLS que refuerza los conceptos clave presentados en el curso del PHTLS.

Acute appendicitis is one of the most common surgical abdominal emergencies worldwide, with a lifetime risk of 8.6% for males and 6.7% for females. This compilation discusses how while non-operative treatment of appendicitis has been proposed as an alternative to surgery, appendicectomy remains the mainstay of treatment in most cases and techniques have shifted from open to laparoscopic methods. The current knowledge in pathogenesis, diagnosis, and clinical management of acute appendicitis is also discussed. Next, the authors present an updated review chapter of appendicitis regarding its prevalence and risk factors, particularly how the diagnosis of appendicitis is based on a history of diffuse abdominal pain, which usually starts in the central region of the abdomen and migrates to the lower right quadrant of the abdomen. The residual remnant or "stump" of the appendix after an initial appendectomy may become inflamed causing what is commonly referred to as stump appendicitis. Treatment with antibiotics may be attempted as an alternative to surgery; however, the vast majority of cases require definitive surgical excision of the remnant appendix. The authors propose that keeping this disease in the differential is important in reducing complications associated with delayed diagnosis.

'During open-chest resuscitations, I've held a non-beating, recently stilled human heart in my hands. And, should you ever get to hold one, you will find the human heart to be rubbery and shockingly light.' What Could Possibly Go Wrong? is a report from the front line of emergency medicine, the first ever account of what it is like to work as an air ambulance doctor. Whether describing cutting through a patient's breastbone to plug a stab wound or barrel rolling a light aircraft at 5,000 feet, Tony Bleetman captures the sheer adrenaline of racing through the sky to save lives. You will learn how to land a helicopter on the side of a mountain, what it means to encounter death every day, and how to perform a tracheotomy in real life (clue: it doesn't involve a ball-point pen). Funny, shocking and moving, What Could Possibly Go Wrong? is a glimpse at a world where the wrong decision can mean the difference between life and death. Originally published as You Can't Park There: The Highs and Lows of an Air Ambulance Doctor.

Le persone rimaste coinvolte in un evento traumatico hanno bisogno di professionisti che forniscano loro un sostegno rapido ed efficace. Le situazioni in cui e richiesto questo tipo di aiuto sono moltissime: un incidente, una diagnosi medica negativa, la perdita di una persona cara, un rovescio economico, ma anche le conseguenze di abusi, tentativi di suicidio, disastri naturali, terrorismo. La cosiddetta crisis intervention, cioe il supporto psicologico nei casi di emergenza, puo essere praticata da medici, educatori, operatori del pronto intervento oppure volontari nei centri d'ascolto - tutti devono sapersi muovere in condizioni di intenso stress emotivo per le vittime. Questa guida pratica fornisce risposte chiare e immediate su come trattare le emergenze piu comuni ed espone i sintomi dei diversi traumi, i casi di studio e i protocolli che e necessario adottare. Una risorsa di rapida consultazione sia per gli esperti sia per chi e al principio della propria esperienza sul campo.

Questo libro si propone di impartire i consigli utili sul modo migliore per accompagnare il paziente traumatizzato grave in sala operatoria, organizzare il lavoro tuo e dell'equipe, sudare sette camicie per risolvere una situazione difficile, ma alla fine chiudere l'intervento con il miglior risultato possibile. In poche parole, una guida pratica sulla chirurgia del trauma destinata non solo agli specializzandi e ai tirocinanti, ma anche ai chirurghi generali interessati al trattamento dei pazienti traumatizzati e ai chirurghi che operano in condizioni difficili - ad esempio presso gli ospedali militari, i distretti rurali o nell'ambito di missioni umanitarie. Sull'atlante chirurgico impari a utilizzare le mani, ma certo non a ragionare, prevenire le mosse e improvvisare, mentre grazie ai nostri consigli pratici apprenderai che quando operi un paziente traumatizzato con emorragia massiva devi usare la testa, oltre che le mani. La prima parte illustra alcuni dei principi generali della chirurgia del trauma, soffermandosi non tanto su come si dovrebbe suturare, quanto piuttosto sulla necessita di sviluppare la capacita di pensare e programmare quando si sta davanti al tavolo operatorio. Purtroppo soltanto di rado, per non dire mai, queste capacita si apprendono frequentando le scuole di specializzazione. La seconda parte e dedicata alla chirurgia del trauma vista come uno sport da contatto: insegna come si trattano specifiche lesioni a carico dell'addome, del torace, del collo e dei vasi periferici, mettendo in particolare evidenza come le cose potrebbero non andare per il verso giusto, un aspetto quasi sempre tralasciato dai testi tradizionali. L'esperienza, invece, ci ha insegnato che imparare dove sono le insidie e essenziale se si vuole imparare ad operare. La lezione piu importante che ci auguriamo tu possa trarre da questa guida e di scegliere sempre la soluzione piu semplice, perche nella chirurgia del trauma e l'unica che non riserva mai sorprese e da risultati."

Tratta le principali problematiche sanitarie e gestionali inerenti al salvataggio in acqua ed e rivolto al personale medico e infermieristico, nonche agli operatori di settore (bagnini addetti al salvamento, forze dell ordine etc.)

Ein psychiatrischer Notfall kommt gar nicht so selten vor: Der aggressive Patient im Altenheim, die junge Frau auf der Fensterbrustung mit Selbstmordabsichten oder der stark alkoholisierte Patient auf der Strasse. Der diensthabende Arzt muss im Notfall genau wissen, was getan werden muss und vor allem was getan werden darf. Auf den Umgang mit psychiatrischen Notfall-Patienten bereitet das Buch jeden Arzt vor - auch junge Assistenzarztinnen und Assistenzarzte in psychiatrischen Kliniken. Ein Buch fur den Notfall - nicht nur fur Psychiater."