During the last decade, the effects of anaesthetics on cerebral blood flow, cerebral metabolic rate of oxygen and intracranial pressure have been studied experimentally and clinically. In this review studies of CBF and CMRO2 during craniotomy have been performed with the classical technique described by Kety and Schmidt. In chapter 1 general considerations concerning the effects of anaesthetics on cerebral blood flow and metabolism are reviewed. In chapters 2 and 3 the effects of inhalation agents and hypnotics on flow and metabolism are considered. Chapters 4 and 5 cover the effects of central analgetics, and neuromuscular blocking agents. In chapter 6 the effects of other drugs in common use in neuroanaesthetic practice are summarized. Chapter 7 considers the effects of drugs used for controlled hypotension. In chapter 8 the application of Kety's method in studies of CBF and metabolism is reviewed, the studies of cerebral circulation and metabolism during nine different techniques of anaesthesia for craniotomy are presented, and other studies of cerebral circulation during neuroanaesthesia are reviewed. In chapter 9 considerations concerning central and cerebral hemodynamics during anaesthesia in the sitting position are considered. This review is primarily addressed to anaesthetists, but it will also be of interest to those working within neurosurgery, neuroradiology and clinical neurophysiology.

When someone has successfully completed a Standard First Aid Course, they often have a desire to extend their knowledge of first aid. The aim of this book is to give the holders of a Standard First Aid Certificate the opportunity to study the principles of first aid in greater detail. It is not intended to convert the first aider into a highly trained paramedic - so a discussion on the use of intra venous fluids, defibrillators etc., is beyond the scope of this book. It is hoped that the book will provide a useful in-depth study for demonstrators, instructors and first aiders likely to be involved in ambulance duties. I am very grateful to Brigadier D.O. O'Brien, Chief Medical Adviser, British Red Cross Society and Mrs. R.H. Smith, Assistant Branch Director (Training), Leicestershire Branch of the British Red Cross Society for their helpful comments and encouragement. I acknowledge the use of illustrations from the Clinical Symposia Series by CIBA on the "Heimlich Manoeuvre" to form the basis of Figures 3.7,3.8 and 3.9."

The terrorist use of diseases as bioweapons has been one of the major security concerns in recent years, particularly after the anthrax letter attacks in the USA in 2001. This uncertain threat of intentional outbreaks of diseases exists side by side with the constantly changing very real threat from diseases, epidemics and pandemics as recently illustrated by the H1N1 influenza pandemic, SARS, and H5N1 bird influenza events. This publication contains case studies on the public health planning for (un)usual disease outbreaks for 11 large and small countries with a focus on South Eastern Europe. In many countries, military entities traditionally play an important role in emergency response to disease outbreaks. In smaller countries, very little exists, however, in terms of specific biopreparedness efforts (in both the military and civilian area), which is at least partly due to a relatively low bioterrorism threat perception, and serious resource constraints. The uncertainty associated with the bioterrorism threat makes public health preparedness planning for such events politically and financially very difficult. The similarity of responding to bioterrorism events and natural disease outbreaks from a public health point of view suggests the merit of looking at biopreparedness as a part of overall health emergency planning, not as a separate effort.

In the twentieth-century, evidence-based injury prevention and control strategies have contributed to a substantial decline in the number of deaths associated with injury. However, researchers in the field of injury prevention have often gathered their study methods from other disciplines; it can be difficult for injury investigators to locate all of the research tools that can be applied to problems related to injury. Injury Control: A Guide to Research and Program Evaluation addresses the growing need for a comprehensive source of knowledge on all research designs available for injury control and research. Included in this accessible guidebook is information about choices in study design, details about study execution and discussion of specific tools such as injury severity scales, programme evaluations and systematic reviews. Epidemiologists, health service investigators, trauma surgeons and emergency medicine physicians will find this a useful source for understanding, reviewing and conducting research related to injuries.

1. Features recent developments like 3-D surgery, telescopic IOL, bionic implants and robotic surgery. 2. Highlights case selection and important precautions to be taken by vitreoretinal surgeons and senior residents. 3. Covers the controversies surrounding primary VR versus RD surgery in Phakic, fresh retinal detachments; Positioning after macular hole/ VR surgery; and to peel or not peel ILM in non-macular hole retinal surgery.

Key Features * Provides practical guidance based on real-life Heart Failure scenarios. * Discusses both acute and chronic care patient-oriented scenarios. * Cover up-to-date and novel concepts in heart failure. * Features the perspectives of current debates and controversies in heart failure. * Highlights the opportunities for research in this field.

Orthopedic Trauma Call for the Attending Surgeon is a clinically focused book that will help guide the orthopedic surgeon through the most commonly encountered injuries when on call. Drs. David J. Hak, Kyros R. Ipaktchi and Steven Morgan are joined by over 50 leading experts to provide a succinct and quick review of the key points that will allow you to provide patients with expert and immediate care. Inside Orthopedic Trauma Call for the Attending Surgeon each chapter is written in an easy to read bulleted format that will allow for a quick review of the key facts you need to know while taking call. Chapters also cover emergent and definitive management and provide guidelines for when to consider referral to a higher level of care. The authors also share their tips and tricks for successful outcomes, while highlighting potential pitfalls and how to avoid them. Since it can be difficult to find time to read a traditional textbook or review article, Orthopedic Trauma Call for the Attending Surgeon is perfect for orthopedic surgeons, physician assistants, extenders who cover ER call, and orthopedic trainees.

The expense of critical care and emergency medicine, along with widespread expectations for good care when the need arises, pose hard moral and political problems. How should we spend our tax d'ollars, and who should get help? The purpose of this volume is to reflect upon our choices. The authors whose papers appear herein identify major difficulties and offer various solutions to them. Four topics are discussed throughout the volume: First, encounters between patients and health professionals in critical situations in general, and where scarcity makes rationing necessary; second, allocation and social policy, including how much to spend on preventive, chronic or critical care medicine, or for medicine in general compared to other important social projects; third, conflicts between or ranking of important goals and values; and fourth, conceptual issues affecting the choices we make. Since these topics are raised by the authors in almost every essay, we did not divide the papers into separate sections within the volume. Warren Reich begins the volume with a parable illustrating a key problem for contemporary medicine and two very different approaches to its solution. His story begins with the "delivery" of three indigent, critically ill, foreign patients to the emergency room of a large American private hospital. Although the hospital is legally bound to care for these patients, providing long term, high cost care for them and others soon becomes a major financial strain.

PATIENT FLOW: Reducing Delay in Healthcare Delivery is dedicated to improving healthcare through reducing the delays experienced by patients. One aspect of this goal is to improve the flow of patients, so that they do not experience unnecessary waits as they flow through a healthcare system. Another aspect is ensuring that services are closely synchronized with patterns of patient demand. Still another aspect is ensuring that ancillary services, such as housekeeping and transportation, are fully coordinate with direct patient care. Past experience shows that effective management of healthcare delays can produce dramatic improvements in medical outcomes, patient satisfaction, and access to service, while also reducing the cost of healthcare. The 15 chapters of this book exposes the healthcare community of researchers, practitioners and administrators to a set of techniques and strategies that can be used by clinicians and administrators to substantially reduce delays in healthcare delivery. It is the first book treatment to have reduction in patient delay as its sole focus, and therefore, provides the foundation by which hospitals can implement change. Reflecting the highly interdisciplinary and practitioner nature of this book, the chapters have been written by doctors, nurses, industrial engineers, system engineers and geographers, and thus, these perspectives provide the comprehensive view needed to address the problem of patient delay.

The book provides a "hands-on" discussion and methods for solving a variety of problems that inhibit prompt and swift health care delivery. Some examples are:

• presents a set of breakthrough strategies that use "real-time" monitoring systems for continuous improvement;
• offers techniques for scheduling staff needs to match patterns in patient demand, and thus reduce predictable delays;
• utilizes simulation modeling techniques for both healthcare design and process improvement;
• provides methods for forecasting the demand for healthcare on a region-wide basis;
• presents queueing theory as a general method for modeling patient waits in healthcare;
• outlines rapid delivery of medication in the event of a catastrophic event, such as a pandemic or terrorist attack;
• demonstrates the importance of optimizing care as patients transition from one care setting to the next care setting with an emphasis on clinical outcomes and the business case;
• provides project management tools to guide the implementation of patient flow projects.

Covers the immediate assessment and management of common plastic and reconstructive surgery emergencies and referrals. A companion for junior doctors starting within plastic surgery, the Plastic Surgery for \Trauma provides succinct and clear presentation together with up to date guidelines on the common plastic surgery emergencies. With clear descriptions of difficult trauma scenarios, illustrated with numerous figures, and updated guidelines for each step of practice, this book will ensure that the reader can access all the information required to help gain confidence and experience .Be the readers passing through a plastic surgery rotation on their way to some other career goal or beginning within plastic surgery and keen to make a strong start with a view to progressing in the speciality, this book provides the support to allow rational and confident clinical decision making from the start. Essential reading for all non-specialists and trainees.

Severe head injuries are a frequent occurrence in the life of every emergency care specialist, traumatologist, neurosurgeon, and rehabilitation specialist. For example, between 30.000 to 40.000 severe head injuries occur in Germany each year. Over 75.000 Americans die each year after having suffered a severe head injury. Nevertheless, treatment is not always optimal. Survival and longterm outcome depends not only on the type of injury but also on timely and appropriate diagnosis and treatment. Thus, all physicians involved must be aware of the current procedures in the management of severe head injuries. This reference book, based on the experience of international experts, provides an up to date and practical guideline.

The Yearbook compiles the most recent developments in experimental and clinical research and practice in one comprehensive reference book. The chapters are written by well recognized experts in the field of intensive care and emergency medicine. It is addressed to everyone involved in internal medicine, anesthesia, surgery, pediatrics, intensive care and emergency medicine.

A collection of 200 high quality ECGs (Electrocardiogram's) that cover the entire spectrum of emergency electrocardiography. The first half of the book represents an intermediate level of difficulty and is ideal for residents in training and for the emergency medicine board review. The second half contains more advanced ECGs and will challenge even the most seasoned emergency medicine practitioner. When taken in its entirety, the book contains one of the best collections of ECGs ever assembled, targeted at advancing the ECG interpretation skills of emergency physicians and other acute health care providers.

Crib death (SIDS) is the most frequent cause of death for infants during the first year. A systematic study of the autonomic nervous system and cardiac system has been performed on a large number of infants and fetuses who died suddenly and unexpectedly, as well as in age-matched control cases. The neurological and cardiac findings are described here, and the relationship between SIDS and unexplained fetal death is discussed.

"Antiepileptic Drugs, Pharmacopoeia" provides a concise guide to the properties and clinical applications of all antiepileptic drugs (AED) currently used in the prophylactic treatment of epileptic seizures. The presentation of each AED follows a clinically orientated template. This is in accordance with the FDA Package insert and the EMA Summary of Product Characteristics, supplemented with recent published reports and expert clinical advice. This pocket-sized, user-friendly guide will be a valuable resource for all those involved in the care of patients with epileptic seizures.

Synthesizing insights from psychiatry, social psychology, and anthropology, this important work sets out a framework for therapy that is as culturally informed as it is productive. An international panel of 23 therapists offers contextual knowledge on PTSD, coping skills, and other sequelae experienced by the survivors of traumatic events. Case studies from Egypt to Chechnya demonstrate various therapeutic approaches. Authors explore the balance of inter- and intrapersonal factors in reactions to trauma and dispel misconceptions that hinder progress in treatment.

To be asked to prepare a second edition of a book is heartening for any author or editor. Apart from the opportunity to make the corrections and amendments which are inevitable in a practical manual there is also the possibility to make additions which enhance its usefulness. Above all a further edition usually means that the book has been found to be accept able to a large number of readers and has fulfilled a need. This is indeed the case with Offshore Medicine, which in its description of the medical aspects of offshore work has provided a unique guide to the occupational health of a new industry. The rapid development of offshore exploration for gas and oil which began in the 1960s created a whole new range of related industries. Most attention was focused on the problems of deep diving in the North Sea because of the great expansion of the diving industry, its technological advances and the high mortality of divers in the early years. Diving, however, is only a fraction of the total endeavour concerned with the offshore industry. The much larger population of workers offshore who man the rigs and barges, the toolpushers, helicop ter pilots, crane drivers, scaffolders and roustabouts, geologists and so on, so sympathetically described by A. Alvarez in his recent book Off shore, A North Sea Journey, and the harsh and difficult conditions in which they often have to work are sometimes forgotten."

Provision of efficient resuscitation is mandatory to the success ful functioning of all hospital wards and departments. Failure to provide such a service increases morbidity and mortality. Resuscita tion falls largely into the domain of the anaesthetist. However, an anaesthetist is not always instantly available and resuscitation has to be initiated by those in other specialities who have had little or no for mal training in resuscitation techniques. The purpose of this book is to guide those involved in resuscitation in the indications and methods of resuscitation. Its creation and con tents were stimulated by noting the difficulties encountered in both teaching centres and provincial hospitals. 'Basic' is included in the title to emphasize that, with the exception of 'the acid-base laboratory', the apparatus is simple and available in all hospitals. Furthermore, 'basic' indicates the authors' intention to limit their discussion on resuscitation to that involved in the first hour following the start of treatment. Successful treatment during these 60 minutes, and very often the first few minutes, is often vital in the sav ing of life. Further management can then be decided by the ap propriate specialist.

This volume is published with a triple aim: to take a look back over the advances during the ten years of the Mediterranean Burns Club and mark its anniversary; to follow up and strengthen the successful twin ning of burns as a clinical, individual illness problem and fires as a societal, disaster management problem; and to look ahead at the per spectives of burn care and fire prevention in the fast-approaching new century. The occasion also marks the tenth annual presentation of the prestigious G. Whitaker International Burns Prize, to which the Mediterranean Burns Club acts as the scientific fulcrum. The award is now established as the most distinguished recognition in burns science worldwide, and it is gratifying that the contributions of many of the renowned recipients will be found in this book. This is a sequel to The Management of Mass Burn Casualties and Fire Disasters, which contained the Proceedings of the First International Conference on Burns and Fire Disasters. The book and the conference have fully justified the authors' initial concept that burn specialists, con stantly combatting burn disease and promoting rehabilitation of the victims, especially in mass casualty situations, had for too long remained separate from that other essential sector, the fire-fighting authorities and fire prevention systems, whose aim is also the protection of the individual and the promotion of safety. This long overdue synergism has now become reality, and the present volume strengthens this desirable trend."

Cardiology Emergencies covers the presentation, investigation, and management of acute cardiac problems that require speedy diagnosis and management. Created as a resource for residents and students, as well as an easy reference guide for physicians, this handbook is organized for quick access and learning. It is divided into three sections: the first provides acute presentations for quick diagnosis, the second addresses specific conditions, and the third offers clear descriptions of how to perform common practical cardiac procedures. Packed with concisely written summaries and bullet-point information, it is the ideal guide to the practical management of cardiac emergencies.

Substantialfundamental workhas been undertaken inthe different aspects of impact biomechanics over the past three decades. Much of this has been motivated and undertaken bythe automotive industry intheirefforts to improve transport safety. More recently, however, it has become app- ent that themultidisciplinary synergies which are realisedby interactions between engineers, scientists and clinical practitioners will ultimately lead to a greater understanding of the complex interacting phenomena withinthe human bodyafter it has sustained an impact. In turn, this greater depth of knowledge will provide more fundamentalinsights into the analysis, d- gnosis, treatment and prevention ofimpact injuries across a broader sp- trum of accident environments. Thescienti?c focus of this IUTAM symposium istoaddress those t- ics that are centrally important to the biomechanics ofimpact. These can be groupedinto those that are concerned with the different causes of - cidents (e. g. , transport, occupational and sports injuries), themechanics - volvedinaccident analysis (e. g. , accident investigation, computational m- elling techniques), the different types of resulting traumatic injuries (incl- ing musculoskeletal, organ, spinal and head injuries), methods of asse- ing the extent of injury (e. g. , injury assessment, injury criteria, constitutive laws for human tissue), and providing protection during an impact (e. g. , injury prevention, energy absorption materials, and safety devices).

Coronary artery disease is the most commonly encountered problem in adult cardiology in the world. Echocardiography is the most commonly used imaging modality encountered in cardiology practice in the world. Even though there are many Acute Coronary Syndrome (ACS) reference books and echocardiography reference books, there is no single practical book so far in the literature with focus on the combined topics. The authors believe that this will be the first book to provide information on how echocardiography can be used in, prevention, diagnosis and treatment of ACS.

Re-EngineeringoftheDamagedBrainandSpinalCord isdedicatedtoTetsuoKanno, M. D. ProfessorofNeurosurgery Bypresenting theoriginal papers thatmakeupthis thefeaturesofthelocalmedicallandscapeinthe- third supplement we wish to make a further contri- gionswheretheyareenacted. Whatismore, progr- bution to the issue of functional rehabilitation, this sivenew?ndingsmustbealsosubjectedtoafrequent soimportantandfascinatingmodernareaofresearch revision. Ontopofthis, itshouldnotbeforgottenthat inthe?eldofneurosciences. Thecongresspaperswe even when committal therapy guidelines are c- haveselectedconstituteagoodre?ectionofthetrans- sistentlyapplied, thereareconsiderablevariationsin disciplinary objectives. The literature references are therangeofpotentialcomplicationsandintheo- designedasaguidetoleadtheinterestedreadertoa comeofprospectivecontrolledmulti-centreandmul- deeperandmoredetailedunderstandingoftheindi- nationalstudiesontheissueofqualitymanagement. vidualissues. Functionalrehabilitationhasbeenanoriginaltask The demand for ''evidence-based medicine'' is well ofneurosurgeryfromtheveryoutset. The1990shave justi?ed; however, it rapidly comes up against the enteredtheannalsofbrainresearchasthe''Decadeof limitsoffeasibility, especiallywherecontrolledthe- theBrain''. Sincethentherehasbeenaneverstronger peuticstudiesareconcerned. TheCochrancollection growthofneuroscienti?cinterestworldwide, accom- of high-quality evidence-based healthcare databases paniedbysubstantial?nancialengagement. Thishas hasthusfarbeenofnohelptousindrawingupthe- primarily resulted in advances in basic neuro- peutic recommendations for the re-engineering of biologicalandneurophysiologicalresearchandalsoin brain and spinal-cord lesions. Today as ever, the thegrowthofneuroscienti?cknowledgeaboutbasic opinion of experts and empirically based medical mechanismsformotor control, paincontrol, aware- treatment and posttraumatic neurorehabilitation ness, cognition, learning and memory. The conse- continuetooccupyanindispensablepositionforthe quencemustbetoensurethattheadvancesmadeinthe everydayclinicalpracticeofneurosurgicalandneu- neuroscienti?cresearchareaareadequatelyexpanded traumatological therapies. Promising adjunct - intopracticalneurosurgicalcareandre-engineeringof proachesincludeneuropharmacology, forcascadesof brainandspinalcordlesionsandtoensureuponnew molecular interactions are known to be underlying approaches. Following this a fundamental path will activity-dependent plasticity and skills learning, as resultinanimprovedandmoree cientpreventionin many of these processes involve the major tra- thefuture, themeasuresthatstandrightatthefore- mitters. Furthermore, biologicalinterventionsby- front of all rehabilitation principles, meaning that ingendogenousneuronsandgliaaswellasexogenous conventionalconceptsmustbemodi?edtokeeppace stemcells, bone-marrowcells, macrophages, andother withthemoretask-speci?c, intensive, andprogressive types may promote the regeneration of nerve cells, demands. In this connection a series of guidelines, tissue, and neural circuitry. Class one studies have recommendations, and expert opinions and also beenmade, andnowclasstwostudieshavebeeni- algorithms have been elaborated by national and tiated, for example in connection with acute spinal international expert panels and multidisciplinary as- cord injury (SCI). The clinical application of fu- sociationsfortheacutemedicalcareofpatients."

Cardiovascular diseases are the most important causes of death in the world today. In adults, the most frequent heart disease is acute myocardial infarction, which can lead to sudden death. To prevent these diseases we need to fight against their main risk factors, which include smoking, lipid disorders, hypertension, diabetes and a sedentary life-style, among others. It has been demonstrated that physical exercise or sports at any age provide notable benefits and can help to decrease other risk factors and reduce the incidence of cardio vascular diseases. Exercise can be simply walking or cycling. Aerobic exercise con tributes to weight loss and also helps to control blood pressure, cholesterol and diabetes. It therefore plays an important role in prevention of heart diseases. Sports for young people are of great value and advisable not only because they con tribute to physical fitness but also because they help in psychological well-being. Young people should be encouraged to include general exercise, and particularly sports, into their daily activities. The following points however, should be kept in mind: I. Although winning at a sport is important, this is only so if it is achieved in natural physical conditions and with the correct training. Therefore, it is advisable to keep well away from any type of activity which artificially increases physical performance, that is, drug taking."

All aspects of ophthalmic trauma from the lid to the optic nerve of both mechanical and nonmechanical trauma are covered in this unique book. The focus is on practical issues and incorporates cutting-edge approaches, such as temporary keratosprosthesis, artificial iris diaphragm, and prophylactic retinectomy.

This book explains and answers not simply the when, the what, and the how, but also the why questions. The information is based on epidemiologic and clinical data from evaluation to management.

All chapters are written using the standardized ocular traumatology terminology. The user-friendly format, including many tables, flowcharts and illustrations, allows the reader to quickly find the information they are looking for.

Written by a well-known expert in the field, this concise pocketbook provides clinically useful information that will be of great help to the attending ophthalmologists and emergency room physicians in the decision-making process. The book has practical recommendations for all who see patients with eye injuries."