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.

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.

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.

The First Wiggers Bernard Conference on Shock, Sepsis, and Organ Failure was envisaged as a meeting of American and European Scientists. It was named after two researchers, one from the "Old" and one from the "New World," who are wellknown for their outstanding achievements in shock research and experimental medicine. This meeting was a point of de parture for a series of workshops that will focus on two to three main topics dealt with in detail by experts in their respective fields. The First Wiggers Bernard Conference addressed three main questions: 1. Multi-organ-failure - is it a sequence of organ failures or a systemic disease? 2. Cellular events in trauma and sepsis - are they due to suppression, activation or both? 3. Mediators of organ failure - are LPS or sepsis necessary? Although many answers were given in this first session, numerous issues remain to be clarified due to the enormous complexity of the subject. How ever, the stage was set for encounters between clinicians and basic medical researchers, since theoretical knowledge will be useful to the clinician ex ploring new approaches to diagnosis, prophylaxis, and therapy. The conference could not have been organized without the generous sup port of the Immuno Company, Vienna, Austria. May we express our special thanks to Dr. Eibl, managing director and head of the research division of Immuno AG, not only for granting financial support but also for his valuable advice, encouragement, and scientific expertise."

Stimulating and provocative work with fiberoptic technology is reported in this volume. Invasive fiberoptic reflectometry has only been used up to now for monitoring intravascular oxygen saturation. These contributions examine how this technique can be clinically applied to measure other parameters in the critically ill patient. Methodological aspects are discussed, but the main focus is on clinical value and application. The authors look at measurements that can be evaluated using a flowdirected fiberoptic pulmonary artery catheter and an arterial fiberoptic thermodulution catheter. These measurements deal with oxygen saturation, intrathoracic and total blood volume, indocyanine green dye liver function, and extravascular lung water. Considering the advanced state of the technology and the innovative physiologic concepts presented here, this book lays the foundation for a new, integrated monitoring system of cardiopulmonary physiology.

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."

The Wiggers Bernard Conferences, named after two great physiologists of the past, are an nual gatherings of the leaders in the field of shock. The meetings focus on specific areas of which appears to be showing the most advancement during the previous year. There are se veral types of sessions; informal presentations during which the seminarian can be intenup ted in order to clarify a particular point; formal discussions follow each presentation; these are followed by informal gatherings in which these discussions continue during meals and libation in a very relaxed environment. The 1990 meeting took place in Durnstein, Austria. A small hamlet in the wine growing area of the Wachau valley, on the Danube above Vien na. This was the site of a former citadel where the English King Richard the Lion-Heart (Coeur de Uon) was held for ransom during the middle ages. The frank beauty and hospi tality of this area in addition to the ancient Roman adage "in vino veritas" acted as a catalyst to crystalize the thoughts of this interdisciplinary group of scientists as they discussed the following areas: 1. Gut as a Source of Organ Failure 2. Metabolic Aspects of the Liver in Sepsis 3. Endothelium as a Target'in Sepsis We would like to thank the participants of the conference for taking time away from their very productive and busy schedules to participate in the conference and for the prompt pre sentation of their manuscripts and editions of their discussions.

Lacking the capacity to store oxygen, the human organism depends on having an unimpaired and continuous supply of oxygen for its survival. Life-threatening disturbances can be encountered by the clinician at any step in the oxygen cascade from ambient air to tissue metabolism. It is therefore necessary for the mechanisms of oxygen uptake, transport, distribution and diffusion into tissues as well as the unaffected cellular metabolism to be well understood and monitored. An international symposium focusing on these issues was held in Munster, FRG, May 11-12, 1990. This book contains the lectures held at the symposium, and thus provides an excellent basis for further discussion.

Publisher's Note: Products purchased from Third Party sellers are not guaranteed by the publisher for quality, authenticity, or access to any online entitlements included with the product. SMALL ENOUGH TO FIT IN YOUR POCKET, DETAILED ENOUGH TO PROVIDE EVERYTHING YOU NEED TO KNOW Essential data on more than 1,000 of the most commonly used prescribed medications and more than 75 drugs most often used in the pre-hospital setting Drug-specific EMS pearls, including signs and symptoms of overdose and specific overdose management Sections on popular medicinal herbs and common street drugs Quick-reference tables encapsulate essential information Street Drug section updated to include "bath salts" and salvia

This little book has been written primarily for the senior house officer in Accident and Emergency and the registrar pursuing a career in the specialty. I hope also that it will be of interest to medical students. Thanks to the initiative of Professor Miles Irving, Professor of Surgery, University of Manchester, medical students have been taught Accident and Emergency in Hope Hospital since 1974. Many of the answers to the questions here have been elaborated as a result of their enquiring minds. It has been a pleasure to teach them. MCQs should be informative and entertaining and not regarded as a tiresome chore merely because of self assessment scoring. I have omitted the boxes and the "don't know" response. The answers are either true or false. I have attempted to slot the questions into various sections with some degree of sequence, but there is an inevitable overlap particularly with regard to the sections on the unresponsive patient, poisoning and injury. The final section is a selected mixture of Accident and Emergency and I thought "Pot pourri" an appropriate title. I have enjoyed compiling the questions and I hope that both undergraduates and postgraduates will find reading them a painless and worthwhile exercise. Finally my thanks are due to my secretary Eileen Bates for her typing and patience."

The significance of a change in Pa02 occuring in a patient with cardiovascular instability cannot be ascertained unless the values for PV0 and CV02 are known. A fall in Pa02 could 2 reflect worsening of pulmonary function or deterioration of cardiac output (with resultant increase in systemic oxygen extraction). PEEP/CPAP would be an appropriate therapy in the former case but frankly deleterious in the latter if applied prior to cardiovascular stabiliza- tion. References 1. Douglas ME, Downs JB, Dannemiller FJ et al (1976) Change in pulmonary venous admixture with varying inspired oxygen. Anesthesia and Analgesia 55:688-695 2. Kelman GR, Nunn JF, Prys-Roberts C et al (1967) The influence of cardiac output on arterial oxygena- tion. A theoretical study. Br J Anaesth 39:450-458 3. Kirby RR (1986) Respiratory vs cardiovascular dysfunction - How can we differentiate? ASA Refresher Course Lectures, 102 4. Nunn JF (1977) Applied respiratory physiology (2nd ed). Butterworth et Co 5. Van Aken H, Lawin P (1981) Der EinfluB des Herzminutenvolumens auf die arterielle Oxygenation.

I felt highly honoured when I was asked to write about the achievements of my late brother, Dr Frank Wilson, MB, BS(Lond.), FF ARCS, DA, DCH, who was the editor of and a contributor to this book. Frank graduated in Medicine at St Bartholomew's Hospital Medical College in 1949 at the early age of 22. Born in Lancaster, his one wish was to return to the North. He held house appointments at Preston, spent his two years of National Service in the Royal Air Force and attained the rank of Squadron Leader. While on National Service, his interests turned to anesthetics, and as Senior Medical Officer on H.M. Troopship 'Devonshire', he developed a love for the sea. Convinced that anesthesia was his career, Frank came to Liverpool and attended the University course in this speciality. The vast experi ence he gained in anesthesia in the Liverpool Hospitals and on the Thoracic, Cardiac, Neurosurgical and Paediatric units, ensured his continued interest in resuscitation and neonatal anesthesia, which led him to design a new tracheostomy tube when he was at Alder Hey Children's Hospital. He became Lecturer in Anesthesia at the University of Liverpool and later Consultant Anesthetist to Southmead Hospital, Bristol, and then to the Burnley group of hospitals and to Lancaster in 1966."

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."

Fundamentals of Frontline Surgery is an easy to read text, written by world class faculty, that provides clinicians with succinct and didactic information about what to do in high intensity, resource limited situations.With global conflicts and humanitarian emergencies on the rise, there has been a dramatic uptake in the number of volunteers for both military and humanitarian operations. This manual aids best practice and fast decision making in the field.

Pre-hospital care plays an increasingly important part in contemporary healthcare delivery and the skills of paramedics, emergency medical technicians and emergency care assistants are a vital part of this. This casebook supports readers to develop the necessary assessment and decision-making skills they need in order to effectively manage a variety of cases typically seen in UK paramedic practice. 100 Cases in UK Paramedic Practice allows for learning and revision through 100 scenarios which aim to encompass cases that may be seen in daily practice. The book covers scenarios that can occur at any moment of the day, from an ambulance shift to primary care settings to event standby duties. The bite-size structure of this book allows the reader to focus on body systems or random case scenarios, depending on their preference. This is an essential, evidence-based guide for students of pre-hospital care and a useful reference for qualified staff as a source of continued professional development or as a revision tool.

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."

’n Onontbeerlike gids vir die uitkenning van al die gevaarlike slange en algemene onskadelike slange in Suider-Afrika, sowel as belangrike en praktiese kitsinligting oor noodhulp ingeval van ’n slangbyt.

Eenvoudige ikone, verspreidingskaarte, bondige teks en talle volkleurfoto's help om slange wat algemeen in die streek voorkom maklik uit te ken. Simptome en behandeling van slangbyte word beskryf, wat die leser lewensbelangrike noodhulpinligting gee.

Slange en Slangbyt in Suider-Afrika is helder, prakties, maklik om te gebruik en van onskatbare waarde vir almal wat van die buitelewe hou.

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.

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)."

Selected Figures and Tables from The Practice of Emergency and Critical Care Neurology, 2nd Edition condenses the main conclusions from each chapter of The Practice of Emergency and Critical Care Neurology, 2nd Edition into a concise and handy pocketbook. Designed as a quick reference, the pocketbook pulls together the most important tables and figures, putting hard to find information in one easy reference. This is by no means a replacement for the larger text, but rather, a quick, yet comprehensive volume to keep what is most vital on hand. Along with the tables and figures, the pocketbook includes important formulas and rating scales, guides to verifying a dose, guides to writing an order set and to provide emergency care of critically ill neurologic patients, guideline references, and a section at the back of the book to allow the practitioner to take notes. This is the go-to guide for every physician, staff neurologist, neurointensivist, resident, and fellow in training with managing acutely ill neurologic patients.

1. A guide to managing paediatric surgical patients in a remote and rural setting 2. Includes guidance on differences in presentation and problems relating to the Tropical environment 3. A key resource in understanding paediatric surgical patients needs when being managed remotely