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."

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."

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.

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.

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.

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.

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.

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.

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."

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

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."

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.