TRUE LIFE-AND-DEATH DRAMA

In taut, thrilling prose, Peter Canning has written a book that captures the rarely seen real world of emergency medicine. A seasoned paramedic who fights under enormous pressure to save lives, Canning trains new paramedics for the rigors of a nonstop, action-packed battle. From a four-month-old baby who has stopped breathing to a sixty-seven-year-old woman with a strange abdominal mass that threatens to explode--these are gripping true stories from the "ER on the streets." An exciting, often moving account, Canning tells a powerful story of camaraderie, selflessness, and courage as paramedics try to stand tall and human through both defeat and victory.

The anesthesia and intensive care in infants and children have assumed positions of primary importance in contemporary medicine. In these delicate sectors of medicine, clinical research activities must be continually supported by interdisciplinary collaborations. Neonatal and pediatric intensive care requires that all involved physicians, including the surgeon and anesthesiologist, be willing to work together as a team. However, coordination of the various pathophysiological and clinical aspects of neonatal and pediatric critical medicine is highly complex. A complete and current review of the anaethesia and intensive care of infants and children must include discussions of morbidity rates, so as to guide the clincians in choosing the diagnostic approach, as well as of monotoring techniques appropriate to support the therapeutic decision. Recent progress in intensive care medicine for infants and children has been significant.

Management of the intensive care patient afflicted by respiratory insufficiency requires knowledge of the pathophysiological basis for altered functions. The etiology and therapy of pulmonary diseases, such as acute respiratory distress syndrome (ARDS) and chronic obstructive pulmonary disease (COPD) are highly complex. While physiologists and pathophysiologists work prevalently with theoretical modes, clinicians employ sophisticated ventilation support technologies in the attempt to understand the pathophysiological mechanisms of the pulmonary diseases which can present with varying grades of severity. Despite the availability of advanced technologies it is common to personalize the treatment protocol according to the patient's physiologic structure.Given the complexity and difficulties of treating respiratory disease, a strong collaboration between clinicians and physiologists is of fundamtental importance.

Because of their therapeutic safety, hydroxyethylstarch, gelatin and dextrans are among the most frequently used drugs in the world. Recent studies have shown that bleeding disorders, anaphylactic reactions and storage in the body depend decisively on the nature of the administered plasma substitute. Through interdisciplinary cooperation the "First European Volume Replacement Conference" has established indications for the use of individual plasma substitutes to improve the efficacy and therapeutic safety of volume replacement therapy.

The critically ill patient in intensive care may present with serious metabolic alterations caused directly by the illness or secondarily by complications (e.g. infections, organ failure or sepsis) developing within a few hours of hospitaliza tion or in the following days. Among the situations which maintain and further trigger rapidly evolving altered metabolism are complex hormonal reactions, particularly those of the hypothalamus-hypophysis-adrenal axis, and abnormal stimulation of the autonomic nervous system. In fact, the sympathetic nervous system is known to cause significant metabolic alterations. For example, a surgery patient afflicted by septic complications may become hypercatabolic and experience significant nitrogen loss; the altered protein metabolism may in turn heavily influence carbohydrate and lipid metabolism as well. Thus, it is apparent that for optimal care of patients with altered metabolic functions, further knowledge is necessary regarding the physiopathology of metabolism and the physiopathological mechanisms, which alter the consump tion of principal energy substrates. Many experimental and clinical studies have investigated the metabolic aspects of individual organs or organ systems. However, for a correct evaluation of such metabolic events, in addition to studying the roles of metabolic enzymes, active metabolites, and the glutathione system, it is interesting to consider the use of indirect calorimetry as a valid and important investigative technique. The critically ill patient with major alterations in nutritional status may require artificial nutritive support administered through either parenteral or enteral routes."

The management of critically ill patients has, in the past few years, been a discipline at the forefront of development which continues to make progress with the support of basic and clinical research in the broadest sense. The application of biotechnology in this particular area has revealed itself to be essential in an attempt to provide the best interpretation of the bio-humoral and functional alterations present in a long series of often complex clinical conditions. The care of the critically ill is also at the forefront in the application of increasingly sophisticated clinical monitoring systems that also contribute to standardizing certain procedures, establish guidelines, and evaluate the efficacy of therapeutic interventions and their costs

About Emergency Care and Transportation of the Sick and Injured, Twelfth Edition: Since 1971, Emergency Care and Transportation of the Sick and Injured has advanced how EMS education is delivered to help train exceptional EMS professionals around the globe. Fifty years later, the Twelfth Edition is now the most advanced EMT teaching and learning system ever developed. Current State-of-the-Art Medical Content Comprehensive coverage of the National EMS Education Standards and the 2020 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (ECC). Evidence-based medical concepts are incorporated to ensure that students and instructors have accurate, insightful interpretation of medical science as it applies to prehospital medicine today. Updated coverage of PPE and CDC guidelines for safe patient care during COVID-19 pandemic. A Focus on Career Readiness and Employability Greater emphasis on soft skill development, including empathy, teamwork, interpersonal skills, and problem solving, and how critical these skills are for better patient outcomes. Enhanced content on provider mental health, wellness, and safety. Evolving patient case studies that deliver clinical education and help prepare students to care for patients in the field. The cases offer increased focus on EMS provider leadership and critical thinking skills throughout the text. A new "Street Smarts" feature that helps bridge the gap between the classroom and field environment by addressing nontechnical skills that improve patient and co-worker interactions. A Foundation for Success The textbook design and layout have been revised to improve visualization of key content and overall readability. Comprehensive anatomy, physiology, pathophysiology, and medical terminology content is delivered in early chapters, and subsequently reinforced in related chapters throughout the textbook. Valuable student resources, including audiobook, interactive lectures, test prep, soft-skill simulations, and videos cater to a variety of learning styles and needs. Educators are supported by a broad range of instructional and assessment resources to fully enable traditional, hybrid, and flipped course delivery.

This volume on scientific advances in critical care testing com piles a number of clinical and laboratory studies related to criti cally ill patients that involve new technology, therapy options, application or interpretation of new tests, patient management and cost benefits. There were a total of 340 applicants for this first International Federation of Clinical Chemistry-AVL Award, and from these, National Winners were selected in 26 member countries of the IFCC. This publication presents the full papers of the ten finalists among the National Winners selected for the international final held in London in July 1996. These ten were chosen by the Inter national Awards Committee of the IFCC. In addition, the editors have decided also to include their choice of the best abstracts from the National Winners, thus giving a broad overview of cur rent research being conducted in the field of critical care medi cine among IFCC members. In keeping with the title of this volume, all major fields of in tensive care medicine are represented, including inflammation, infection, stress, hypoxia, ischaemia, cardiology, haemodynamics, blood gases, electrolytes, trace -elements, nephrology, gastroenter ology and haematology. In addition, there is also a chapter on new technology in critical care testing and on miscellaneous top ics."

This volume presents an overview of the pathophysiology, clinical features, and treatment of disseminated intravascular coagulation with regard to those conditions encountered most often during intensive medical care. The excellent organization of the book enables the reader to easily find answers to specific, individual questions.

At the APICE '96 research scientists and clinicians were provided with updated guidelines for the treatment of patients with acute and chronic critical conditions. This volume contains 100 chapters,in which the main pathophysiological concepts were reviewed, with special emphasis on the cardiovascular, respiratory, metabolic, and neurologic systems. Special reference is made to the pharmacologic and biotechnologic strategies currently being used to support those vital functions that are affected by severe and sometimes devastating diseases. The topics of infection, sepsis,and SIRS have been reviewed and updated in keeping with the most recent information available, and particular focus has been directed to ethics.

Belastende Einsatze, belastete und handlungsunfahige Helfer.

Die psychosozialen Anforderungen im Rettungsdienst werden meistens unterschatzt. Psychologie in der Notfallmedizin und im Rettungsdienst wendet sich an Notarzte und alle Rettungsdienstmitarbeiter, die taglich mit Notfallen und menschlichen Katastrophen umgehen mussen. Das Lehrbuch vermittelt eine sichere Handlungsbasis fur psychologische Problemlosungen am Notfallort:

* Psychologische Grundlagen in Notfallsituationen und Katastrophen

* Praktische Kenntnisse in Pravention, Belastungsbewaltigung sowie Nachsorge

* Separate Kapitel zur psychologischen Betreuung spezieller Notfallpatienten

Plus fur die Praxis: Pravention von Burnout, Informationen zu Fuhrung, Aufbau von Supervisionsgruppen. Neu in der 2. Auflage: alle Beitrage komplett uberarbeitet mit praktischen Hinweisen und Ubersichten

Ein unentbehrlicher Praxisleitfaden fur Mitarbeiter in Notfalldienst und Rettungswesen, um mit fremden und der eigenen Seele sorgsam umgehen zu konnen"

The Yearbook compiles the most recent, widespread developments of 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.

This critical care medicine book substantially differs from others due to the range of peculiarities that characterize it. Since it deals with acute patients in critical conditions, this is, as it were, a 'borderline'book, in the sense that it is intended for those, who, in their activity, need a continuous and in-depth interdisciplinary approach to optimize the quality of the treatments offered to critically-ill patients. This book helps to have a better understanding of the current limits of human intervention and aims at supplying updated guidelines; in particular, it is intended for those who, although having to guarantee continuity and top-quality therapies, must decide when and why the collaboration with and intervention by experts is necessary

Long recognized as the gold standard emergency airway management textbook, The Walls Manual of Emergency Airway Management, Sixth Edition, remains the most trusted reference on this challenging topic. This practical reference, edited by Drs. Calvin A. Brown III, John C. Sakles, Nathan W. Mick, Jarrod M. Mosier, and Darren A. Braude, is the foundation text for these nationally recognized programs: The Difficult Airway Course: Emergency (TM), The Difficult Airway Course: Critical Care (TM), The Difficult Airway Course: EMS (TM), and The Difficult Airway Course: Residency Edition (TM). Its hands-on approach provides the concrete guidance you need to effectively respond wherever adult or pediatric airway emergencies may occur, including in and out of hospital settings, emergency departments, and urgent care centers. Includes new chapters on Physiologically Difficult Airway; Human Factors in Emergency Airway Management; Intubating the Highly Infectious Patient (including COVID-19 considerations); and the Massively Soiled Airway Emphasizes practicality with step-by-step instructions, mnemonics, easy-to-follow algorithms, and rich illustrations Esteemed contributors from previous editions, Dr. Jarrod M. Mosier and Dr. Darren A. Braude, bring their extensive expertise in critical care and prehospital airway management, respectively, as new editors of this edition Enrich Your eBook Reading Experience Read directly on your preferred device(s), such as computer, tablet, or smartphone. Easily convert to audiobook, powering your content with natural language text-to-speech.

The Yearbook compiles the most recent, widespread developments of 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.

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

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

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

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.

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

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

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

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

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.