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.

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 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 focuses on the operational and clinical strategies needed to improve care of Emergency Psychiatric patients. Boarding of psychiatric patients in ED's is recognized as a national crisis. The American College of Emergency Physicians identified strategies to decrease boarding of psychiatric patients as one of their top strategic goals. Currently, there are books on clinical care of psychiatric patients, but this is the first book that looks at both the clinical and operational aspects of caring for these patients in ED setting. This book discusses Lean methodology, the impact of long stay patients using queuing methodology, clinical guidelines and active treatment of psychiatric patients in the ED.

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.

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.

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.

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."

The continued high mortality (up to 70 %) in patients with necro- tizing pancreatitis and diffuse peritonitis has led to the develop- ment of various surgical strategies within the past few decades. Up to the present decisions about the management of these disea- ses have been rather difficult because of the individual courses differ considerably, even being incomparable. Today, as a result of our in creased knowledge of the pathophysiology, the impro- ved imaging procedures, and the standaridized intensive care, the rend is moving toward delayed surgical intervention. The goals in the surgical treatment of necrotizing pancreatitis and diffuse peritonitis are still surgical removal of the focus of infection, elimination of endotoxins by lavage, and optimal drainage of the peritoneal cavity. Depending on the patient's general condition this cannot always be achieved in the first surgi- cal intervention. A number of surgical methods have therefore been developed, such as postoperative dorsoventral lavage, step- by-step lavage therapy, postoperative closed continuous perito- neal lavage, and open treatment (laparostomy). The last-mentioned method ist not new; it was first described by KOR'J;E in 1894 for the treatment of necrotizing pancreatitis. However, due to the progress in intensive care medicine (long- term respiratory therapy, hemofiltration, etc.) in the last few years this method of management has become successful and gai- ned in recognition.

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.

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.

Point of care ultrasound is a critical tool required for assessing all patients, providing rapid answers to clinical questions and facilitating high quality care for patients. This essential guide caters for all generalist clinicians beginning their ultrasound journey and extends to more advanced assessments for those with established ultrasound experience wishing to advance their knowledge and skills. It covers a wide range of ultrasound topics from echocardiography, thoracic and COVID-19 to emerging areas such as palliative care, hospital at home and remote and austere medicine. An extensive collection of colour images, videos and examples of clinical applications will inspire readers to acquire the skills of point of care ultrasound quickly, safely and systematically. The printed code on the inside of the cover provides access to an online version on Cambridge Core. An essential aid for acute clinicians, paramedics, general practitioners as well as remote medical providers, medical educators and students.

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

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.

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."

Apley & Solomon's Concise System of Orthopaedics and Trauma is firmly established as the leading introductory textbook of orthopaedic practice and the principles of fracture and trauma management. Praised in previous editions for the systematic approach, balanced content and easy-to-read style, this fifth edition has been brought fully up to date under the direction of the new and distinguished authorial team, while remaining true to the teaching principles of Alan Apley and his successor Louis Solomon. Key features: Focused - on diseases and clinical signs with additional detail on anatomy where appropriate International - enhanced coverage of 'global orthopaedics' reflect the changing pattern of musculoskeletal disease and trauma around the world Relevant - provides helpful guidance on simple procedures without unnecessary operative detail Readable - increased emphasis on concise presentation Current - updates reflect developments in molecular biology, genetics and imaging technology This fifth edition remains the first choice for medical students, trainee surgeons and other health professionals seeking a convenient introduction to this large and complex subject and is a natural precursor to the more detailed coverage offered by its larger parent, Apley & Solomon's System of Orthopaedics and Trauma.

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.

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."

Recognition and diagnosis of child abuse and neglect creates an important foundation for the protection of children. Physicians and other healthcare providers have a fundamental role in this process, and need to be confident that they can identify correctly the signs and symptoms that provide clues to non-accidental injuries resulting from child maltreatment. Diagnosis of Non-accidental Injury: Illustrated Clinical Cases is an invaluable tool to aid prompt and appropriate diagnosis, presenting various types of findings and challenging the reader with both common and not-so-common manifestations that may result from - or be confused with - child abuse and neglect. The book describes various clinical scenarios through a brief clinical history accompanied by high-quality clinical images. Questions focus on the important concepts to be learned from each case. The answers are revealed after a turn of the page, sometimes with additional images to explain critical aspects, and feature a diagnosis, the 'ruling out' of abuse or neglect, further diagnostic options where relevant, and helpful treatments.

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."