The acute abdomen often perplexes the expert as well as the young physician. There are few areas in medicine in which Hippocrates' aphorism-the art is long, life is short, decision difficult, and delay perilous-is more applicable than here. Too often the harried physician fails to listen to the patient who is trying desperately to suggest the diagnosis. The significance of various types and location of pain often are neglected by the doctor. Physical findings are influenced by experience; the presence or absence of tenderness or a mass may be answered in entirely different ways by various observers. Because solid facts frequently are lacking, attempts to resolve diagnostic dilemmas by computer analysis or by algorithms are not likely to be successful. Fortunately, in the great majority of cases, unusual and difficult diagnostic procedures are not necessary for the identification of the acute abdomen and of the major disease. Astute clinical judgment must be based primarily upon careful attention to the pa tient's words and detailed observation."

Die Behandlung der aktuten respiratorischen Insuffizienz steht hiiufig im Mittelpunkt therapeutischer Bemiihungen warnend der postoperativen Phase sowie in der Intensivmedizin. Entsprechend lag und liegt das wissenschaftliche Hauptinteresse zahlreicher Arbeitsgruppen verschiedenster medizinischer Fachrichtunge- von der Physiologie liber die Pathologie, Rontgenologie, Chirurgie, Innere Medizin bis hin zur Aniisthesiologie und Intensivmedizi- im Bemiihen, den Pathomechanismus der akuten respiratorischen Insuffizienz aufzukliiren und hieraus therapeutische Konsequenzen zu entwickeln. Das vorliegende Heft beinhaltet Vortriige, die auf einem inter- nationalen Symposium, veranstaltet yom Institut flir Aniisthesiolo- gie der Universitiit MUnchen, gehalten worden sind. Die themati- sche Palette reicht von der Darstellung der normalen Lungenfunk- tion bis hin zur Diskussion detaillierter Fragen der Beeinflussung von PEEP auf die Hamodynamik. Es wird die pathologische Anato- mie der akuten respiratorischen Insuffizienz dargestellt, das rontge- nologische Substrat bei dieser Erkrankung diskutiert und die ver- schiedensten therapeutischen Verfahren werden angesprochen. Von besonderem Interesse wird flir Experten die Diskussion der Frage nach der Bedeutung des !lerzens, insbesondere des rechten Ven- trikels unter den Bedingungen der respiratorischen Insuffizienz sein. Es ist das liel der Zusammenstellung der verschiedenen Sympo- siumsbeitrlige, fdr Studenten wie auch fUr Arzte, die an Fragen der Intensivmedizin interessiert sind, eine lesenswerte Arbeitsgrundlage zu schaffen. Mein Dank gilt deshalb den Autoren sowie dem Springer-Verlag.

F.A. Bauhofer, Geneva In disaster situations, the particular concern of WHO is not so much to offer immediate relief and assistance for affected communities, but to have ready prepared plans for the provision of primary medical care as well as for resuscitation and casualty services. Disast ers are characterized by a need for rapid assistance and by the inability of affected communities to cope with the large scale mortality, morbidity, and damage to essential installations and homes. In some highly elaborate and centralized societies even small scale events may assume the proportion of a disaster, if they result in the serious break down of vital services. The Executive Board of the World Health Organization has defmed disasters or "emergencies," as situations where there are unforeseen, serious, and immediate threats to public health. Particularly severe disasters may be classified as catastrophes; such -occurrences, whether natural or man-made, disturb or overthrow the existing order. For planning purposes, it is important to distinguish between different types of catastrophes since they require special relief measures. In the past, medical assistance was primarily needed in epidemics of, for example, plague, cholera, and smallpox. Today, health authorities face emergency problems brought about by major accidents and outbreaks of chemical pollution and poisoning, which may have long-term effects. The role of health services may differ quite extenSively in different types of cata strophes, and an attempt must be made to draw up specific plans to deal with them."

The backbone of in-patient care is the hospital ward, and I believe that this will remain so in the future. Shortcomings in the staffing, organization and layout of the conventional ward have been recog nized for a long time, but there have been few changes and not all these have benefited the patient. The evolution of specialized treat ment centres for poliomyelitis, thoracic surgery, burns and so on, showed the need for a new staffing structure-a re-organization of patient care and of secondary importance, new forms of accom modation. These regional or referral centres serve large populations or areas and are collectively known as specialized intensive care (or therapy) units. The idea of using similar principles of staffing, organ ization and facilities to serve each large district hospital came much later (1959) and was first applied in the United States. Thus, the general intensive care unit was born, a unit which would treat critically ill patients irrespective of the nature of their disease, in sharp contrast to the specialized intensive care unit. The staffing structure and technologies of the two are however similar. Special ized intensive care consists of a single speciality or two specialities, for example thoracic surgery and thoracic anaesthesia. General intensive care cannot be a speciality because it embraces the whole of acute medicine, acute surgery, accident surgery, toxicology and many more individual specialities. This very diversity makes it difficult to organize, but interesting to perform.

Traditional Doctor / Nurse boundaries are being eroded with nurses expanding their sphere of practice to encompass assessment skills and enable them to manage total episodes of patient care with true autonomy (DOH 2000). More recently we have seen the emergence of Nurse Practitioners undertaking this advanced level of health assessment in the acute medical arena. This book will support the decision-making process and treatment that can be offered by these individuals.

"Acute Medicine - A Handbook for Nurse Practitioners"is an up-to-date, practical and comprehensive guide, offering invaluable information and advice on the management of acute medical conditions. Key features include:

Assessment, investigation, diagnosis and management of the most acute medical conditions A guide through the management of the patient and identification of priorities for treatment Legal, professional and ethical issues faced by nurses working at an advanced level Role development The development of protocols and prescribing Examples of Clinical Management Plans for the supplementary prescriber and Patient Group Directions to support practice

Written by an experienced Consultant Nurse in Acute Medicine, this engaging book will serve as a text from which the busy and highly skilled nurse can refer to for information on assessment, diagnosis and management of acute medical conditions.

Including previously unpublished guidelines and recent care descriptions not available in any other text, this reference provides illustrative chapters on the identification, diagnosis, and management of commonly encountered diseases and conditions in the care of the critically-ill patient. Researching the most recent clinical trials and supplying a extensive amount of tables, references, and figures, this guide examines issues significantly affecting the efficacy of care in the ICU, such as nutritional formulations, sedation methods, pain control, life-support technology, and the electronic health record.

Mastering Emergency Medicine is a concise, revision-focused textbook that covers everything that candidates need to know in order to pass the College of Emergency Medicine's (CEM) membership examination (MCEM) to enter training, and to the pass fellowship examination (FCEM) to complete the Certificate of Specialist Training. With over 100 OSCE scenarios designed to stimulate everyday emergency department clinical encounters, Mastering Emergency Medicine covers all the key areas of the CEM syllabus, including: clinical examinations and practical skills, communication skills, teaching and management. This book takes a practical approach to the subject - core facts are presented and common scenarios are explored using an OSCE style, as used in the Part C MCEM and the FCEM examinations - which makes it an invaluable blueprint for management of cases. Closely linked to the current CEM syllabus, each chapter comprises three parts: Core topics that supplement revision for Part A and B. Clinical scenarios, including data and relevant practical skills that can be used to prepare for Parts B and C. Mock 'Scoring Scenarios' that give specific guidance on how to perform in OSCEs. Mastering Emergency Medicine is a highly detailed revision guide for the OSCE examinations and an essential study guide for all those who are preparing for the MCEM or FCEM examinations. It will also be useful to those who are wishing to pursue a career in Acute Medicine.

The Nutrition and Health series of books have had great success because each volume has the consistent overriding mission of providing health professionals with texts that are essential because each includes (1) a synthesis of the state of the science, (2) timely, in-depth reviews by the leading researchers in their respective ?elds, (3) extensive, up-to-date fully annotated ref- ence lists, (4) a detailed index, (5) relevant tables and ?gures, (6) identi?cation of paradigm shifts and the consequences, (7) virtually no overlap of information between chapters, but targeted, inter-chapter referrals, (8) suggestions of areas for future research, and (9) balanced, data-driven answers to patient as well as health professionals questions which are based upon the totality of evidence rather than the ?ndings of any single study. The series volumes are not the outcome of a symposium. Rather, each editor has the potential to examine a chosen area with a broad perspective, both in subject matter and in the choice of chapter authors. The editor(s), whose training(s) is (are) both research and practice oriented, has(ve) the opportunity to develop a primary objective for their book, de?ne the scope and focus, and then invite the leading authorities to be part of their initiative. The authors are encouraged to provide an overview of the ?eld, discuss their own research, and relate the research ?ndings to potential human health consequences.

Obesity is a global public health issue; significant numbers of the world's population are overweight, growing numbers are obese, and many are morbidly obese. As obesity is associated with a range of co-morbidities (namely cardiovascular disease, diabetes, cancer, depression, and sleep apnoea), it presents a daunting peri-operative challenge to the anaesthetist. The increasing size and weight of patients presenting for surgery involves multiple issues from starting intravenous lines through to intubation and ventilation challenges. The Oxford Textbook of Anaesthesia for the Obese Patient is a highly authoritative, evidence-based account of the principles and clinical practice within the field. Across 36 chapters, this resource provides comprehensive coverage of all aspects of the subject including physiological and pharmacological modifications in the obese patient, bariatric and non-bariatric surgery, specific clinical issues such as fluid management and tissue oxygenation, as well as challenges arising from obesity in the setting of paediatrics, obstetrics, intensive care and trauma. Written and edited by experts in the field, this resource is the definitive guide to clinical management of the obese patient, exploring various international approaches to practice, with helpful case studies, and practical advice on common intra-operative challenges, and how to resolve them using evidence and best practice.

The fifth edition of this popular textbook continues to provide a solid foundation of pharmacological knowledge for all those working in anaesthesia and intensive care. The content has been thoroughly revised to include expanded chapters with clearer figures, ensuring readers are kept abreast of the ever-changing landscape of clinical pharmacology. Conveniently divided into four sections covering the basic principles of pharmacology, core drugs in anaesthetic practice, cardiovascular drugs, and other important drugs and complemented by new diagrams, tables and chemical formulae to facilitate learning. All four chapters on core drugs in anaesthetic practice have been updated along with others exploring applied pharmacokinetic models, antimicrobials, and drugs used in diabetes. An ideal aid to study and practice for junior and trainee anaesthetists and intensive care specialists preparing for exams. Also an invaluable resource for theatre practitioners, ICU nurses and physicians working in areas that demand a solid knowledge of pharmacology.

Including previously unpublished guidelines and recent care descriptions not available in any other text, this reference provides illustrative chapters on the identification, diagnosis, and management of commonly encountered diseases and conditions in the care of the critically-ill patient. Researching the most recent clinical trials and supplying a extensive amount of tables, references, and figures, this guide examines issues significantly affecting the efficacy of care in the ICU, such as nutritional formulations, sedation methods, pain control, life-support technology, and the electronic health record.

This book will provide 300 practice MCQs divided into three practice papers. Correct answers will follow, accompanied by short referenced notes drawing from recent important journal articles, major critical care textbooks and selected internet resources. Since there is no other dedicated intensive care MCQ book on the market, this book would be relevant to the following groups: junior intensive care trainees, senior intensive care nursing staff wishing to enhance their medical knowledge, intensive care consultants as a teaching aid and trainees preparing for professional examinations. This MCQ book will also be ideal in preparation for the European Diploma in Intensive Care Medicine (EDIC) Part 1 examination, as the questions will be matched as closely as possible in style and difficulty to those in the EDIC Part 1. The EDIC is an internationally recognised qualification for medical trainees in intensive care, set by the European Society for Intensive Care Medicine (ESICM). It is a two-part examination consisting of a 100-question multiple choice paper (Part 1) and a clinical and viva voce examination (Part 2). To ensure relevance, the questions will be designed with reference to the training syllabus provided by the ESICM.

The Annual Update compiles reviews of the most recent developments in clinical intensive care and emergency medicine research and practice in one comprehensive book. The chapters are written by well recognized experts in these fields. The book is addressed to everyone involved in intensive care and emergency medicine, anesthesia, surgery, internal medicine, and pediatrics.

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

This second edition of Clinical Pediatric Anesthesia: A Case-Based Handbook offers a comprehensive review of the options, advantanges, and disadvantages of different aspects of the perioperative management of the pediatric patient, as well as examples of a wide range of relevant clinical scenarios. Chapters are organized into 15 sections and cover the field of pediatric anesthesiology with a point-of-care approach. Written by a team of over 50 Pediatric Anesthesiologists at tertiary children's hospitals, this highly accessible text provides readers with multiple approaches to the anesthetic care of the pediatric patient. Each chapter includes an introduction to the topic, followed by learning objectives, clinical vignettes, and a discussion section styled in a question-and-answer format, concluding with a summary of the highest-yield and most salient information. Chapters also provide annotated references and suggestions for further reading to facilitate in-depth study of topic. The variety of cases presented, along with the contributors' expertise, render valuable real-life clinical situations that promote critical thinking and evaluation necessary for all pediatric anesthesiology consultants.

This issue of Physician Assistant Clinics, guest edited by Kim Zuber, PA-C and Jane S. Davis, CRNP, DNP, is devoted to Critical Care Medicine. This comprehensive issue includes the following articles: The PA in Critical Care Medicine; Pharmacology in Critical Care: When, What, and How Much; Bacteria and Viruses: The Bogeymen in the ICU; The Heart of the Matter: CHF, Cardiac Arrest, Cardiac Shock, ST Elevation MI's, Cardiac Arrhythmias, Hemodynamics, and Hypertensive Crisis; The Heart of the Matter: Cardiac Surgery, Cardiovascular Surgery Complications, Mechanical Devices, and ECMO; Breathe In, Breathe Out: Respiratory Considerations in the ICU; When the Kidney goes Rogue: Acute Kidney Infection in the ICU; Bridge Over Troubled Water: Fluid in the ICU; The Gland Plan: Endocrine Emergencies in Critical Care; Slip, Slipping Away: The Brain in the ICU; Gastroenterology, Hepatology, and Nutrition in the ICU; Special Intensive Care: The SICU; The Sick Child: the PICU; Crash: Trauma Management; and Saying Goodbye: Discussing End of Life Issues with the Critically Ill Patient and Family. CME credits are also available to subscribers of this series.

Written in a straightforward, readable, and highly informative style, Navigating the ICU: A Guide for Patients and Families is a compact, affordable guide to today's intensive care unit. This unique, patient-focused handbook is designed to help patients and their families navigate the complexities of the ICU-from the role of each member of staff, to common procedures, medications, and laboratory tests, to what to expect after the hospital stay. Author and ICU nurse Alex Gottsch concisely explains the ICU experience and provides accessible answers to common questions asked by patients and families. Provides a single, accessible resource for patients and families in the high-stress setting of the ICU, where life-changing decisions often need to be made rapidly in an unfamiliar and intimidating environment Improves communication between patients, families, and health care providers by educating families about how the ICU works, what questions to ask, and how to advocate for themselves and family members Guides you through the ins and outs of the ICU experience with an intuitive, easy-to-use table of contents Answers questions you may not have known you had, such as "What is the most important part of the day for me to be present?" and "What Medical Care Would I Want If I Could Not Choose?" Addresses a wide range of post-ICU possibilities including Post-Intensive Care Syndrome (PICS), what to expect from skilled nursing facilities and long-term acute care facilities, and end-of-life issues Includes a Foreword by Patricia M. Davidson, Dean of The Johns Hopkins School of Nursing 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.

50 Studies Every Intensivist Should Know presents key studies that have shaped the practice of critical care medicine. Selected using a rigorous methodology, the studies cover topics including: sedation and analgesia, resuscitation, shock, ARDS, nutrition, renal failure, trauma, infection, diabetes, and physical therapy. For each study, a concise summary is presented with an emphasis on the results and limitations of the study, and its implications for practice. An illustrative clinical case concludes each review, followed by brief information on other relevant studies. This book is a must-read for health care professionals and anyone who wants to learn more about the data behind clinical practice.

1 Historische Entwicklung der Tracheotomie.- 1.1 Verbreitung der Tracheotomie im 19. Jahrhundert.- 1.2 Indikation und Technik der Tracheotomie um 1900.- 1.3 Technik der operativen Tracheotomie heute.- 1.4 Entwicklung der perkutanen Tracheo[s]tomie.- Literatur.- 2 Topographische Anatomie der vorderen Halsregion.- 2.1 Grenzen und Form des Halses.- 2.2 Subkutane Strukturen.- 2.3 Faszien und Bindegewebsraume.- 2.4 Halseingeweide.- 2.5 Gefasse im mittleren Halsdreieck.- 2.6 Operativer Zugang zur Trachea.- 3 Indikation und Zeitpunkt der Tracheotomie in der Intensivmedizin.- 3.1 Vor- und Nachteile der prolongierten translaryngealen Intubation.- 3.1.1 Laryngotracheale Intubationsschaden.- 3.1.2 Nosokomiale Infektionen.- 3.1.3 Atemphysiologie.- 3.1.4 Akzidentelle Extubation.- 3.2 Indikationen zur Tracheotomie.- 3.2.1 Laryngotracheale Schaden.- 3.2.2 Nosokomiale Infektionen.- 3.2.3 Atemphysiologie.- 3.2.4 Logistische, oekonomische und pflegerische Aspekte.- 3.3 Zeitpunkt der Tracheotomie.- 3.3.1 Gibt es pradiktive Faktoren fur die Notwendigkeit einer Tracheotomie?.- 3.4 Zusammenfassung.- Literatur.- 4 Perkutane Tracheotomie - Techniken und Komplikationen.- 4.1 Allgemeine Vorbemerkungen.- 4.1.1 Beatmungsverfahren und Monitoring wahrend der perkutanen Tracheotomie.- 4.1.2 Vorbereitung des Patienten und benoetigte Materialien.- 4.1.3 Personelle Voraussetzungen.- 4.1.4 Anatomische Landmarken.- 4.2 Allgemeine Komplikationen wahrend perkutaner Tracheotomie.- 4.3 Gegenwartige Techniken der perkutanen Tracheotomie und ihre speziellen Komplikationen.- 4.3.1 Perkutane Dilatationstracheotomie (PDT).- 4.3.2 Guide Wire Dilating Forceps (GWDF).- 4.3.3 Translaryngeale Tracheotomie (TLT).- 4.3.4 Ciaglia Blue Rhino (CBR).- 4.4 Besonderheiten des Trachealkanulenwechsels nach perkutaner Tracheotomie.- 4.5 Spatkomplikationen der Tracheotomie.- Literatur.- 5 Respiratorische Insuffizienz, Gerinnungsstoerungen und andere typische Probleme in der Intensivmedizin - Tracheotomie bei wem und wie?.- 5.1 Respiratorische Insuffizienz.- 5.1.1 Konventionell-offene Tracheotomie.- 5.1.2 Perkutane Techniken.- 5.2 Gerinnung.- 5.3 Schwierige anatomische Verhaltnisse.- Literatur.- 6 Die Tracheotomie aus Sicht der Hals-Nasen-Ohrenheilkunde.- 6.1 Tracheotomie in der Kopf-Hals-Chirurgie.- 6.2 Tracheotomie in der Intensivmedizin.- 6.3 Technik.- 6.4 Kontraindikationen der trachealen Punktionstechniken.- 6.5 Koniotomie.- 6.6 Stomaverschluss.- 6.7 Komplikationen der Tracheotomie.- 6.8 Postoperative Komplikationen.- Literatur.- 7 Die Tracheotomie in der pneumologisch-internistischen Intensivmedizin.- 7.1 Neue Techniken.- 7.2 Indikationen zur Tracheotomie.- 7.2.1 Schutz der Atemwege vor Komplikationen der Langzeitintubation?.- 7.2.2 Tracheotomie nach translaryngealer Intubation?.- 7.2.3 Zeitpunkt der Tracheotomie.- 7.2.4 Logistik der Tracheotomie.- 7.3 Tracheotomie und nicht-invasive Beatmung.- 7.4 Management von Trachealstenosen nach Tracheotomie oder translaryngealer Langzeitintubation.- 7.5 Zusammenfassung.- Literatur.- 8 Die Tracheostomie heute - aus der Sicht der Chirurgie.- 8.1 Moderne Methoden.- 8.2 Indikationen und Kontraindikationen.- 8.3 Aktueller Stand und Ausblick.- Literatur.- 9 Stellenwert der Tracheotomie aus der Sicht der Kinderheilkunde.- Literatur.- 10 Die Tracheotomie in der Kiefer- und Gesichtschirurgie.- 10.1 Tumorchirurgie.- 10.2 Kongenitale Anomalien.- 10.3 Gesichtstraumatologie.- 10.4 Dentogene Entzundungen.- 10.5 Operative Aspekte.- 10.6 Aspekte der stationaren Nachsorge.- 10.7 Schlussbemerkung.- Literatur.- 11 Nottracheotomie, Notkoniotomie und Notfalle bei Tracheostomatragern.- 11.1 Tracheotomie bei respiratorischen Notfallen.- 11.2 Die notfallmassige Koniotomie.- 11.2.1 Nu-Trake Krikotomie Set.- 11.2.2 Melker Notfall-Krikothyrotomie-Katheterset.- 11.3 Der Trachealkanulentrager als Notfallpatient.- Literatur.

Mayo Clinic Critical Care Case Review is a unique compellation of cases presented at the highly rated Mayo Clinic Clinical Pathological Case (CPC) Conference. Designed to cover rare cases in a short amount of time, these reviews are set up in what is called the "unknown" format: highlighting the clinically key elements of the patient's hospital course, singling out the diagnostic dilemmas, and concludes with a question and answer format that allows clinicians to take home relative points for clinical practice. Written by practicing intensivists and critical care fellows for practicing intensivists and critical care fellows, this book combines interesting reading experiences with critical care medicine review. Each chapter ends with questions and answers that provide a board style review for the readers. Each case begins on the left-hand page with the discussion on the right, written succinctly to provide quick diagnostic understanding. While most critical care review books focus solely on an organ-system format, Mayo Clinic Critical Care Case Review captures the spirit of the CPC Conference in its text and illustrations.

"It's raining and the reflections of the red and white lights are dancing off the buildings as we race down the wet streets. Sirens are screaming a warning to the very few people who dare to walk the street at night.
We make a final turn and the scene comes into view. There's a lone police car; its light bar extinguished so as not to call attention to itself. We follow suit and shut our lights and siren off as we approach. In the center of the rain-soaked street, a crowd has gathered. A woman is screaming, being held up by friends or family. A man lies crumpled in the middle of the road next to his wheelchair. The cop looks nervous as we roll to a stop and exit the ambulance. 'He's been shot - a lot, ' he shouts from about 10 feet away.
The decibel level immediately increases from the crowd of distraught onlookers. We know we're going to have to work quickly to try to save the patient and get away from the scene for our own safety. We grab the heart monitor, oxygen, trauma bag and the stretcher for the fourth time this shift and once again go wading into chaos..."
Paramedics and EMTs are the front line of the world's emergency medical system and serve as eyewitnesses to some of life's most precious and equally most tragic moments.
Wading Into Chaos, written by a veteran paramedic, gives you a first hand, real life glimpse inside the chaotic world of Emergency Medical Services. Ride along and experience the emotions, the frustration, the sadness and the dark humor that accompanies responding to fatal car crashes, 14-year-old suicides, inner city gang violence, train accidents, med-e-vac helicopter landings, and the forgotten elderly who just need someone to talk to.