Craig’s RESTORATIVE DENTAL MATERIALS THIRTEENTH EDITION

Craig’s

RESTORATIVE

DENTAL

MATERIALS

THIRTEENTH EDITION

OH’S INTENSIVE CARE MANUAL Sixth Edition

OH’S INTENSIVE

CARE MANUAL

Sixth Edition

Edited by

Andrew D BerstenMB BS MD FANZCA FJFICM

TRAUMA - INITIAL MANAGEMENT

TRAUMA  - INITIAL MANAGEMENT  

The initial management of the severely injured patient requires the surgeon to make rapid choices between various diagnostic and therapeutic interventions. In patients with a single severe injury there is a single set of priorities. In sharp contrast, a patient with critical injuries to several different organ systems often presents conflicting priorities in management. The thoughtful and accurate ordering of diagnostic and therapeutic interventions is critical to provide the optimal outcome and is perhaps the most important task of the trauma surgeon.^[13]

Priorities in Initial Management

It is essential to begin with the assumption that the physiologic state of the patient is likely to deteriorate, perhaps abruptly, and that there is more than one serious injury present. It is also essential to realize that the most obvious or most dramatic injury may not be the most critical one. The trauma surgeon must adopt a very focused approach in which problems are addressed in strict order of their threat to life and function. Even a small delay for the treatment of a more minor injury cannot be tolerated. Within this focused approach, the surgeon must be constantly reassessing the situation as new data are obtained and be able to instantly change the focus and the order of priorities as new injuries or new findings are brought to light. The necessity to balance various conflicting priorities and accurately direct the initial diagnosis and treatment requires an approach to the patient as a whole, not as isolated organ systems. The overall management of the patient is best directed by one person who has the experience and authority to make difficult immediate decisions under stressful circumstances.

PRINCIPLES OF ETHICS FOR EMERGENCY PHYSICIANS

PRINCIPLES OF ETHICS FOR EMERGENCY PHYSICIANS

Contents 

I.                   Principles of Ethics for Emergency Physicians

II.                 Ethics in Emergency Medicine: An Overview  

A.    Ethical Foundations of Emergency Medicine  

1. Moral pluralism  

2. Unique duties of emergency physicians  

3. Virtues in emergency medicine  

B. The Emergency Physician-Patient Relationship  

1. Beneficence  

2. Nonmaleficence  

3. Respect for patient autonomy  

4. Justice  

Hypoglycemia

                            Hypoglycemia

Hypoglycemia or hypoglycæmia is the medical term for a state produced by a lower than normal level of blood glucose. The term literally means "under-sweet blood" (Gr. hypo-, glykys, haima).

Hypoglycemia can produce a variety of symptoms and effects but the principal problems arise from an inadequate supply of glucose as fuel to the brain, resulting in impairment of function (neuroglycopenia). Effects can range from vaguely "feeling bad" to seizures, unconsciousness, and (rarely) permanent brain damage or death.

The most common forms of moderate and severe hypoglycemia occur as a complication of treatment of diabetes mellitus with insulin or oral medications. Hypoglycemia is less common in non-diabetic persons, but can occur at any age, from many causes. Among the causes are excessive insulin produced in the body, inborn errors of carbohydrate, fat, amino acid or organic acid metabolism, medications and poisons, alcohol, hormone deficiencies, certain tumors, prolonged starvation, and alterations of metabolism associated with infection or failures of various organ systems.

Common Emergencies

                  Common Emergencies

Brain Hemorrhage

Lay the patient on his back with the head and shoulders slightly raised. Apply cold cloths or ice bag to the head. Insist on absolute quiet. Use great care in moving the patient. Do not use stimulants.

Drunkenness

Patient will usually sleep off the condition m a few hours. If the patient can be aroused, make him vomit and then give coffee. Apply artificial respiration if patient stops breathing.

Fainting

If a person feels faint make him lie down with his body level. Keep him lying down, and lower his head. If he is in a chair tilt the chair back ward. If it is impossible to lower his head, elevate his legs. Loosen tight clothing. Smelling salts inhaled may be helpful, but do not use ammonia. Sprinkle the face with cold water. After consciousness returns, give stimulant by mouth.

First Aid

                                                                             First Aid

In attending an injured person:

1. Keep the injured person lying down in a comfortable position, his head level with his body, until you know whether the injury is serious.

2. Look for hemorrhage, stoppage of breathing, poisoning, wounds, burns, fractures, and dislocations. Be sure you locate every injury. Remove enough clothing to determine the extent of the injury. Rip the seams if necessary. Attempts to remove the clothes in the usual manner may cause unnecessary suffering or may aggravate injury. Serious bleeding, stoppage of breathing, and poisoning must be treated immediately before anything else is done.