1/2. MAST: medical antishock trousers.MAST are a simple, safe and sound device with applicability in all shock states; they provide a number of benefits to the hypotensive patient. The main benefits seem to be autotransfusion of peripherally pooled blood originating from the MAST encased areas, increase in peripheral vascular resistance, external tamponade of bleeding vessels and an aid to stabilization of fractured bones of the pelvis and lower extremities. Because an area of hypoperfusion can lead to complications, the pathophysiologic effects of MAST must be understood. The greatest complications occur when MAST are too rapidly removed. They must be removed in an appropriate place by trained physicians under controlled conditions. The key is to deflate the MAST over a prolonged period of time using a gradual release of external pressure. Volume status and acid-base balance must be carefully monitored. In the last few years MAST have had an ever expanding role in both the pre-hospital and hospital phases of care of the critically ill and injured patients. All physicians involved in the care of these patients must be familiar with this device. Applied and removed properly, MAST will sustain blood pressure and save lives.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/2. The importance of seizure-inducing factors in the control of refractory forms of epilepsy.Of over 40 known epileptogenic mechanisms, some 10 vary from hour to hour, depending upon habit factors and the daily activities of the patients. Tension states, alterations of level of consciousness, sleep deprivation, disturbances of water and acid-base balances, sensory and drug stimulation, and drug withdrawal are the principal factors involved. Their importance varies widely in patients, as well as with time. This fact and the concentration of physicians upon drug therapy have served to deemphasize this aspect of antiepileptic therapy. This point was clearly verified by reviews of the literature. In a prospective study of 500 drug-resistant patients, such seizure-inducing mechanisms were studied. methods of identification, evaluation, and regulation were developed. The results indicate that in selected patients the regulation of such factors may play a significant role in the stabilization and improvement of the underlying epileptic condition. In 17% of a refractory group, such factors were found to be of crucial importance. In spite of intensive efforts with drug therapy over the past 4 decades, the incidence of drug-resistant cases remains high. The more comprehensive approach suggested offers an attractive, partial solution to this difficult problem.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |