1/28. The efficacy of integrating "smart simulated casualties" in hospital disaster drills.INTRODUCTION: Full-scale disaster drills are complex, expensive, and may involve hundreds or thousands of people. However, even when carefully planned, they often fail to manifest the details of medical care given to the casualties during the drill. OBJECTIVE: To assess the feasibility of integrating physicians among the simulated casualties of a hospital disaster drill. methods: A total of 178 physicians graduating an Advanced Trauma life Support (ATLS) course participated in eight hospital disaster drills during 1994 as "Smart Victims." The participants were given cards with descriptions of their injury and detailed instructions on how to manipulate their medical condition according to the medical care provided in the hospital. They also were given coded questionnaires to fill out during the process of the drill. Conclusions were drawn from analysis of the questionnaires and from a roundtable discussion following each drill. RESULTS: The "smart casualties" made comments on the following topics: 1) triage (over-triage in 9%, and under-triage in 4%); 2) treatment sites; 3) medical equipment usage (i.e., shortage of ventilators and splinting devices); 4) medical knowledge and care rendered by the hospital staff; 5) evacuation and escorting of the wounded; 6) management of patients with post-traumatic stress disorder; and 7) medical documentation. Their comments contributed valuable information on the quality of medical care and organization, and identified obstacles that otherwise would have been overlooked. The "smart casualties" were very cooperative and indicated that their participation in the drill contributed to their understanding of disaster situations in hospitals. CONCLUSION: Integrating physicians among the simulated casualties in a hospital disaster drill may contribute to achieving the objectives of hospital disaster drills and add to disaster management education of the simulated casualty physicians.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/28. Importance of examination of buccal cavity, trachea, hand and all injuries.Four cases are discussed, with the point in view that examination of oral cavity, trachea, hands and all injuries is a vital part of post-mortem examination for the administration of justice. The cases are as follows. 1. Alleged case of death due to faulty treatment by physician, in which the death was due to choking by a medicinal tablet given forcefully to the child by his grandmother. 2. A case of hanging in which examination of the left palm revealed a ball pen testing mark on the hypothenar region. 3. In a case of homicidal death, a metal fragment was found in an incised wound which became an important piece of evidence for the administration of justice. 4. A case of hanging in which the suicide note was found in the oral cavity.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
3/28. Maggot debridement therapy in outpatients.OBJECTIVE: To identify the benefits, risks, and problems associated with outpatient maggot therapy. DESIGN: Descriptive case series, with survey. SETTING: Urban and rural clinics and homes. PARTICIPANTS: Seven caregivers with varying levels of formal health care training and 21 ambulatory patients (15 men, 6 women; average age, 63 yr) with nonhealing wounds. INTERVENTION: Maggot therapy. MAIN OUTCOME MEASURE: Therapists' opinions concerning clinical outcomes and the disadvantages of therapy. RESULTS: More than 95% of the therapists and 90% of their patients were satisfied with their outpatient maggot debridement therapy. Of the 8 patients who were advised to undergo amputation or major surgical debridement as an alternative to maggot debridement, only 3 required surgical resection (amputation) after maggot therapy. Maggot therapy completely or significantly debrided 18 (86%) of the wounds; 11 healed without any additional surgical procedures. There was anxiety about maggots escaping, but actual escapes were rare. pain, reported by several patients, was controlled with oral analgesics. CONCLUSIONS: Outpatient maggot debridement is safe, effective, and acceptable to most patients, even when administered by nonphysicians. Maggot debridement is a valuable and rational treatment option for many ambulatory, home-bound, and extended care patients who have nonhealing wounds.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
4/28. Maternal persistent vegetative state with successful fetal outcome.A woman suffered from massive blunt injuries in a motor vehicle accident at a presumed 4 weeks' gestation, but she successfully carried the fetus for an additional 29 weeks. Premature labor began at 33 weeks' gestation and a live 1,890 g male was delivered. His development was normal for the 12-months postnatal follow-up period. The patient remained in a persistent vegetative state. Only 12 cases of severely brain-injured pregnant patients who delivered babies have been reported in English literature. Such patients need special maternal and fetal monitoring. As shown in our patient, successful fetal outcome could be obtained in a mother who suffered from hypovolemic shock and diffuse axonal injury, was treated with numerous medications from 4 weeks' gestation, and survived premature labor at 33 weeks' gestation in a persistent vegetative state. This report represents the longest interval from maternal vegetative state to obstetric delivery. From our case, it would seem that no clear limit exists that restricts the physician's ability to support a severely injured pregnant patient.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
5/28. Constraints and heroes.A story, perhaps apocryphal, is told about the united states surgical team which pioneered the first artificial heart procedure. It is said that the team received a number of telephone calls from people around the country who, worried about the ailing heart recipient, offered to donate to him their own hearts. When the surgical team, justifiably curious, sent psychiatrists to examine these donors, they found to their surprise that many of the donors were rational, competent, sincere, and fully aware that as a consequence of donating their hearts they would die....My concerns here will be threefold. First, I want to add some substance to the widely-held intuition that there is something morally objectionable about a physician participating in procedures which put even a willing subject at risk. In so doing, I want to explore the larger question of why such a puzzle arises -- why physicians, and many others, find it morally objectionable to help someone do something which all agree to be heroic. Finally, I will start by examining some ways of framing the issue, widely employed in medical ethics, which I believe are simply wrong. This sort of puzzle is much more interesting than proponents of these standard arguments would have us believe, and it illustrates some larger points about morality which are often overlooked.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
6/28. tetanus. A threat to elderly patients.tetanus rarely occurs in young persons now that childhood immunization programs are widespread. Many older patients, however, are not completely immunized, and mortality in this group is high. Since many of the wounds from which tetanus arises are minor, patients may not bring them to medical attention. Thus, physicians should include assessment of immunization status during routine office visits in all age-groups and provide immunization against tetanus and against diphtheria if indicated.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
7/28. domestic violence in the outpatient setting.Domestic abuse is a serious problem that may present directly or indirectly in the clinical setting. The astute physician may have the opportunity to directly intervene in this national dilemma. We present a patient who indirectly sought help through the medical setting, review the physician's responsibilities, and offer guidelines for management.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
8/28. The first report of hypnotic treatment of traumatic grief: a brief communication.In 1813 the Dutch physicians Wolthers, Hendriksz, De Waal, and Bakker reported the hypnotic treatment of a woman suffering from traumatic grief, in which the therapist had to deal directly with the patient's spontaneous reenactments of the circumstances surrounding the death. This report, summarized in the present article, has historical value, as it is probably the first known precursor of the uncovering hypnotic approach. The original authors' views on the case are discussed, and a modern view for understanding the patient's traumatic grief and its treatment is presented.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
9/28. Post-traumatic stress disorder following traumatic injuries in adults.The residuals of traumatic injuries from home or workplace accidents, automobile accidents, physical assault, or other unintentional human error can affect victims both physically and psychologically. Symptoms of post-traumatic stress disorder (PTSD) are common among survivors of accidents and nonsexual assaults and can impede recovery. Early identification of PTSD and timely referrals to mental health providers can greatly reduce medical expenses, disability payments, lost wages, lost work productivity, and direct mental health costs. A physician-screening tool to identify PTSD is outlined in this article and can be completed in a few minutes. Implementation of this screening following traumatic injuries can promote early diagnosis of possible psychological complications and facilitate referral to appropriate mental health professionals.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
10/28. An overlooked association of brachial plexus palsy: diaphragmatic paralysis.Diaphragmatic paralysis in newborns is related to brachial plexus palsy. It can be overlooked if thorough examination isn't done. We present a two-weeks-old baby with a birth weight of 3800 grams who had a left-sided brachial plexus palsy and torticollis with an undiagnosed left diaphragmatic paralysis even though he was examined by different physicians several times. The role of physical examination, the chest x-rays of patients with brachial paralysis and the treatment modalities of diaphragmatic paralysis due to obstetrical factors are discussed.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
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