tag:blogger.com,1999:blog-711500097301135682024-02-20T22:23:23.606-08:00EM on the EdgeMilitary, Civilian & Wilderness Medicine: The Final BLOG.
docvpbhttp://www.blogger.com/profile/17349160261907900884noreply@blogger.comBlogger30125tag:blogger.com,1999:blog-71150009730113568.post-12194784687136832652019-08-13T04:44:00.002-07:002019-08-13T04:45:46.710-07:00Hi Guys,<br />
Right in the link my recent lecture on Damage Control RESUS!!!!<br />
Enjoy.......<br />
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<a href="https://www.slideshare.net/docvpb/damage-control-resus-163474847" target="_blank">Damage Control RESUS easy way</a>docvpbhttp://www.blogger.com/profile/17349160261907900884noreply@blogger.com0tag:blogger.com,1999:blog-71150009730113568.post-91383961698914595222018-10-23T05:08:00.001-07:002018-10-23T05:17:30.039-07:00<div style="font-family: "helvetica neue"; font-stretch: normal; line-height: normal;">
<span style="font-kerning: none;"><b><span style="font-size: 11px;"> </span>THE FXXXKIN VENOMOUS SNAKE</b></span><br />
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<span style="font-kerning: none;"> you are a doctor or medic going on expedition or remote site sooner or later you will have to cope with snake, venomous venomous, bites.</span></div>
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<span style="font-kerning: none;">There are several species of snakes spread across the four continents</span></div>
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<span style="font-kerning: none;">AFRICA AND MIDDLE EAST: Cobras, spitting cobras, vipers and asps</span></div>
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<span style="font-kerning: none;">ASIA: Cobras, Russel s viper and Pit Viper</span></div>
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<span style="font-kerning: none;">AUSTRALASIA: black snakes, tiger snakes</span></div>
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<span style="font-kerning: none;">AMERICAS: coral snakes, rattlesnakes</span><br />
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PRESENTATION</div>
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<li style="font-family: "helvetica neue"; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-stretch: normal; line-height: normal;"></span><span style="font-kerning: none;">local pain, swelling, bruising, blistering on the site of bite</span></li>
<li style="font-family: "helvetica neue"; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-stretch: normal; line-height: normal;"></span><span style="font-kerning: none;">regional linphnodes enlargement</span></li>
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<span style="font-kerning: none;">Depending on snake:</span></div>
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<li style="font-family: "helvetica neue"; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-stretch: normal; line-height: normal;"></span><span style="font-kerning: none;">incoagulable blood and spontaneous systemic bleeding</span></li>
<li style="font-family: "helvetica neue"; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-stretch: normal; line-height: normal;"></span><span style="font-kerning: none;">Hypotension to shock</span></li>
<li style="font-family: "helvetica neue"; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-stretch: normal; line-height: normal;"></span><span style="font-kerning: none;">progressive generalized paralysis </span></li>
<li style="font-family: "helvetica neue"; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-stretch: normal; line-height: normal;"></span><span style="font-kerning: none;">acute renal failure from rabdomiolisis</span></li>
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<span style="font-kerning: none;">TREATMENT</span></div>
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<li style="font-family: "helvetica neue"; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-stretch: normal; line-height: normal;"></span><span style="font-kerning: none;">Remove rings and bracelets from the site affected before swalling</span></li>
<li style="font-family: "helvetica neue"; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-stretch: normal; line-height: normal;"></span><span style="font-kerning: none;">clean wound and apply pressure-immobilization: perform a bandage such as for ankle sprains with a 10 cm wide bandage as long as possible and include a splint to immobilize the limb affected</span></li>
<li style="font-family: "helvetica neue"; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-stretch: normal; line-height: normal;"></span><span style="font-kerning: none;">supportive therapy: cristalloids and colloids in case of shock and acute renal insufficiency</span></li>
<li style="font-family: "helvetica neue"; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-stretch: normal; line-height: normal;"></span><span style="font-kerning: none;">assist ventilation in case of respiratory distress by respiratory muscles paralysis </span></li>
<li style="font-family: "helvetica neue"; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-stretch: normal; line-height: normal;"></span><span style="font-kerning: none;"> ANTIVENOM: SLOW IV INJECTION OF 4-5 VIALS DILUTED IN 500 ML OF NORMAL SALINE (usually antivenin is polyvalent for the most dangerous species of snake for a specific region.</span></li>
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<span style="font-kerning: none;">Be prepared with Adrenaline 0,5 mg i.m. in case of anaphylactic shock.</span><br />
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<span style="font-kerning: none;"><a href="https://youtu.be/FBV6g8q-pjE" target="_blank">Pressure bandage</a></span><br />
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<span style="font-kerning: none;">I triede to do the stuff as simple as possible from yours docvpb that’s all </span></div>
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<span style="font-kerning: none;">HAVE A NICE DAY ON THE</span></div>
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<span style="font-family: "helvetica neue";">EDGE!!!!!</span><br />
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docvpbhttp://www.blogger.com/profile/17349160261907900884noreply@blogger.com0tag:blogger.com,1999:blog-71150009730113568.post-29145587001058297352015-05-05T02:26:00.002-07:002015-05-05T02:34:03.156-07:00Welcome to the Fabulous World of Thoracic Traumas (Part. 1)<div class="MsoNormal">
Hi Guys!!!!</div>
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Recently I realized something very strange: after attending, over the years, courses such as ATLS, ETC, PHTLS, PTC etc ... my mind
became in such a way compartmentalized, schematized, excuse the term:
protocollized; and if, on one hand this thing has been of great help giving me
the cold blood to perform lifesaving maneuvers even in moments of extreme
excitement and agitation, on the other hand<span style="mso-spacerun: yes;"> in part </span>made me lose flexibility in my way of thinking clinically, which
in some cases could get me out of situations with no apparent way out. </div>
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Chest
traumas for example: </div>
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when I think of a chest trauma my mind immediately set up
on ATLS scheme: life-threatening injuries that require immediate treatment:
pneumothorax, hemothorax, flail chest, Cardiac tamponade etc ... but the
problem is that my mind tends to consider these lesions as separate entities
!!!! ....What happens when all come together in the same patient ?? !!<o:p></o:p></div>
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Clinical case: </div>
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A military vehicle passes over a pressure
plate and triggers an Improvised Explosive Device (IED); aftermath is a big
explosion ... but well located: Endeed all the kinetic energy has been absorbed by anterior-left
section of the vehicle ... .and then indirectly has invested in full the driver only.<br />
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When Medevac
Helo arrives the patient's conditions are already extremely critical; </div>
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At first
glance: Subject is conscious in extreme respiratory distress; </div>
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CatC.: no overt
external bleedings;</div>
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<b>A</b>: airway patent;</div>
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<b>B</b>: the problem is purely in the chest (a
very bad contusion)....In addition to a widespread bruising you notice multiple
rib fractures on the right with feeble paradoxical movements of the chest cage: thoracic excursions are very limited ;<br />
at <b>palpation</b>: widespread
crackles with great pain evoked: in short words, you do not discern where there
is subcutaneous emphysema or a broken rib!!!!<br />
<b>Auscultation</b>: absolutely of no use
(for background noise);<br />
saturation nearly 76% in O2 mask;</div>
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<b>C</b>: FC. 120 bb / min.
NBP: 80/50 mmHg, One 14 Gauge IV access.</div>
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At this point mind of Medevac doctor is fully in ATLS
mode: the B is critical and requires action; Overt lesions are bilateral
PNX and Flail chest and he focuses on those; Thus Bilateral chest tube and RSI, followed by endotracheal intubation and
IPPV... </div>
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but the clinical situation seems to improve only slightly: the SatO2
goes up from 67% to 82%; the heart rate remains at 110 bb / min; NBP settles on
85 mmHg sys... Even if not copletely satisfied the doctor takes on board the
patient for transport but still feels that something is missing ... the mind at
this point goes for the tangent ... Head become a caldron of questions:</div>
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"the
B is complete; I treated all that was to be treated !!!",</div>
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" maybe I
missed internal bleedings?! but there are no signs of intraabdominal
haemorragies !! ",</div>
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" No fractures evident ",</div>
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" but why heart
rate doesn’t go down? "</div>
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... and so on ...Patient arrives at Role 2 hospital
alive....<br />
.... but what wasn’t<span style="mso-spacerun: yes;"> </span>right ?? !!:</div>
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A rib fragment had damaged the pericardium and was about to give cardiac
tamponade... if transport had lasted more than 10 min. perhaps the wounded would die... </div>
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At this point a big question arises: "Why doctor had not thought
of that?"... </div>
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very easy: his mind was so schematically focused on more
obvious lesions to not be able to move with flexibility on the occult....</div>
<div class="MsoNormal">
Bottom line: In certain situations such as those of extreme
urgency, although the schematic way of thinking, given to us by courses such as ATLS, is
often a necessary factor and essential to avoid falling into panic, however is
always better to keep mind trained to a minimum of flexibility just in attempt to
save the day even in these rare and complex clinical cases. </div>
<div class="MsoNormal">
Just talking about
thoracic traumas give a glimpse on how many underlying lesions a blunt thoracic trauma can hide: </div>
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not one, not two, not three but we could say an entire Fabulous world of
chest injuries!!!!!</div>
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<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
We start from the aforementioned life-threatening injuries:<o:p></o:p></div>
<div class="MsoNormal">
<b><i>1) Tension pneumothorax:</i></b><o:p></o:p></div>
<div class="MsoNormal">
Most often a<span style="mso-spacerun: yes;"> </span>result of <span style="mso-spacerun: yes;"> </span>blunt thoracic trauma, the Tension PNX is
consequence of a progressive accumulation of pressurized air in the pleural
cavity with valve mechanism; air enters in the pleural space at each
inspiratory phase but cannot get out, is trapped during the expiratory phase;
The consequence of this mechanism is not only the complete collapse of the
affected lung but also the compression, by air accumulated, on mediastinum and its shifting and compression on
controlatheral Emithorax (thus on controlatheral lung and also vascular
structures).<o:p></o:p></div>
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<b>Clinical features:</b><o:p></o:p></div>
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the patient will show respiratory distress but also
hypotension and tachycardia, due to the pressure exerted on great vessels and
then due to all the pathophysiological consequences resulting from a reduced
venous return to the heart.... could be also detected a reduced expansion
of<span style="mso-spacerun: yes;"> </span>involved Hemithorax and absent breath
sounds on auscultation (Mmmmhhh….try a little to auscultate a patient in an
outdoor setting or in a crowded ED... .Mmmmmmmhhh….);<br />
to all this stuff add open
or closed hemorrhagic lesions almost constantly present in this type of trauma
and...... going back to my opening speech ....What a mess !!!!!<o:p></o:p></div>
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I<b>nstrumental diagnosys:</b><o:p></o:p></div>
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Just two words: as soon as possible FAST US, FAST US, FAST
US and again FAST US ... <o:p></o:p></div>
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<b>Treatment:</b><o:p></o:p></div>
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In prehospital setting the classic needle decompression can
really save the day;<o:p></o:p></div>
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There are specially crafted needles for this purpose ... ...
fast, easy and comfortable to use .... (Thanks to my friends US Army paramedics
to let me try those needles)....<br />
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.... unfortunately in Italy they are not
available... .to us Italians if it's too easy we don’t like it right ???! So
usually 14G needle in 2nd intercostal space on the midclavicular or better
in 4th or 5th intercostal space lateral approach (I tried them both and I
guarantee that the lateral positioning was successful in 98% of cases ... but it’s up to you!!!!).<br />
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More recently in the prehospital setting was
introduced the so-called "Finger Thoracostomy" but I cannot express
myself on this field not having tried
it yet.<o:p></o:p></div>
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Clearly the needle is only a bridge leading to the insertion
of the chest tube ... .a technique usually reserved for the ED ... .insertion
in 4th or 5th intercostal space midaxillary .... recommend use in adults at
least a 36F.<o:p></o:p><br />
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<div class="MsoNormal">
<b><i>2) Open Pneumothorax:</i></b><o:p></o:p></div>
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A consequence of penetrating injuries of the chest and more
in particular a result in the vast majority of cases of gunshot wounds.<br />
<o:p></o:p></div>
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The primary cause is the establishment of a
pathophysiological link between the pleural space and outdoor environment with
loss of pressure balance in thoracic cavity.<o:p></o:p></div>
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In practice, the lung will tend to collapse during
inspiration and to expand slightly during expiration.<o:p></o:p></div>
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<b>Clinical feature:</b><o:p></o:p></div>
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In severe cases, the wounded will be in respiratory distress
and you will see clearly the picture of “sucking chest wound”: very noisy
airflow mixed with blood (foam and bubbles ) going out from the lesion.<o:p></o:p></div>
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<b>Treatment:</b><o:p></o:p></div>
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In prehospital
setting an Ashermann’s dressing (fairly widespread also in our country)<br />
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or the
classic bandage closed on three sides can save the day.<o:p></o:p><br />
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Obviously everything on hold for chest tube in ED.<o:p></o:p><br />
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However, keep in mind that when a bullet enter the chest will
demage all organs that meets on his way and then comes out ... if goes well!!!!
And again we go back to the initial speech ... .The open PNX will always
be in good company !!!!<br />
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... And for this post is all about ... to continue your
journey into the terrifying world of thoracic traumas you will have to wait few
days ... ..<br />
<o:p></o:p></div>
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from your docvpb <o:p></o:p></div>
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have a nice day on the Edge…..<o:p></o:p><br />
<br />
References:<br />
<br />
1. <a href="http://www.amazon.com/2--Set-Rosens-Emergency-Medicine/dp/1455706051/ref=sr_1_1?ie=UTF8&qid=1430814822&sr=8-1&keywords=rosen+emergency">Rosen's Emergency Medicine</a><br />
<br />
2. <a href="http://www.amazon.com/Roberts-Clinical-Procedures-Emergency-Medicine/dp/145570606X/ref=pd_sim_b_1?ie=UTF8&refRID=19WWE0DQCG7QWSPBJ7TJ">Roberts and Hedges' Clinical Procedures in Emergency Medicine, 6e (Roberts, Clinical Procedures in Emergency Medicine)</a><br />
<br />
3. <a href="http://www.amazon.com/Tintinallis-Emergency-Medicine-Comprehensive-Tintinalli/dp/0071484809/ref=pd_sim_b_2?ie=UTF8&refRID=1R51VGP0NVTZRYZR2VVH">Tintinalli's Emergency Medicine: A Comprehensive Study Guide, Seventh Edition</a><br />
<br />
4. <a href="http://www.amazon.com/Emergency-War-Surgery-Survivalists-Reference/dp/1616083905/ref=sr_1_1?s=books&ie=UTF8&qid=1430815039&sr=1-1&keywords=emergency+war+surgery">Emergency War Surgery: The Survivalist's Medical Desk Reference</a><br />
<br />
5. <a href="http://www.amazon.com/Trauma-Seventh-Kenneth-Mattox/dp/0071663517/ref=sr_1_1?s=books&ie=UTF8&qid=1430815305&sr=1-1&keywords=trauma+mattox">Trauma, Seventh Edition</a><br />
<br />
6. <a href="http://www.amazon.com/Wilderness-Medicine-Enhanced-Features-Auerbach/dp/1437716784/ref=sr_1_1?s=books&ie=UTF8&qid=1430815417&sr=1-1&keywords=wilderness+medicine+auerbach">Wilderness Medicine: Expert Consult Premium Edition - Enhanced Online Features and Print, 6e (Auerbach, Wilderness Medicine)</a><br />
<br />
7. <a href="http://www.amazon.com/Special-Operations-Forces-Medical-Handbook/dp/161608278X/ref=pd_sim_b_1?ie=UTF8&refRID=0WCVG9GB90XYAP8MZQWD">Special Operations Forces Medical Handbook</a></div>
docvpbhttp://www.blogger.com/profile/17349160261907900884noreply@blogger.com1tag:blogger.com,1999:blog-71150009730113568.post-27239482955048496662015-04-28T00:19:00.005-07:002015-04-28T00:22:26.522-07:00Forward Surgical Team (FST); What means to be a War Doc....Hi Guys!!!!<br />
Have you ever wondered what would it means to work in a Battlefield Operating Room??!!<br />
Check out this Awesome video....<br />
<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0dZfeygNdRdwG9iF28B9EQmnLgHVpRJOrdITOJZ3EQuM7X2ywTMN3RzgqHKOKGTVz4dIFAmdm3B-5DP_wWdioCPSbq5jIa0fYHavC21BMWltIJNwWV5X6AMHuOYl8chR-RG-b_ZLUUas/s1600/hires_121120-N-IE116-481.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0dZfeygNdRdwG9iF28B9EQmnLgHVpRJOrdITOJZ3EQuM7X2ywTMN3RzgqHKOKGTVz4dIFAmdm3B-5DP_wWdioCPSbq5jIa0fYHavC21BMWltIJNwWV5X6AMHuOYl8chR-RG-b_ZLUUas/s1600/hires_121120-N-IE116-481.jpg" height="213" width="320" /></a></div>
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<a href="https://www.youtube.com/watch?v=DmDL14dUkb8">Battlefield OR</a>docvpbhttp://www.blogger.com/profile/17349160261907900884noreply@blogger.com1tag:blogger.com,1999:blog-71150009730113568.post-18152175663921839072015-04-16T05:33:00.003-07:002015-04-16T05:33:48.876-07:00MEDEVAC during Vietnam war....when everything began....<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwH-H7Skc2ky7yYaw0KRL4Iv2dpTZMsf8YJvgTomy7EotedGrSbocnsETxhfd9Xw8cYxcWkguuW6zolFIrAMriVayo2GKEv0EQAa-nHH1qTxGyPjkF8V-Yg3uLdUnjlMZc1_miUoeVx-o/s1600/Unknown.jpeg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="https://www.youtube.com/watch?v=x3A5r3FMk6w">Vietnam war MEDEVAC</a><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqmkH027bSqoIYFBNsHKS-IyWG7xUOgdlaXiXaTANP-CYU0HNPS9YDsFkVEQiu6ilZraSOZYBuuddBJrY_NUqeEUJ-EDJ4E6q3l_MjV21Nyy13M8UoLSx3Yin5PNaZs0_dWyzYx-z42Ks/s1600/82nd+door+insignia+small.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwH-H7Skc2ky7yYaw0KRL4Iv2dpTZMsf8YJvgTomy7EotedGrSbocnsETxhfd9Xw8cYxcWkguuW6zolFIrAMriVayo2GKEv0EQAa-nHH1qTxGyPjkF8V-Yg3uLdUnjlMZc1_miUoeVx-o/s1600/Unknown.jpeg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwH-H7Skc2ky7yYaw0KRL4Iv2dpTZMsf8YJvgTomy7EotedGrSbocnsETxhfd9Xw8cYxcWkguuW6zolFIrAMriVayo2GKEv0EQAa-nHH1qTxGyPjkF8V-Yg3uLdUnjlMZc1_miUoeVx-o/s1600/Unknown.jpeg" /></a></div>
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My new post on EMpills....follow the link below!!!!....<br />
<br />
<a href="http://empills.com/2015/02/capnografia-e-asma-accoppiata-vincente/">Capnografia e Asma: accoppiata vincente?!</a><br />
<br />
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<br />docvpbhttp://www.blogger.com/profile/17349160261907900884noreply@blogger.com0tag:blogger.com,1999:blog-71150009730113568.post-27645908004395317102014-12-31T08:17:00.002-08:002014-12-31T08:17:10.464-08:00Massive Transfusion Protocol: UpdatesHi Guys!!!!<br />
My new post on EMpills in the link below....<br />
<br />
<a href="http://empills.com/2014/12/protocollo-di-trasfusione-massiva-updates/">Massive Transfusion Protocol: Updates</a><br />
<br />
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<br />docvpbhttp://www.blogger.com/profile/17349160261907900884noreply@blogger.com0tag:blogger.com,1999:blog-71150009730113568.post-90430265261758477472014-11-25T07:55:00.001-08:002014-11-25T07:55:17.587-08:00Mechanical Ventilation: A guide for Dummies....Oxylog What?!<span style="background-color: white; color: #666666; font-family: 'Trebuchet MS', Trebuchet, Verdana, sans-serif; font-size: 13px; line-height: 18px;">Hi Guys!!!!.....</span><br />
<div style="color: #666666; font-family: 'Trebuchet MS', Trebuchet, Verdana, sans-serif; font-size: 13px; line-height: 18px;">
My new post on EMpills:</div>
<div style="color: #666666; font-family: 'Trebuchet MS', Trebuchet, Verdana, sans-serif; font-size: 13px; line-height: 18px;">
Mechanical Ventilation: A guide for Dummies....Oxylog What?!</div>
<div style="color: #666666; font-family: 'Trebuchet MS', Trebuchet, Verdana, sans-serif; font-size: 13px; line-height: 18px;">
<span style="background-color: white;">Follow the link below:</span></div>
<div style="color: #666666; font-family: 'Trebuchet MS', Trebuchet, Verdana, sans-serif; font-size: 13px; line-height: 18px;">
<span style="background-color: white;"><a href="http://empills.com/2014/11/ventilazione-meccanica-guide-for-dummies-oxylog-what/">Mechanical Ventilation: A guide for Dummies....Oxylog What?!</a></span></div>
<div style="color: #666666; font-family: 'Trebuchet MS', Trebuchet, Verdana, sans-serif; font-size: 13px; line-height: 18px;">
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docvpbhttp://www.blogger.com/profile/17349160261907900884noreply@blogger.com0tag:blogger.com,1999:blog-71150009730113568.post-17610455043747357692014-09-13T00:44:00.002-07:002014-09-13T00:44:29.944-07:00DSI (Delayed Sequence Intubation): My Experience......Hi Guys!!!!.....<br />
<div>
My new post on EMpills:</div>
<div>
DSI (Delayed Sequence Intubation): My personal Experience....</div>
<div>
Follow the link below:</div>
<div>
<br /></div>
<div>
<a href="http://empills.com/2014/09/dsi-delayed-sequence-intubation-tecnica-utile/">DSI (Delayed Sequence Intubation): Una tecnica utile...</a></div>
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docvpbhttp://www.blogger.com/profile/17349160261907900884noreply@blogger.com0tag:blogger.com,1999:blog-71150009730113568.post-16236741331084150582014-08-17T23:19:00.002-07:002014-08-17T23:21:47.384-07:00Ketamine in Traumatic Brain Injury: Just a DOGMA?!Contraindications to use of Ketamine in TBI: Pure DOGMA?!<br />
<div>
Check it out on EMpills!!...Just follow the link below.....</div>
<div>
<br /></div>
<div>
<br /></div>
<div>
<a href="http://empills.com/2014/08/ketamina-nel-trauma-cranico-puro-dogma/">http://empills.com/2014/08/ketamina-nel-trauma-cranico-puro-dogma/</a></div>
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docvpbhttp://www.blogger.com/profile/17349160261907900884noreply@blogger.com0tag:blogger.com,1999:blog-71150009730113568.post-86023917370673544962014-06-10T14:24:00.000-07:002014-06-10T14:24:20.096-07:00COMBAT EMERGENCY MEDICAL SERVICES…ARE YOU CURIOUS…???!!!<div class="MsoNormal">
Hi Guys…...............................!!!!!!!!!!!!!!!!!!!<o:p></o:p></div>
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<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjv7PVezX4FNSYgHi2cLME9IWgOqgUpefHOUxLmzdIJN0khmNUPHDhI7UcLU08kSoPUnhufk4NmbqszGmc6YLzLjSvCYDFCvw0Ja958zY_PJ8R_VVb82ljzzfCZxHeZJpxvZhkTZyOWIFs/s1600/foto.PNG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjv7PVezX4FNSYgHi2cLME9IWgOqgUpefHOUxLmzdIJN0khmNUPHDhI7UcLU08kSoPUnhufk4NmbqszGmc6YLzLjSvCYDFCvw0Ja958zY_PJ8R_VVb82ljzzfCZxHeZJpxvZhkTZyOWIFs/s1600/foto.PNG" height="200" width="199" /></a></div>
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<br /></div>
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Just in case you are wondering how Emergency Medical
Service works in the war zones, here is my personal review…..so enjoy it.<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
War emergency medicine means just a simple foundation concept:<o:p></o:p></div>
<div class="MsoNormal">
10-1-2;<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
10: Immediate life saving procedures must be applied within
10 minutes of wounding.<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
1: advanced stabilization manouvres must commenced within 1
hour of wounding (Enhanced field care).<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
2: if necessary Emergency war surgery must be performed
within 1 hour but not later 2 hours of wounding.<o:p></o:p></div>
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<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhe4IxNbq5gKnw3hmqbFsFUrp_VtMWW65Vl6sD36_uoOUNTGDrEQsEUkq5OqgqqTbwn3FwqMf9qdQDDrST0GeGHqVb2BeBgji0_CAfsI6fFtxvjK93N6UBmC4l_tEmTqc8o6sFfv-Gt_YU/s1600/images.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhe4IxNbq5gKnw3hmqbFsFUrp_VtMWW65Vl6sD36_uoOUNTGDrEQsEUkq5OqgqqTbwn3FwqMf9qdQDDrST0GeGHqVb2BeBgji0_CAfsI6fFtxvjK93N6UBmC4l_tEmTqc8o6sFfv-Gt_YU/s1600/images.jpeg" height="146" width="320" /></a></div>
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<br /></div>
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How these numbers are fulfilled??!!<o:p></o:p></div>
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<br /></div>
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As in every military sector even war medicine requires a meticulous tactical planning, defining means and professional figures to be employed in specific theatres of operation.<o:p></o:p></div>
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<br /></div>
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This is how it works in Afghanistan:<o:p></o:p></div>
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<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFeH-1056QCrbYquybvPsF3FoJMph14kH2WcO6Kj4eboHrZdxpo8RNpljEsSJot6JxAAspbYpw1a5N5DkGu_0pdpa6PqQK9Hgr9FSTpDIpmA0-esDLhHgSyf4OmGkV66_to7qQr__1Oys/s1600/foto+2.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFeH-1056QCrbYquybvPsF3FoJMph14kH2WcO6Kj4eboHrZdxpo8RNpljEsSJot6JxAAspbYpw1a5N5DkGu_0pdpa6PqQK9Hgr9FSTpDIpmA0-esDLhHgSyf4OmGkV66_to7qQr__1Oys/s1600/foto+2.JPG" height="181" width="320" /></a></div>
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<br /></div>
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<br /></div>
<div class="MsoNormal">
Everything starts in the HOT ZONE (zone of fightings) where
usually the wounding happens;<o:p></o:p></div>
<div class="MsoNormal">
What can be done?!<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Very few things!!! </div>
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<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjc0z24MTRQMKBNFsOn8DdB0J-B_GcSGyfhd20ZivKt-XJjT6YkBOgC_vG_ihYWVaggnNenfRS6KVE7IM4dpPeETScjFva3UH-C1r0yQd39e6yp8CALp1vlfBcXC7uIeNUREFvmM4JLjM0/s1600/57.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjc0z24MTRQMKBNFsOn8DdB0J-B_GcSGyfhd20ZivKt-XJjT6YkBOgC_vG_ihYWVaggnNenfRS6KVE7IM4dpPeETScjFva3UH-C1r0yQd39e6yp8CALp1vlfBcXC7uIeNUREFvmM4JLjM0/s1600/57.jpg" height="320" width="317" /></a></div>
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<br /></div>
<div class="MsoNormal">
This is what we call “Care under fire”:</div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
1) Respond
to fire and search for fire cover; reach for the wounded only when possible…
Heroism could be<span style="mso-spacerun: yes;"> </span>rewarded just with two wounded instead of one!!!!<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
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<span style="mso-spacerun: yes;"><br /></span></div>
<div class="MsoNormal">
2)Stop bleedings with combat tourniquet or compressive
dressings, mantained by self aid if able.<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
3)Airway management is generally best deferred until Enhanced
field care (EFC) phase.<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
4)Bring the wounded ASAP in the WARM ZONE for Enhanced
field care(EFC).<o:p></o:p></div>
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<br /></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhPciYbdiJYcnGiR5XTl5wl4TiDlSrgqi-8imUtZzLveKNShdflDdbtmqVwO_OFu36MD_k_kh1NcQFt1iLX-d3fCkEd_Y4i9m9brvJFO7ERLQi4I6eLvFebP3lM8Pvo-rB1jgX_tZE-LC8/s1600/2842.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhPciYbdiJYcnGiR5XTl5wl4TiDlSrgqi-8imUtZzLveKNShdflDdbtmqVwO_OFu36MD_k_kh1NcQFt1iLX-d3fCkEd_Y4i9m9brvJFO7ERLQi4I6eLvFebP3lM8Pvo-rB1jgX_tZE-LC8/s1600/2842.jpg" height="212" width="320" /></a></div>
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<br /></div>
<div class="MsoNormal">
Who perform these manouvres??!!<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
Bleeding control can be performed by the wounded himself;
if uncounscious could be performed by a buddy ("Buddy to Buddy Aid") or the combat medic (a soldier trained in Immediate life support techniques, if present); usually there
is one in every company.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhd9SL-AHpYn05SSMHqTWSDEGpbwKtphrkDDHvUn9FinLD6iW0CL8zOx-FmiZTDJ619nULjmZg50YJ3Afmw9S9HMwUQOv3R3AgbZCLxUVaD9Dmp1oKgT0-xcv3tmYg0_H5-b8qfDAv7CO4/s1600/%2524T2eC16dHJHwE9n8ii%252BO%252BBP64FUFY2g%257E%257E60_35.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhd9SL-AHpYn05SSMHqTWSDEGpbwKtphrkDDHvUn9FinLD6iW0CL8zOx-FmiZTDJ619nULjmZg50YJ3Afmw9S9HMwUQOv3R3AgbZCLxUVaD9Dmp1oKgT0-xcv3tmYg0_H5-b8qfDAv7CO4/s1600/%2524T2eC16dHJHwE9n8ii%252BO%252BBP64FUFY2g%257E%257E60_35.JPG" /></a></div>
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<br /></div>
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<br /></div>
<div class="MsoNormal">
In the WARM ZONE or semipermissive zone:<o:p></o:p></div>
<div class="MsoNormal">
Personnel could be still threatened by indirect fire but Enhanced field care (EFC)
manouvres can be put in place under cover;<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
What I mean for under cover:<o:p></o:p></div>
<div class="MsoNormal">
The ideal would be<span style="mso-spacerun: yes;"> </span>a
true Company Aid Post, in reality<span style="mso-spacerun: yes;"> </span>EFC is
performed on the back of a tank or everything can provide protection from fire.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhc7yM1ph9Y1iIw7c3zgkKHxN04L14EIHynnn2s8DbF_503aO5co1dmBRSItTtg1GONEDThjpH6rPWkthSqKTO4BeKCty6349p6N2KGNS-Zf53W3MwC3_e9oBGNJPDoJD2Efifnupze-eg/s1600/US_Navy_070524-N-6247M-005_Hospital_Corpsman_from_Naval_Hospital_Oak_Harbor_participate_in_Tactical_Combat_Casualty_Care_(TC3)_training.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhc7yM1ph9Y1iIw7c3zgkKHxN04L14EIHynnn2s8DbF_503aO5co1dmBRSItTtg1GONEDThjpH6rPWkthSqKTO4BeKCty6349p6N2KGNS-Zf53W3MwC3_e9oBGNJPDoJD2Efifnupze-eg/s1600/US_Navy_070524-N-6247M-005_Hospital_Corpsman_from_Naval_Hospital_Oak_Harbor_participate_in_Tactical_Combat_Casualty_Care_(TC3)_training.jpg" height="228" width="320" /></a></div>
<div class="MsoNormal">
<br /></div>
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<br /></div>
<div class="MsoNormal">
Who perform EFC:<o:p></o:p></div>
<div class="MsoNormal">
It depends on the Nation: US army has specifically trained
Medics and Paramedics, EUropean forces often have a nurse or a doctor on
the field; </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Italian Army itself is implementing a new strategy: A rescue helicopter
with a critical care Physician and nurse on board, already on area of
operations; the aim of this strategy is to save the time between the call for a MEDEVAC and<span style="mso-spacerun: yes;"> </span>the MEDEVAC itself, that,I guarantee,in Afghanistan
could be very long; furthermore it allow advanced stabilization manouvres
right on the field or straight during flight.</div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwicmz-7ZsqVAtDzlnM6KlZ5DzOBfdx9QfLYFgX6K4VAdjPPh4O5Amwi1iUKUTSQRs0EKHYQIk-s-dLn-Asi8xADexJZIbrli_Ap4E5jiLwGA-UoaFqHeBEjTFK74zjeE6z2Ev9ob8me8/s1600/ranger-casualty2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwicmz-7ZsqVAtDzlnM6KlZ5DzOBfdx9QfLYFgX6K4VAdjPPh4O5Amwi1iUKUTSQRs0EKHYQIk-s-dLn-Asi8xADexJZIbrli_Ap4E5jiLwGA-UoaFqHeBEjTFK74zjeE6z2Ev9ob8me8/s1600/ranger-casualty2.jpg" height="212" width="320" /></a></div>
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<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
What does it mean Enanched field care (EFC)??!! </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In small words what we call Damage control resuscitation in
the civilian setting; </div>
<div class="MsoNormal">
anyway battlefield is very different from
an Highway or every other possible civilian scenario so also life support techniques allowed are different;</div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOAk0-9dcnIOjuNcTInIq-3yIjTTytu3I2HhEqRZIjB-yZB7HZQZD45M1p2wtqNwczw6Ymy5p7KFOVWTlhtgXrlK8SZ6BB1F7ro8wQkkoBQh0qtKKUxw-A1RFZqsS85-eOOIU8fgQxlQ4/s1600/surgeons-office-imparts-life-saving-techniques-in-burkina-faso.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOAk0-9dcnIOjuNcTInIq-3yIjTTytu3I2HhEqRZIjB-yZB7HZQZD45M1p2wtqNwczw6Ymy5p7KFOVWTlhtgXrlK8SZ6BB1F7ro8wQkkoBQh0qtKKUxw-A1RFZqsS85-eOOIU8fgQxlQ4/s1600/surgeons-office-imparts-life-saving-techniques-in-burkina-faso.jpeg" height="224" width="320" /></a></div>
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<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
On the field (Tactical Field Care):<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<C> catastrophic haemorragy control: If not yet performed
bleeding control is essential: Combat<span style="mso-spacerun: yes;"> </span>Tourniquet
and compressive dressings.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
A: open airways<span style="mso-spacerun: yes;"> ; If the wounded is unconscious: </span>naso-orofaringeal cannula or recovery position or SGA (Supraglottic airways - Usually the iGel) if airway
obstruction. </div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEju_wEaSsNdQFdrD79EyzvFADFqqyqPLo_CuvV7nOgWN9qTOD2pvlbwrrakbT6tybYCBHfudGQG6uask2Cyeg2h7gzACP0r8oatGJ507RVdA6dnZ-AXnCGJQkeBr7esznnBqB7IvCiVDY4/s1600/110317-M-ZD328-007.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEju_wEaSsNdQFdrD79EyzvFADFqqyqPLo_CuvV7nOgWN9qTOD2pvlbwrrakbT6tybYCBHfudGQG6uask2Cyeg2h7gzACP0r8oatGJ507RVdA6dnZ-AXnCGJQkeBr7esznnBqB7IvCiVDY4/s1600/110317-M-ZD328-007.jpg" height="213" width="320" /></a></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
What about the Neck Collar??</div>
<div class="MsoNormal">
In military setting Neck collar is kept just for victims of <span style="mso-spacerun: yes;"> </span>Blasts and vehicles accidents.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
B: Breathing problems and torso trauma??... we go straight
to needle decompression and occlusive medication in case of of open or sucking
chest wounds; SGA if necessary.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
C: IV (Intravenous infusion line) or IO (Intraosseous infusione line), (In the last times we tend to go straight by IO); Thus TXA (Tranexamic Acid) and
start Normal Saline infusion,following damage control resuscitation guidelines.<o:p></o:p></div>
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<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLaDzg95Xts3FQij3tipXUEQrDEMJ5nGbkQa3g95oTWNE5pWB6gCYlapo0uhqoaFHJyg0d3aE8SOWsLHe6hEGwEbkYiUWpE35U6GubttIqez_AEMnhyjjimJeQLfXo6zWVyyQC3b3Do4E/s1600/120705-M-TF033-001.JPG.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLaDzg95Xts3FQij3tipXUEQrDEMJ5nGbkQa3g95oTWNE5pWB6gCYlapo0uhqoaFHJyg0d3aE8SOWsLHe6hEGwEbkYiUWpE35U6GubttIqez_AEMnhyjjimJeQLfXo6zWVyyQC3b3Do4E/s1600/120705-M-TF033-001.JPG.png" height="213" width="320" /></a></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Every nurse or physiscan present on the field are trained to perform those manouvres; </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Anyway More advanced techniques could be performed whereas<span style="mso-spacerun: yes;"> </span>critical care trained personnel is available
and this usually happens just before or during trasport on MEDEVAC helicopters.<o:p></o:p></div>
<div class="MsoNormal">
These advanced techniques usually are Emergency CRIC to
control airways, finger thoracostomy for PNX; Italian MEDEVAC is implementing
PENTAX VL intubation instead of CRIC, but evidences are still very few…<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9qt6uVkz-RGwSMuxl-ICQs6FI91vzvirIrMsdVmHNjjLVGTN6NfzHJtcmSa9yyY24d24VrISP39crnyjZm678r5fu4l2sVOAXupJh324IvUIWQ2hsuRA8cUZZ9xbrkh8zbqhfhENpg4o/s1600/medevac2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9qt6uVkz-RGwSMuxl-ICQs6FI91vzvirIrMsdVmHNjjLVGTN6NfzHJtcmSa9yyY24d24VrISP39crnyjZm678r5fu4l2sVOAXupJh324IvUIWQ2hsuRA8cUZZ9xbrkh8zbqhfhENpg4o/s1600/medevac2.jpg" /></a></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Some MEDEVAC service such the US one have 0-neg on board and
can even start blood transfusions…..this is great stuff!!!!!<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
Surgical treatment:<o:p></o:p></div>
<div class="MsoNormal">
Definitive surgical treatment not always can be
performed between 2 hours of wounding in<span style="mso-spacerun: yes;">
</span>an advanced medical facility (a role 3 Field Hospital)…To obviate this problem NATO forces invented FST (Forward surgical teams): Highly versatile operating
rooms deployed in advanced military outpost, able to perform just damage
control surgery; this strategy permits to gain time and transport patient to an AMF (Advanced Medical Facility) for definitive treatment in a following time.</div>
<div class="MsoNormal">
Usually an FST is manned by 20 - person team: 1 Orthopedic surgeon, 3 General <a class="mw-redirect" href="http://en.wikipedia.org/wiki/Surgeons" style="background-color: white; background-image: none; color: #0b0080; font-family: sans-serif; font-size: 14px; line-height: 22px; text-decoration: none;" title="Surgeons">surgeons</a><span style="background-color: white; color: #252525; font-family: sans-serif; font-size: 14px; line-height: 22px;">,2 Anaesthetists or </span><span style="background-color: white; color: #252525; font-family: sans-serif; font-size: 14px; line-height: 22px;">certified registered nurse anesthetists (CRNAs)</span><span style="background-color: white; color: #252525; font-family: sans-serif; font-size: 14px; line-height: 22px;"> 3 Registered Nurses</span><span style="background-color: white; color: #252525; font-family: sans-serif; font-size: 14px; line-height: 22px;">, 1 administrative officer, 1 detachment sergeant, 3 licensed practical nurses (LPN)'s, 3 </span><a href="http://en.wikipedia.org/wiki/Surgical_technologist" style="background-color: white; background-image: none; color: #0b0080; font-family: sans-serif; font-size: 14px; line-height: 22px; text-decoration: none;" title="Surgical technologist">surgical techs</a><span style="background-color: white; color: #252525; font-family: sans-serif; font-size: 14px; line-height: 22px;"> and 3 </span><a href="http://en.wikipedia.org/wiki/Medic" style="background-color: white; background-image: none; color: #0b0080; font-family: sans-serif; font-size: 14px; line-height: 22px; text-decoration: none;" title="Medic">medics</a><span style="background-color: white; color: #252525; font-family: sans-serif; font-size: 14px; line-height: 22px;">.</span> </div>
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<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBp2eFILa2HsDdAtOq7YAc-PtWU8wWgicncCNKkp6TXCCEp9JpNYV8kEFGRnY3HTuNmj0qfDqzr-Tmkw_EICyV_m3Xj_7Bk2nKv39VKoJvlR3BDWpkl28A9x1OxzvXYnm_rW_wSf95OIc/s1600/450x338_q75.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBp2eFILa2HsDdAtOq7YAc-PtWU8wWgicncCNKkp6TXCCEp9JpNYV8kEFGRnY3HTuNmj0qfDqzr-Tmkw_EICyV_m3Xj_7Bk2nKv39VKoJvlR3BDWpkl28A9x1OxzvXYnm_rW_wSf95OIc/s1600/450x338_q75.jpg" height="240" width="320" /></a></div>
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<div class="MsoNormal">
<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
To sum up current War EMS organization is the result of experiences gained during the most recent<span style="mso-spacerun: yes;"> </span>conflicts: IRAQ and Afghanistan and is constantly<span style="mso-spacerun: yes;"> </span>evolving; </div>
<div class="MsoNormal">
endeed in next combat operations
could become obsolete……Just Think to a war in a place where the enemy has air
supremacy……Helicopter MEDEVAC that now is so important, in a moment could become useless…………..<o:p></o:p></div>
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<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-4ALH0JtxhJmfxSD5_Opw_ckDo48DEQfTX2_SRmSFoo5eug9wusU0izFn0jAeZ6v4mxKOndx0SDDsszoaOOl4OukcS1B2cvN2aGw5_jEHYiRC2KIH0RPPQa7ix9RC59EihluryniNQ5M/s1600/IMG_3834.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-4ALH0JtxhJmfxSD5_Opw_ckDo48DEQfTX2_SRmSFoo5eug9wusU0izFn0jAeZ6v4mxKOndx0SDDsszoaOOl4OukcS1B2cvN2aGw5_jEHYiRC2KIH0RPPQa7ix9RC59EihluryniNQ5M/s1600/IMG_3834.jpg" height="213" width="320" /></a></div>
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<br /></div>
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<br /></div>
<div class="MsoNormal">
…..Have a good day on the Edge and Bye Bye……..</div>
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<br /></div>
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<br /></div>
<div class="MsoNormal">
References:</div>
<div class="MsoNormal">
1, <a href="http://www.ncbi.nlm.nih.gov/pubmed/24478385">For debate: the Operational Patient Care Pathway</a></div>
<div class="MsoNormal">
2, <a href="http://www.naemt.org/Libraries/PHTLS%20TCCC/TCCC%20Guidelines%20120917.sflb">TCCC: Tactical Combat Casualty Care Guidelines</a></div>
<div class="MsoNormal">
3, <a href="http://www.amazon.com/Emergency-War-Surgery-Survivalists-Reference/dp/1616083905/ref=sr_1_1?ie=UTF8&qid=1402434141&sr=8-1&keywords=emergency+war+surgery">Emergency War Surgery: The Survivalist's Medical Desk Reference </a><br />
4, <a href="http://www.amazon.com/21st-Century-Emergency-Surgery-Textbook-ebook/dp/B004HILSAM/ref=sr_1_1?ie=UTF8&qid=1402434230&sr=8-1&keywords=21+century+emergency+war+surgery">21st Century Emergency War Surgery Textbook by the U.S. Army - Weapons Injuries, Triage, Shock, Anesthesia, Infections, Critical Care, Amputations, Burns, Specific Injury Treatment</a><br />
5, <a href="http://www.amazon.com/First-Cut-Real-World-Scenarios-Emergency-ebook/dp/B007MUIYDG/ref=sr_1_1?ie=UTF8&qid=1402434383&sr=8-1&keywords=first+to+cut+trauma+lessons">First to Cut: Trauma Lessons Learned in the Combat Zone, Real-World Scenarios of Patient Care and Surgery, Valuable Advice for Surgeons (Emergency War Surgery Series)</a><br />
6, <a href="http://www.amazon.com/Wilderness-Medicine-Enhanced-Features-Auerbach/dp/1437716784/ref=sr_1_2?ie=UTF8&qid=1402434473&sr=8-2&keywords=wilderness+medicine">Wilderness Medicine: Expert Consult Premium Edition - Enhanced Online Features and Print, 6e (Auerbach, Wilderness Medicine)</a> </div>
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<o:p></o:p></div>
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<br /></div>
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docvpbhttp://www.blogger.com/profile/17349160261907900884noreply@blogger.com2tag:blogger.com,1999:blog-71150009730113568.post-88734437765444483262014-05-30T07:20:00.001-07:002014-05-30T23:13:53.671-07:00Code Black.......<div class="" style="clear: both; text-align: center;">
It's Adrenaline addicting....it's a mess....It's noisy...sometime very noisy....It's crowded.......It's Dirt....just the dirt of blood when you are lucky.....it's dangerous....It's exhausting....It's the BEST!!!....It's the ER.......!!!!</div>
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<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.youtube.com/embed/xSGOSwhzibw?feature=player_embedded' frameborder='0'></iframe></div>
docvpbhttp://www.blogger.com/profile/17349160261907900884noreply@blogger.com0tag:blogger.com,1999:blog-71150009730113568.post-32277493608674151822014-04-23T08:36:00.001-07:002014-04-23T08:36:58.970-07:00SMACC (Social Media & Critical Care ) GOLD Conference 19-21/03/2014 : Gold Coast, Queensland, Australia...... Oops I Did It Again ! !Hi Guys......<br />
this time I had the honor to be guest of one of the best #FOAM websites in Italy: <a href="http://www.medicinadurgenza.org/">www.medicinadurgenza.org</a><br />
My post is a review of The BEST CONFERENCE EVER: SMACC Gold 2014....Yes!!!! I did it again .....Second round!!!!!!<br />
Obviously the post is in Italian but the translation programme attached to the website is great!!! so can be read also in English without problems.....<br />
Follow the link below and enjoy!!!......<br />
From docvpb.... Have good Day on the Edge!!!!.....and See you at SMACC CHICAGO (May 2015)!!<br />
<a href="http://www.medicinadurgenza.org/content/smacc-social-media-critical-care-gold-conference-ooops-i-did-it-again-tenente-valerio-pisano">http://www.medicinadurgenza.org/content/smacc-social-media-critical-care-gold-conference-ooops-i-did-it-again-tenente-valerio-pisano</a><br />
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<br />docvpbhttp://www.blogger.com/profile/17349160261907900884noreply@blogger.com0tag:blogger.com,1999:blog-71150009730113568.post-40688567351612970682013-12-24T03:45:00.001-08:002013-12-24T03:45:59.979-08:00Medical Planning for Extended Remote Expeditions<div class="MsoNormal">
Hi Guys!!!!....<o:p></o:p></div>
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Recently I read a great paper from the Wilderness &
Environmental Medicine Journal about Medical Planning for Extended Remote
Expeditions (follow the link below):<o:p></o:p></div>
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<a href="http://www.wemjournal.org/article/S1080-6032(13)00149-X/abstract">http://www.wemjournal.org/article/S1080-6032(13)00149-X/abstract</a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiEnIePTJ0m-SYuSL1YwpaT1yEADwJXjwcm1R6TLqnN0Wr3QdfW_V0nATZOrbB3lG50n0DD2A-8zygdoiIpexK9lq0gSySw8Js561acW4heK1FiL0g3KmLdGLAhQPA6vxIJZsoMLHpfCN8/s1600/11_08_09-ces_ft_expeditions-05_1712262-580px.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiEnIePTJ0m-SYuSL1YwpaT1yEADwJXjwcm1R6TLqnN0Wr3QdfW_V0nATZOrbB3lG50n0DD2A-8zygdoiIpexK9lq0gSySw8Js561acW4heK1FiL0g3KmLdGLAhQPA6vxIJZsoMLHpfCN8/s320/11_08_09-ces_ft_expeditions-05_1712262-580px.jpg" width="320" /></a></div>
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It gives not only 10
guidelines to help planners on the key, medically relevant elements of a
workable remote healthcare system, but it gives also,as explanation for
every point, a summary of a real clinical case.<o:p></o:p></div>
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This is my personal brief review:<o:p></o:p></div>
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“<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">Remote travelers have long been concerned about their medical care.
Alexander the Great traveled with his personal physician, Philippus, as he
conquered the world. In the early twentieth century, Admiral Robert Peary took
Dr Frederick Cook on his 1891 Greenland expedition, where he set Peary’s
fractured leg. Ernest Shackleton brought Eric Marshall on Antarctic expeditions
as his chief surgeon/cartographer/surveyor. On his ill-fated 1912 expedition,
Robert Falcon Scott chose Edward Wilson as his doctor/marine
biologist/ornithologist.</span><o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfrElyEejhsSM9UWC0ry9wGtrm7QHM2O2Ubdb3B2AEPyTNFPi6heHmRGuNR5ax0PAyZqXKwFDsKvMFCTx4UYEU89lMeFd3ST-NVIcFkAx7pXpdXKTFhLumJ9GnzwtfrAkbA_zhYZ0NWTw/s1600/Soviet-Antarctic-Expedition1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="215" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfrElyEejhsSM9UWC0ry9wGtrm7QHM2O2Ubdb3B2AEPyTNFPi6heHmRGuNR5ax0PAyZqXKwFDsKvMFCTx4UYEU89lMeFd3ST-NVIcFkAx7pXpdXKTFhLumJ9GnzwtfrAkbA_zhYZ0NWTw/s320/Soviet-Antarctic-Expedition1.jpg" width="320" /></a></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">Remote expedition medicine provides medical diagnosis and treatment to teams traveling to the developing</span><span style="font-family: Times;"> </span><span style="font-size: 13pt;">world or to remote geographical regions “where
access to definitive medical care will involve prolonged evacuation over many
hours or days.”</span><span style="color: #2085c8; font-size: 9pt; position: relative; top: -5pt;">1 </span><span style="font-size: 13pt;">The practice of remote medicine involves many
challenges, including dealing with isolated environments, limited clinical
diagnostic support and specialist services, limited resources and equipment,
altered treatment protocols, and longer patient contact times. Medical
practitioners on these expeditions must have increased clinical acumen, public
health knowledge, and a cross-cultural understanding of their team members and
the region’s indigenous populations. They also must be able to provide and use
diagnostic and management advice via telecommunications, devise and implement
innovative practice methods, work beyond their normal scope of practice, make
independent decisions, and assume increased responsibility….”</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVq0cb0Utc5-KIqdx8FnLu1LPasDGb_Tu1XlqmrjVlizljaa3n30QtPjIXmd3JU6AmjY4b-_7a0-X5-eQ2220PrS7DN1gDBVpv6dNrmk5xUamRY2hVXQPX-Yu1RWSZHERVd5N9MCogbLc/s1600/endurance-beset.a.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="237" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVq0cb0Utc5-KIqdx8FnLu1LPasDGb_Tu1XlqmrjVlizljaa3n30QtPjIXmd3JU6AmjY4b-_7a0-X5-eQ2220PrS7DN1gDBVpv6dNrmk5xUamRY2hVXQPX-Yu1RWSZHERVd5N9MCogbLc/s320/endurance-beset.a.jpg" width="320" /></a></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;"><b>N°1) Optimize workers fitness</b><o:p></o:p></span></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">Before every kind of Expedition is important to
perform workforce predeployment screening medical examinations in order to
identify ailments and abnormalities and therefore anticipate and be prepared to
cope with common and less common chronic illnesses, such as Allergies, Asthma,
Diabetes, Hypertension, Epilepsy, Cardiovascular deseases and so
forth….(General Dental screening could be also useful….Statistical
studies showed that 5% to 15% of all offshore oil workers evacuations were due
to Dental problems).<o:p></o:p></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiaPMUInXR9mFSC7pIl_2MfrZUcvdWbX87q2CkYYH1-_KEK-iMLoBId34ONGK0s0jw9VGRCB0jSR_nEbJ6IbIu8Mp7Ww8c6R9iOF9vAATowMvvlPkxJuj0OajKLCAR8Y6DvKRqSDDGQ96M/s1600/mountain-expedition53.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiaPMUInXR9mFSC7pIl_2MfrZUcvdWbX87q2CkYYH1-_KEK-iMLoBId34ONGK0s0jw9VGRCB0jSR_nEbJ6IbIu8Mp7Ww8c6R9iOF9vAATowMvvlPkxJuj0OajKLCAR8Y6DvKRqSDDGQ96M/s320/mountain-expedition53.jpg" width="320" /></a></div>
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<b><span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;"><o:p> </o:p></span><span style="font-size: 13pt;">N°2) Anticipate Treatable Problems</span></b></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">“Improvisation is the name of the game”<o:p></o:p></span></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">Planners should base their medication and equipment
stock on the most common presentation to EDs; a good resource could be : “ED
section of the annual National Hospital Ambulatory Medical Care survey based on
US hospitals”.<o:p></o:p></span></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">In general most commonly encountered problems
during expeditions are minor conditions: Gastrointestinal diseases, skin
deseases, minor trauma…furthermore dental and ophtalmological problems must not be forgot
and underestimated.<o:p></o:p></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4IGk16T8BjDkt2E2__-08B7pv8fmkDiHuH_vyZ9m1Lxo4uAXNpB6_5b26W5y24JVKCtjsslTQFXWWNk1iZ2bXzqmz8WhS-vyPU7uJFr3xtrmfH77kA5XEpD3AWhBa4qFV23M2gAcaJnU/s1600/Oil-Rig-1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="215" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4IGk16T8BjDkt2E2__-08B7pv8fmkDiHuH_vyZ9m1Lxo4uAXNpB6_5b26W5y24JVKCtjsslTQFXWWNk1iZ2bXzqmz8WhS-vyPU7uJFr3xtrmfH77kA5XEpD3AWhBa4qFV23M2gAcaJnU/s320/Oil-Rig-1.jpg" width="320" /></a></div>
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<span style="font-size: 13pt;"><o:p> </o:p></span><b style="font-size: 13pt;">N°3) Stock appropriate Medications</b></div>
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<span style="font-size: 17px; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> A)</span><span style="font-size: 9px; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"><span style="font-family: Times New Roman;"> </span></span><span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">Stock
FIRST-LINE medications for the commonly anticipated illnesses; If possible
supply first-line medications with multiple uses such as Adrenaline and
diphenhydramine.<o:p></o:p></span></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;"> B)Stock
additional medications for specific environments: for instance otitis externa
medications and O2 for diving expeditions or Acetazolamide, Dexamethasone,
Salmeterole, Nifedipine and O2 for High Altitude ventures.<o:p></o:p></span></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;"> C)Quantity:
“(probable numer of pts. Needing the medication) x </span><span style="font-size: 13pt;">(the
number of doses needed to treat one pt.).</span></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;"><b>N°4) Provide appropriate Equipment<o:p></o:p></b></span></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">“The major criterion is to provide what clinicians
will need to diagnose and treat common problems, to convert patient evacuations
to restricted duty, or to convert emergency evacuations to scheduled departures.
This includes most equipment required for ophthalmologic, otolaryngologic,
dental, traumatic, orthopedic, and extraction/evacuation situations.”<o:p></o:p></span></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">Additional equipment such as advanced airways,
ventilation, laboratory testing and diagnostic imaging depends on remoteness of
location, expedition size, Medical provider experience and expertise.<o:p></o:p></span></div>
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<span style="font-size: 13pt;">It’s very important to test every piece of
equipment before </span><span style="font-size: 17px;">departure in</span><span style="font-size: 13pt;"> order to avoid bad surprises.....for example in the midth of
the Ocean…….<o:p></o:p></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9Ac_fVjzBwp1pNsMbL4UY4pXj5J2cYaLFHA9upvdK9eIUaeIoSc3eOpP32bmcelz9K5dWeOHcMwaKJyxslejZHXXoQ2ykZGnH6CL3hAFKSWcAQHM5GbwZCMvBC-786KmzfOH8QoyKYhk/s1600/draugen_platform_oil_rig_3.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9Ac_fVjzBwp1pNsMbL4UY4pXj5J2cYaLFHA9upvdK9eIUaeIoSc3eOpP32bmcelz9K5dWeOHcMwaKJyxslejZHXXoQ2ykZGnH6CL3hAFKSWcAQHM5GbwZCMvBC-786KmzfOH8QoyKYhk/s320/draugen_platform_oil_rig_3.jpg" width="320" /></a></div>
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<span style="font-size: 13pt;"><br /></span></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;"><b>N°5) Provide adequate logistical support</b><o:p></o:p></span></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">“Given the situational constraints and the need for
frontline medical providers to have the tools they need, planners should ensure
that expedition logistics function as smoothly as possible using proven
healthcare supply systems.</span><span style="color: #2085c8; font-family: Times; font-size: 9.0pt; mso-bidi-font-family: Times; mso-text-raise: 5.0pt; position: relative; top: -5.0pt;">”</span><span style="font-family: Times; mso-bidi-font-family: Times;"><o:p></o:p></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgU4Vot6SesATH4FCmGrCKL8ACAvw6yHcScSfxQcxrEwf6poKPFu3M26uIiEeF7khLDb4kSm0xrjMCYYuT31ZH8KgeAGdI7s9FsIcoxVFuGFM38OVbb60-oGo8GPB629a_aF_TL2ED0VJU/s1600/The-ice-breaker-LAstrolabe-in-the-Antarctic-sea-1024x607.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="189" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgU4Vot6SesATH4FCmGrCKL8ACAvw6yHcScSfxQcxrEwf6poKPFu3M26uIiEeF7khLDb4kSm0xrjMCYYuT31ZH8KgeAGdI7s9FsIcoxVFuGFM38OVbb60-oGo8GPB629a_aF_TL2ED0VJU/s320/The-ice-breaker-LAstrolabe-in-the-Antarctic-sea-1024x607.jpg" width="320" /></a></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;"><b>N°6) Provide Adequate medical communication</b><o:p></o:p></span></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">Large Extended expeditions require as a minimum Internet access with sufficient bandwidth;<o:p></o:p></span></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">Indeed the internet can be used not only to send
clinical images and Ultrasound movies but even for specialist referrals (VolP)
for particular clinical cases.<o:p></o:p></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifymRFD_vZuX3m7KW8YNzVMDiEwhuDrm0-PwQfuz15-ubDmKdqL-XUIyxDQs6hbsVAHaMO9lzU5ZkZXzuOynudjjEV2H46kqzd32cLXTfK0DGSVM6ZmI7fKGWSz4XIM0LZ04_U1tembss/s1600/vvc1099.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifymRFD_vZuX3m7KW8YNzVMDiEwhuDrm0-PwQfuz15-ubDmKdqL-XUIyxDQs6hbsVAHaMO9lzU5ZkZXzuOynudjjEV2H46kqzd32cLXTfK0DGSVM6ZmI7fKGWSz4XIM0LZ04_U1tembss/s320/vvc1099.jpg" width="320" /></a></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;"><br /></span></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;"><b>N°7) Know the Environmental Limitations on Patient
Access and Evacuation</b><o:p></o:p></span></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">When planning an expedition patient accessibility
in terms of weather, local environmental conditions and availability of
trasportation must always be considered;<o:p></o:p></span></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">Time requested for an eventual Medical Evaquation
must be took into account;<o:p></o:p></span></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">Moreover before an expedition the clinician must be
aware of local healthcare facilities and quality of Medicare available.<o:p></o:p></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqR4MoOxR_KWeFNpI72vgn8HFIKIYw8jGtQW1cMXD0CpMsUPaczhYtgIRjkRFL9ciKQlqJxaFb3WXHfgGXHgiQ9AmkPHsNHlEzwSW4zSsKad962-qFwW9AqBekk26NPdsDvDU_OJ2yl24/s1600/10747-1600x1200.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqR4MoOxR_KWeFNpI72vgn8HFIKIYw8jGtQW1cMXD0CpMsUPaczhYtgIRjkRFL9ciKQlqJxaFb3WXHfgGXHgiQ9AmkPHsNHlEzwSW4zSsKad962-qFwW9AqBekk26NPdsDvDU_OJ2yl24/s320/10747-1600x1200.jpg" width="320" /></a></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;"><b>N°8) Use qualified Providers</b><o:p></o:p></span></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">Expedition doctor should have previous
experience<span style="mso-spacerun: yes;"> </span>in Emergency and prehospital
care, expedition medicine and the ability to operate effectively in remote
environments.<o:p></o:p></span></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">Familiarity with the specific conditions of the
expedition (for instance altitude related illnesses or Barotrauma) is
desiderable.<o:p></o:p></span></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">In my opinion ability to IMPROVISE is the most
important skill of an expedition doctor!!!!<o:p></o:p></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuyILLp6Ty2EjCsB0qfEuBFIHG4NWyXWv1krj4noif14bsrhwfbPsTI2vTz-5KRNzelAb24ZCys7tl6V1tXDB4EXKTwgDMrJ_jNYb0W2pU07yeXku8cZAroW8Kgwr8eTkDOtB7QjLNGFI/s1600/antartic-02.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuyILLp6Ty2EjCsB0qfEuBFIHG4NWyXWv1krj4noif14bsrhwfbPsTI2vTz-5KRNzelAb24ZCys7tl6V1tXDB4EXKTwgDMrJ_jNYb0W2pU07yeXku8cZAroW8Kgwr8eTkDOtB7QjLNGFI/s320/antartic-02.jpg" width="320" /></a></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;"><br /></span></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;"><o:p> </o:p></span><b style="font-size: 13pt;">N°9) Arrange for Knowledgeable and Timely
Consultations</b></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">Before departure is important to make Arrangements
to have a team of base specialists (possibly expert of remote medical
problems), ready for consultation even from remote locations. <o:p></o:p></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-5v6ixKc-g7H7TDzjBW1oamyebWSPa9ENjYNG3QSNCfo7aEfHBlIOp83K62QlvguxK_zdzGFOsxHJOrAAdlv34RveatZg9EoJFEQBAO593E4lY37bdl9oPxJQpAxcr4nYgH0hNFMNM68/s1600/shutterstock_35154892-617x416.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="215" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-5v6ixKc-g7H7TDzjBW1oamyebWSPa9ENjYNG3QSNCfo7aEfHBlIOp83K62QlvguxK_zdzGFOsxHJOrAAdlv34RveatZg9EoJFEQBAO593E4lY37bdl9oPxJQpAxcr4nYgH0hNFMNM68/s320/shutterstock_35154892-617x416.jpg" width="320" /></a></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;"><b>N°10) Establish and Distribute Rational
Administrative Rules</b><o:p></o:p></span></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">Before the expedition medical personnel must be
aware of all administrative rules Sponsor’s specific and Country setting of expedition specific..<o:p></o:p></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjv9nZ5cs7YciEQsB8EfeHeLE_tG8h8ylm1lNFKzC61IcV2lbNEM2QQIsXUo6mLedqEM3LIRFgFaDhyh6XeVSS369-zi1fE3S0qbnNT_zjsVA2BJowKEu38e9U-Wl0odUnXgMvn2SW0FCA/s1600/Cultural-desert-...-an-oi-007.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="192" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjv9nZ5cs7YciEQsB8EfeHeLE_tG8h8ylm1lNFKzC61IcV2lbNEM2QQIsXUo6mLedqEM3LIRFgFaDhyh6XeVSS369-zi1fE3S0qbnNT_zjsVA2BJowKEu38e9U-Wl0odUnXgMvn2SW0FCA/s320/Cultural-desert-...-an-oi-007.jpg" width="320" /></a></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;"><br /></span></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;"><o:p> </o:p></span><span style="font-size: 13pt;">To sum up the following are the golden rules for
medical planning of a Remote expedition:</span></div>
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<!--[if !supportLists]--><span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times; mso-fareast-font-family: Times;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">Optimize
workers’ fitness <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times; mso-fareast-font-family: Times;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">Anticipate
treatable problems <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times; mso-fareast-font-family: Times;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">Stock
appropriate medications <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times; mso-fareast-font-family: Times;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">Provide
appropriate equipment <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times; mso-fareast-font-family: Times;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">Provide
adequate logistical support <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times; mso-fareast-font-family: Times;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">Provide
adequate medical communications <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times; mso-fareast-font-family: Times;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">Know the
environmental limitations on patient
access and evacuation <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times; mso-fareast-font-family: Times;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">Use
qualified providers <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times; mso-fareast-font-family: Times;"><span style="mso-list: Ignore;">9.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">Arrange
for knowledgeable and timely consultations <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times; mso-fareast-font-family: Times;"><span style="mso-list: Ignore;">10.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">Establish and distribute rational administrative
rule <o:p></o:p></span></div>
<div class="separator" style="clear: both; text-align: center;">
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">Remember
that a good planning concurs for about 70% of success of a remote expedition
and this is true even for medical planning….<o:p></o:p></span></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">But
remember also that </span><span style="font-size: 17px;">while practicing medicine in Extreme Environments</span><span style="font-size: 13pt;"> I<b>mprovisation</b> skills
could make the difference…..</span></div>
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<span style="font-family: Times; font-size: 13.0pt; mso-bidi-font-family: Times;">Hoping
you will enjoy this publication and my review…….as always… have a good day on
the Edge!!!!<o:p></o:p></span></div>
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docvpbhttp://www.blogger.com/profile/17349160261907900884noreply@blogger.com5tag:blogger.com,1999:blog-71150009730113568.post-20134398096673204722013-12-21T09:59:00.003-08:002013-12-21T09:59:53.883-08:00Hi Guys......<br />
this time I had the honor to be guest of one of the best #FOAM websites in Italy: <a href="http://www.medicinadurgenza.org/">www.medicinadurgenza.org</a><br />
Thanks to Gemma Morabito (twitter ash.: @MedEmit...follow her) for hosting me...<br />
My post is a review on a Great Conference I recently attended: Essentials of Emergency Medicine 2013 in San Francisco!!!!<br />
Obviously the post is in Italian but the translation programme attached to the website is great!!! so can be read also in English without problems.....<br />
Follow the link below and enjoy!!!......<br />
From docvpb.... Merry Christmas on the Edge!!!!<br />
<a href="http://www.medicinadurgenza.org/content/essentials-emergency-medicine-2013-io-cero-tenente-valerio-pisano-brasca-md-ufficiale-medico">http://www.medicinadurgenza.org/content/essentials-emergency-medicine-2013-io-cero-tenente-valerio-pisano-brasca-md-ufficiale-medico</a><br />
<br />
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<br />docvpbhttp://www.blogger.com/profile/17349160261907900884noreply@blogger.com0tag:blogger.com,1999:blog-71150009730113568.post-30892419453255525332013-12-14T09:18:00.001-08:002013-12-14T09:18:06.961-08:00High altitude illnesses....My personal fast review
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<span style="font-family: Cambria; font-size: 15px; line-height: 18px; text-align: center;">Hi Guys!!!!.....In this post I'd like to cover maybe the biggest issue in Expedition Medicine: H</span><span style="font-family: Cambria; font-size: 11pt; line-height: 120%;">igh altitude related illnesses….and this is my
personal fast review:</span></div>
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<span style="font-family: Cambria; font-size: 11pt; line-height: 120%;"><br /></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGnAozQgUmWvbVQUVNl_ZCnn3LtaMlPiehO5S8jixR_pDM7ASoviOsicMVRFACCNTh_PYyD3rtK7SYnTlS_WF2T_yAjGcgUE129yGfK3VnqAohXQu0kGxWO4bSvIkrt0HcscflaQyfbtk/s1600/everest-expedition.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="181" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGnAozQgUmWvbVQUVNl_ZCnn3LtaMlPiehO5S8jixR_pDM7ASoviOsicMVRFACCNTh_PYyD3rtK7SYnTlS_WF2T_yAjGcgUE129yGfK3VnqAohXQu0kGxWO4bSvIkrt0HcscflaQyfbtk/s320/everest-expedition.jpg" width="320" /></a></div>
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<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Hypobaric
hypoxia found at high altitudes (especially over 2400m) is a strong stressor
for the body especially in unacclimatized or not correctly acclimatized persons
and may produce from a simple Headache, to Mountain sickness, to
life-threatening conditions such as Acute polmonary Edema and Acute Cerebral Edema.<o:p></o:p></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvknnddqb9JBRZSa7I-mMFISAyUsuiB_I5FKqSjqZBC4wxBfcw3QnRRDHnxk-8Q34087qN-IdgS52eKhcs9rAuDPAggH9pUdWppCKM6OiyKyrocaCAJzuUSHi84WRLJwtAEnWUaGJrcqs/s1600/Mountain-Expedition-1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="230" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvknnddqb9JBRZSa7I-mMFISAyUsuiB_I5FKqSjqZBC4wxBfcw3QnRRDHnxk-8Q34087qN-IdgS52eKhcs9rAuDPAggH9pUdWppCKM6OiyKyrocaCAJzuUSHi84WRLJwtAEnWUaGJrcqs/s320/Mountain-Expedition-1.jpg" width="320" /></a></div>
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<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></div>
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<b><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Prevention is of the utmost
importance:</span></b></div>
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<b><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></b></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdlCZvDbYyU_UJFOsaX5Aw4_XqRL-6uFO9uJ_HBaH0iCQWAdjsc2AJ-KMJlIDvoeDfE5LTKX-Rq9mkRyxW0AbRWn68d_T9NUB2sfFpjDJn3JOToJqyCcs-thqEvIVRjLU3zGXw7VDXVt4/s1600/ams3.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdlCZvDbYyU_UJFOsaX5Aw4_XqRL-6uFO9uJ_HBaH0iCQWAdjsc2AJ-KMJlIDvoeDfE5LTKX-Rq9mkRyxW0AbRWn68d_T9NUB2sfFpjDJn3JOToJqyCcs-thqEvIVRjLU3zGXw7VDXVt4/s320/ams3.jpg" width="277" /></a></div>
<div class="Corpo2">
<b><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></b></div>
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<b><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></b></div>
<div class="Corpo2" style="margin-left: 36.0pt; mso-list: l4 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Staged
ascent:<o:p></o:p></span></div>
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<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">-First
camp no higher 2400m.<o:p></o:p></span></div>
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<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"> Increase of no-more 300-600m per night.<o:p></o:p></span></div>
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<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"> OR<o:p></o:p></span></div>
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<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"> Two nights at same altitude for every increase
of 600m.<o:p></o:p></span></div>
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<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">-If
expedition starts above 2700m: First two nights must be spent acclimatizing.<o:p></o:p></span></div>
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<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">-Just
a TIP: ”climb high,sleep slow”: proceed higher during the day, return to a
lower elevation to sleep.</span></div>
<div class="Corpo2" style="margin-left: 36.0pt; mso-list: l4 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Diet rich in
carbohydrates may aid acclimatization and prevent High altitude illness.</span></div>
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<!--[if !supportLists]--><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Is important
to avoid excessive exercise until ucclimatized.<o:p></o:p></span></div>
<div class="Corpo2" style="margin-left: 36.0pt; mso-list: l4 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">High
altitude increases fluid losses, Thus adeguate hydration ( maybe judged by Clear
urine) is helpful.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Drug
Prophylaxis (Just for persons with previous history of AMS or forced rapid
ascent):<o:p></o:p></span></div>
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<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">-Acetazolamide: </span></div>
<div class="Corpo2">
<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><b>250 mg twice/day orally, starting day before ascent.</b><o:p></o:p></span></div>
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<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">-Dexamethasone
(Just people intolerant to Acetazolamide or forced ascent to altitude over 4.200m - for instance in case of rescue operations):</span></div>
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<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><b>4 mg every 8h orally.</b><o:p></o:p></span></div>
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<br /></div>
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<b><span lang="SV" style="font-family: Cambria; font-size: 14.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">High altitude Headache (HAH):<o:p></o:p></span></b></div>
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<b><span lang="SV" style="font-family: Cambria; font-size: 14.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></b></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhYgOLtNTMae9N6dlgXeokB4dwcopl64gnL82zcHB-KCG11VtESek52DOkuaevK-ObcDO1Gn3wd3c5WeN9p61ISVRX5RXpdphyphenhyphenoLOLmriLWVUr0zBj602gw2MYUeSxabIHex9xv8vspSTs/s1600/ams2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhYgOLtNTMae9N6dlgXeokB4dwcopl64gnL82zcHB-KCG11VtESek52DOkuaevK-ObcDO1Gn3wd3c5WeN9p61ISVRX5RXpdphyphenhyphenoLOLmriLWVUr0zBj602gw2MYUeSxabIHex9xv8vspSTs/s320/ams2.jpg" width="320" /></a></div>
<div class="Corpo2">
<b><span lang="SV" style="font-family: Cambria; font-size: 14.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></b></div>
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<b><span lang="SV" style="font-family: Cambria; font-size: 14.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></b></div>
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<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Usually
is the First unpleasent symptom of High altitude exposure.<o:p></o:p></span></div>
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<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></div>
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<i><u><span lang="SV" style="font-family: Cambria; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">-Feautures</span></u></i><i><span lang="SV" style="font-family: Cambria; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">:<o:p></o:p></span></i></div>
<div class="Corpo2" style="margin-left: 36.0pt; mso-list: l2 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; font-size: 11.0pt; line-height: 120%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Occurs with
an ascent greater than 2500m.<o:p></o:p></span></div>
<div class="Corpo2" style="margin-left: 36.0pt; mso-list: l2 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; font-size: 11.0pt; line-height: 120%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">developes
within 24h after ascent and resolves 8h after descent.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; font-size: 11.0pt; line-height: 120%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Can be
defined <b>HAH</b> if has two of the
Following characteristics:<o:p></o:p></span></div>
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<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">-Bilateral.<o:p></o:p></span></div>
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<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">-frontal
or fronto-temporal.<o:p></o:p></span></div>
<div class="Corpo2" style="border: none; mso-border-shadow: yes; mso-padding-alt: 31.0pt 31.0pt 31.0pt 0cm;">
<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">-dull
or pressing quality.<o:p></o:p></span></div>
<div class="Corpo2" style="border: none; mso-border-shadow: yes; mso-padding-alt: 31.0pt 31.0pt 31.0pt 0cm;">
<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">-aggravated
by exertion, coughing, bending, movements, straining.<o:p></o:p></span></div>
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<br /></div>
<div class="Corpo2" style="border: none; mso-border-shadow: yes; mso-padding-alt: 31.0pt 31.0pt 31.0pt 0cm;">
<i><span lang="SV" style="font-family: Cambria; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">-Tr<u>eatment:<o:p></o:p></u></span></i></div>
<div class="Corpo2" style="border: none; mso-border-shadow: yes; mso-padding-alt: 31.0pt 31.0pt 31.0pt 0cm;">
<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Ibuprofene,
Aspirin or Paracetamole/Acetaminophene.<o:p></o:p></span></div>
<div class="Corpo2" style="border: none; mso-border-shadow: yes; mso-padding-alt: 31.0pt 31.0pt 31.0pt 0cm;">
<br /></div>
<div class="Corpo2" style="border: none; mso-border-shadow: yes; mso-padding-alt: 31.0pt 31.0pt 31.0pt 0cm;">
<b><span lang="SV" style="font-family: Cambria; font-size: 14.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Acute Mountain Sickness:<o:p></o:p></span></b></div>
<div class="Corpo2" style="border: none; mso-border-shadow: yes; mso-padding-alt: 31.0pt 31.0pt 31.0pt 0cm;">
<b><span lang="SV" style="font-family: Cambria; font-size: 14.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></b></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8YNRPExypfSZ82Kb50A5qD_nsn4oh8XuhCNz7nEudYjh_s_goWFuJVJF4z8QH56yBVJcylL7TmkrOci1Pu45UDJPrOd9857TcP8lSLLKAa8I6HX65t4rgvK8IDaeX63dv5bAC_ABJQOY/s1600/ams4.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="170" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8YNRPExypfSZ82Kb50A5qD_nsn4oh8XuhCNz7nEudYjh_s_goWFuJVJF4z8QH56yBVJcylL7TmkrOci1Pu45UDJPrOd9857TcP8lSLLKAa8I6HX65t4rgvK8IDaeX63dv5bAC_ABJQOY/s320/ams4.jpg" width="320" /></a></div>
<br />
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<b><span lang="SV" style="font-family: Cambria; font-size: 14.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></b></div>
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<i><u><span lang="SV" style="font-family: Cambria;">-Feautures:</span></u></i></div>
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<i><u><span lang="SV" style="font-family: Cambria;"><br /></span></u></i></div>
<div class="Corpo2" style="border: none; mso-border-shadow: yes; mso-padding-alt: 31.0pt 31.0pt 31.0pt 0cm; tab-stops: center 225.5pt;">
<b><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Headache </span></b><b><span lang="SV" style="font-family: Cambria; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><o:p></o:p></span></b></div>
<div class="Corpo2" style="border: none; mso-border-shadow: yes; mso-padding-alt: 31.0pt 31.0pt 31.0pt 0cm;">
<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">+<o:p></o:p></span></div>
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<b><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">At least One of:</span></b></div>
<div class="Corpo2" style="border: none; mso-border-shadow: yes; mso-padding-alt: 31.0pt 31.0pt 31.0pt 0cm;">
<b><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"> -Anorexia<o:p></o:p></span></b></div>
<div class="Corpo2" style="border: none; mso-border-shadow: yes; mso-padding-alt: 31.0pt 31.0pt 31.0pt 0cm;">
<b><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"> -Nausea/Vomiting<o:p></o:p></span></b></div>
<div class="Corpo2" style="border: none; mso-border-shadow: yes; mso-padding-alt: 31.0pt 31.0pt 31.0pt 0cm;">
<b><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"> -dizziness<o:p></o:p></span></b></div>
<div class="Corpo2" style="border: none; mso-border-shadow: yes; mso-padding-alt: 31.0pt 31.0pt 31.0pt 0cm;">
<b><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"> -disturbed sleep<o:p></o:p></span></b></div>
<div class="Corpo2" style="border: none; mso-border-shadow: yes; mso-padding-alt: 31.0pt 31.0pt 31.0pt 0cm;">
<b><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"> -lassitude</span></b><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><o:p></o:p></span></div>
<div class="Corpo2" style="border: none; mso-border-shadow: yes; mso-padding-alt: 31.0pt 31.0pt 31.0pt 0cm;">
<b><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></b></div>
<div class="Corpo2" style="border: none; mso-border-shadow: yes; mso-padding-alt: 31.0pt 31.0pt 31.0pt 0cm;">
<i><u><span lang="SV" style="font-family: Cambria; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">-Treatment:<o:p></o:p></span></u></i></div>
<div class="Corpo2" style="border: none; mso-border-shadow: yes; mso-padding-alt: 31.0pt 31.0pt 31.0pt 0cm;">
<i><u><span lang="SV" style="font-family: Cambria; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></u></i></div>
<div class="Corpo2" style="border: none; margin-left: 36.0pt; mso-border-shadow: yes; mso-list: l3 level1 lfo3; mso-padding-alt: 31.0pt 31.0pt 31.0pt 0cm; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; font-size: 11.0pt; line-height: 120%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Stop ascent
and wait for improvement.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; font-size: 11.0pt; line-height: 120%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">O2 to reach
and mantain SpO2>90%.<o:p></o:p></span></div>
<div class="Corpo2" style="border: none; margin-left: 36.0pt; mso-border-shadow: yes; mso-list: l3 level1 lfo3; mso-padding-alt: 31.0pt 31.0pt 31.0pt 0cm; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; font-size: 11.0pt; line-height: 120%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Acetazolamide:
250 mg twice/day orally (If intolerant: Dexamethasone 4 mg every 8h orally).<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; font-size: 11.0pt; line-height: 120%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Treatment of
Symptoms: -Haedache: Aspirine or Paracetamole/Acetaminophene.<o:p></o:p></span></div>
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<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"> -Nausea: Promethazine.<o:p></o:p></span></div>
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<br /></div>
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<b><span lang="SV" style="font-family: Cambria; font-size: 14.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">HAPE (High Altitude Pulmonary
Edema)<o:p></o:p></span></b></div>
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<b><span lang="SV" style="font-family: Cambria; font-size: 14.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></b></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhyphenhyphenP2Jo4X9UNFEbMvkFABOIKoDJkkp-WZPPy1PNSNcIJ2XyIW30rTjDO7T3chVGHL2NLQv6jG3szQTi3Iz8Sp1tz9CNHs4lNCxpW2w-gcKGKU7n2iOgtb0k42zdiBjB8gyH3u6QqcRSeM/s1600/hape.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhyphenhyphenP2Jo4X9UNFEbMvkFABOIKoDJkkp-WZPPy1PNSNcIJ2XyIW30rTjDO7T3chVGHL2NLQv6jG3szQTi3Iz8Sp1tz9CNHs4lNCxpW2w-gcKGKU7n2iOgtb0k42zdiBjB8gyH3u6QqcRSeM/s320/hape.jpg" width="320" /></a></div>
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<b><span lang="SV" style="font-family: Cambria; font-size: 14.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></b></div>
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<i><u><span lang="SV" style="font-family: Cambria; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">-Feautures:</span></u></i></div>
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<i><u><span lang="SV" style="font-family: Cambria; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></u></i></div>
<div class="Corpo2" style="border: none; mso-border-shadow: yes; mso-padding-alt: 31.0pt 31.0pt 31.0pt 0cm;">
<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Dyspnea
on exertion, fatigue, dry cough, that can proceed to frothy sputum, crackles on
lung auscultation.<o:p></o:p></span></div>
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<br /></div>
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<i><u><span lang="SV" style="font-family: Cambria; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">-Treatment:<o:p></o:p></span></u></i></div>
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<i><u><span lang="SV" style="font-family: Cambria; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></u></i></div>
<div class="Corpo2" style="border: none; margin-left: 36.0pt; mso-border-shadow: yes; mso-list: l1 level1 lfo4; mso-padding-alt: 31.0pt 31.0pt 31.0pt 0cm; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; font-size: 11.0pt; line-height: 120%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><b><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">immediate Descent of 600m-1200m.</span></b><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"> <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; font-size: 11.0pt; line-height: 120%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">If descent
is impossible:a Portable hyperbaric bag is a temporary lifesaving device (50 min. in bag -
10 min. break every hour).</span></div>
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<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></div>
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<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></div>
<div class="Corpo2" style="border: none; margin-left: 36.0pt; mso-border-shadow: yes; mso-list: l1 level1 lfo4; mso-padding-alt: 31.0pt 31.0pt 31.0pt 0cm; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; font-size: 11.0pt; line-height: 120%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">O2 to reach
and mantain SpO2>90%.<o:p></o:p></span></div>
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<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhu6soM8Z3sU9R3tO_tDX67V5NGB4PwiDHXvu7uEIIfViqmPASiegkz1i8JTIP-A5EkyYFLlaJpXXQ_vAzFwS2hyphenhyphenJfvhqOMJwzYvThU3HrWT1-BwJOFA8AELyjCuCT4FuI2djcFFdKxnIY/s1600/images.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhu6soM8Z3sU9R3tO_tDX67V5NGB4PwiDHXvu7uEIIfViqmPASiegkz1i8JTIP-A5EkyYFLlaJpXXQ_vAzFwS2hyphenhyphenJfvhqOMJwzYvThU3HrWT1-BwJOFA8AELyjCuCT4FuI2djcFFdKxnIY/s1600/images.jpeg" /></a></div>
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<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></div>
<div class="Corpo2" style="margin-left: 36.0pt; mso-list: l1 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; font-size: 11.0pt; line-height: 120%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Nifedipine
10mg oral.<o:p></o:p></span></div>
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<br /></div>
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<b><span lang="SV" style="font-family: Cambria; font-size: 14.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">HACE (High Altitude Cerebral
Edema)</span></b></div>
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<b><span lang="SV" style="font-family: Cambria; font-size: 14.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></b></div>
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<b><span lang="SV" style="font-family: Cambria; font-size: 14.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></b></div>
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<b><span lang="SV" style="font-family: Cambria; font-size: 14.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></b></div>
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<i><u><span lang="SV" style="font-family: Cambria; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">-Feautures:<o:p></o:p></span></u></i></div>
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<i><u><span lang="SV" style="font-family: Cambria; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></u></i></div>
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<b><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Headache<o:p></o:p></span></b></div>
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<b><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"> + <o:p></o:p></span></b></div>
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<b><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Change in the level of
consciousness.<o:p></o:p></span></b></div>
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<br /></div>
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<i><u><span lang="SV" style="font-family: Cambria; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">-Treatment:<o:p></o:p></span></u></i></div>
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<i><u><span lang="SV" style="font-family: Cambria; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></u></i></div>
<div class="Corpo2" style="margin-left: 36.0pt; mso-list: l0 level1 lfo5; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; font-size: 11.0pt; line-height: 120%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><b><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Immediate descent of 600m-1200m</span></b></div>
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<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"> (Portable Hyperbaric chamber as
temporizing measure if descent is impossible).<o:p></o:p></span></div>
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<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></div>
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<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></div>
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<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></div>
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<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; font-size: 11.0pt; line-height: 120%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">O2 to reach
and mantain SpO2>90%.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; font-size: 11.0pt; line-height: 120%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Dexamethasone:
8-12 mg by the route fastly available, than 4 mg every 6 hours until simptoms
subside.<o:p></o:p></span></div>
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<span lang="SV" style="font-family: Cambria; font-size: 11.0pt; line-height: 120%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">....And
This is it....!!!!!!!!<o:p></o:p></span></div>
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you Enjoy.....</span></div>
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<!--EndFragment-->docvpbhttp://www.blogger.com/profile/17349160261907900884noreply@blogger.com0tag:blogger.com,1999:blog-71150009730113568.post-41269273996348965452013-09-10T11:41:00.000-07:002013-09-10T11:41:02.782-07:00...Just a Meditation......Hi Guys!!!...<br />
This time just a personal Meditation:<br />
I always thought that the BEST in Trauma was working in WAR zones.....<br />
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<br /></div>
but Maybe I wasn't right...Maybe the BEST in Trauma is working 24/7 in an Hospital like this!!!...<br />
<br />
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<div class="kl_button kl_all" focus="return false;" onselectstart="return false;">
<canvas class="button_canvas" height="32" width="32">8</canvas></div>
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<canvas class="button_canvas" height="32" width="32">q</canvas></div>
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<canvas class="button_canvas" height="32" width="32">r</canvas></div>
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<canvas class="button_canvas" height="32" width="32">t</canvas></div>
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<canvas class="button_canvas" height="32" width="32">y</canvas></div>
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<canvas class="button_canvas" height="32" width="32">u</canvas></div>
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<canvas class="button_canvas" height="32" width="32">i</canvas></div>
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<div class="kl_button kl_all" focus="return false;" onselectstart="return false;">
<canvas class="button_canvas" height="32" width="32">;</canvas></div>
<div class="kl_button kl_all" focus="return false;" onselectstart="return false;">
<canvas class="button_canvas" height="32" width="32">'</canvas></div>
<div class="kl_button kl_all" focus="return false;" onselectstart="return false;">
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</div>
<div class="kl_button kl_system kl_system_shift" focus="return false;" onselectstart="return false;">
<canvas class="system_button_canvas" height="32" width="32">shift</canvas></div>
<div class="kl_button kl_all" focus="return false;" onselectstart="return false;">
<canvas class="button_canvas" height="32" width="32">`</canvas></div>
<div class="kl_button kl_all" focus="return false;" onselectstart="return false;">
<canvas class="button_canvas" height="32" width="32">z</canvas></div>
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<canvas class="button_canvas" height="32" width="32">,</canvas></div>
<div class="kl_button kl_all" focus="return false;" onselectstart="return false;">
<canvas class="button_canvas" height="32" width="32">.</canvas></div>
<div class="kl_button kl_all" focus="return false;" onselectstart="return false;">
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<canvas class="system_button_canvas" height="32" width="32">shift</canvas></div>
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<div class="kl_layout_selector kl_top_round_corners kl_bottom_round_corners">
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docvpbhttp://www.blogger.com/profile/17349160261907900884noreply@blogger.com0tag:blogger.com,1999:blog-71150009730113568.post-78063721513129023052013-07-05T12:52:00.000-07:002013-09-10T11:51:27.451-07:00 4th episode of my "Best Retrieval Services in the world" Series: The LONDON HEMS!!!!!!Hi Guys!!!!!!<br />
<br />
It's time for the 4th episode of my "Best Retrieval Services in the world" Series:<br />
<br />
.............. London Bridge is fallin'down??!!!....No matter...They are always ready to intervene...anywhere...anytime:<br />
<br />
.......The LONDON HEMS!!!!!!<br />
<br />
Enjoy and have a good day on the EDGE!!!!!!!!!!!!!!<br />
<br />
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<div class="kl_button kl_all" focus="return false;" onselectstart="return false;">
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<canvas class="system_button_canvas" height="50" width="100">Return</canvas></div>
<div class="kl_return_lower">
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<div class="kl_button kl_system kl_system_capslock" focus="return false;" onselectstart="return false;">
<canvas class="system_button_canvas" height="32" width="32">capslock</canvas></div>
<div class="kl_button kl_all" focus="return false;" onselectstart="return false;">
<canvas class="button_canvas" height="32" width="32">a</canvas></div>
<div class="kl_button kl_all" focus="return false;" onselectstart="return false;">
<canvas class="button_canvas" height="32" width="32">s</canvas></div>
<div class="kl_button kl_all" focus="return false;" onselectstart="return false;">
<canvas class="button_canvas" height="32" width="32">d</canvas></div>
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<div class="kl_button kl_all" focus="return false;" onselectstart="return false;">
<canvas class="button_canvas" height="32" width="32">g</canvas></div>
<div class="kl_button kl_all" focus="return false;" onselectstart="return false;">
<canvas class="button_canvas" height="32" width="32">h</canvas></div>
<div class="kl_button kl_all" focus="return false;" onselectstart="return false;">
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<div class="kl_button kl_all" focus="return false;" onselectstart="return false;">
<canvas class="button_canvas" height="32" width="32">k</canvas></div>
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<div class="kl_button kl_all" focus="return false;" onselectstart="return false;">
<canvas class="button_canvas" height="32" width="32">;</canvas></div>
<div class="kl_button kl_all" focus="return false;" onselectstart="return false;">
<canvas class="button_canvas" height="32" width="32">'</canvas></div>
<div class="kl_button kl_all" focus="return false;" onselectstart="return false;">
<canvas class="button_canvas" height="32" width="32">\</canvas></div>
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<canvas class="system_button_canvas" height="32" width="32">shift</canvas></div>
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<canvas class="button_canvas" height="32" width="32">`</canvas></div>
<div class="kl_button kl_all" focus="return false;" onselectstart="return false;">
<canvas class="button_canvas" height="32" width="32">z</canvas></div>
<div class="kl_button kl_all" focus="return false;" onselectstart="return false;">
<canvas class="button_canvas" height="32" width="32">x</canvas></div>
<div class="kl_button kl_all" focus="return false;" onselectstart="return false;">
<canvas class="button_canvas" height="32" width="32">c</canvas></div>
<div class="kl_button kl_all" focus="return false;" onselectstart="return false;">
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<div class="kl_button kl_all" focus="return false;" onselectstart="return false;">
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<br />docvpbhttp://www.blogger.com/profile/17349160261907900884noreply@blogger.com0tag:blogger.com,1999:blog-71150009730113568.post-25583778494258581342013-05-08T08:52:00.001-07:002013-05-08T09:16:56.338-07:00The Crush Syndrome...expect the unexpected...Hi Guys!!!!<br />
<br />
Recently I had to handle this uncommon desease....never happened to me in years of work as a civilian Resident!!!!!<br />
<br />
Nevertheless this is a Syndrome well known by military doctors and doctors working in Developing Countries.<br />
<br />
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<br />
<br />
At the moment I had some doubts about treatment: Fluids ok but.....Bicarb or not Bicarb....and what about Mannitol???!!!<br />
<br />
Finally I decided just for optimal fluid resuscitation...everything went in the right way and ARF was avoided....But I decided to go deeper inside the world of disaster medicine and The Crush Syndrome...<br />
These my Findings:<br />
<br />
<br />
The Crush Sindrome is a
tipical war illness that occurs especially where bomb shellings are frequent
(look for exemple to the present Sirian conflict);<br />
<br />
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Endeed the modern history of Crush sindrome begins
with Bywaters’ and Beal’s description of the entrapped bomb victims of London
during WWII; However large numbers of patient with Crush sindrome have been
reported also after the collapse of mines, landslides, hearthquackes, building
collapses and severe beatings.<br />
<br />
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<br />
<br />
<b>Rhabdomyolisis</b>The etiological feauture of
Crush Sindrome is Rhabdomyolisis: Direct compression of muscles causes muscle
ischemia, as tissue pressure rises to a level that exceeds capillary perfusion
pressure; Prolonged muscle compression and the subsequent ischemia imply the activation of lithic enzimes, Lipid
peroxidation, Decreased ATP production and an increase of Neutrophil
chemoattractants. Skeletal muscle can tolerate warm ischemia for up to two
hours without damage. Two to four hours of ischemia lead to irreversible
anatomic and functional changes, and muscle necrosis usually occurs by six
hours of ischemia; on the other hand When the compression is relieved, the
muscle tissue is reperfused. Reperfusion determine an increased local
concentration of Neutrophiles that are
responsible for the production of large amount of proteolytic enzymes, free radicals and
hypoclorus acid. All these factors together contributes to produce muscle cells
membranes damage, cellulare swelling, lysis and accumulation of fluid in the
interstitial space<br />
Muscle ischemia followed by
reperfusion (ischemia – reperfusion injury) represents pathophysiologic
mechanism of rhabdomyolisis.<br />
In muscle groups confined in
tight, fibrous sheats with low compliance (calf, forearm etc…),
intracompartmental pressure rises quickly, leading to muscle tamponade and
myoneuronal damage; the so-called Compartment syndrome.<br />
<br />
<b>Crush Syndrome</b><br />
<b><br /></b>
<b><br /></b>
<br />
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<b><br /></b>
Crush Syndrome is the
aftermath of muscle compression relief or correction of vascular compression;<br />
Three are the essential pathological
and clinical features:<br />
<span style="font-family: Wingdings;">v<span style="font-family: 'Times New Roman';"> </span></span><!--[endif]-->Hypovolemia: Large volumes of intravascular fluid can
be sequestred in the involved extremities due to increased capillary
permeability, depleting intravascular
volume and resulting in hypovolemic shock.<br />
<o:p></o:p> Hypovolemia is often the first
manifestation of Crush Syndrome.<br />
<br />
<span style="font-family: Wingdings;">v<span style="font-family: 'Times New Roman';"> </span></span><!--[endif]-->Electrolytes abnormalities and Acidosis: Once muscle
compression is relieved large amounts of toxins and chloridic acid accumulated
in the affected tissue are massively released into circulation, impling acidosis and life threatening electrolyte
abnormalities (Hyperkalemia, Hypocalcemia, Hyperphosphatemia, Acidemia).<br />
<o:p></o:p> Hyperkalemia and its associated
cardiotoxicity represent the<br />
Second most common cause of early
deaths following Crush<br />
Injury.<br />
<br />
<span style="font-family: Wingdings;">v<span style="font-family: 'Times New Roman';"> </span></span><!--[endif]-->3)Acute renal failure: 4 to 33% of patients with
rabhdomyolisis will develop ARF; This is a consequence of three main
mechanisms:<br />
<o:p></o:p>A)Decreased renal perfusion:<br />
It results from the
Hypovolemia and the stimulation of the Renin-Angyotensin-Aldosterone axis with
subsequent renal vasoconstriction in
presence of Myoglobin.<br />
<br />
B)Direct Myoglobin renal
toxicity:<br />
is likely the main component
in the development of renal failure after rabdhomyolisis; Increasing evidences
support free radical mediated renal injury.<br />
<br />
C)Cast formation and tubular
obstruction:<br />
It is a consequence of increased plasma levels of Free Myoglobin
(greater than 0,5-1,5 mg/dl). Free Myoglobin is filtered by the kidney but not
reabsorbed, giving tea-coloured urines (Myoglobinuria).<br />
High concentrations of
Myoglobin in the renal tubules and acidic urine induce Myoglobin casts
formation and tubular obstruction.<br />
<br />
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<br />
<br />
<b>Diagnosis</b><br />
<b><br /></b><b> </b><span style="font-family: Symbol;">·<span style="font-family: 'Times New Roman';"> </span></span><!--[endif]-->History:<br />
<o:p></o:p> Patients in whom there is a history
of being entrapped for a<br />
prolonged period of time.<br />
<br />
<span style="font-family: Symbol;">·<span style="font-family: 'Times New Roman';"> </span></span><!--[endif]-->Physical findings:<br />
<o:p></o:p> Interested extremities may appear
swollen, cool and tense.<br />
Patient may have severe pain out of
proportion.<br />
Anaesthesia and paralysis of
extremities maybe present.<br />
<br />
<span style="font-family: Symbol;">·<span style="font-family: 'Times New Roman';"> </span></span><!--[endif]-->Laboratory:<br />
<o:p></o:p> -CK usually> 100,000 IU/mL<br />
-“Iced tea” colour Urine.<br />
<br />
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<br />
<br />
<b>Treatment</b><b> </b>There are two main schools:
Those who advocate that an early fluid
resuscitation is the only useful therapy; and those who argue that fluid
resuscitation must be accompanied by induction of solute diuresis and urine
alkalinization.<br />
<br />
<b>N°1)</b>Many authors and studies
have shown that an early and large crystalloid infusion is alone sufficient to
produce a good solute dyuresis and to
mantain alkalotic urine.<br />
<br />
Technique:<br />
<br />
-<b>Before and during extrication:<br /><o:p></o:p></b>A)Establish large bore IV
access in a free arm or leg vein.<br />
B)Obviously avoid Potassium
and Lactate containing IV solutions.<br />
<b>C)At least 1 L prior to
extrication and up to 1 L/h (short extrication time) to a maximum of 6-10 L/d
in prolonged entrapments.</b><br />
<br />
-<b>Hospital care:<br />IV crystalloids aiming to
establish and mantain urine output between 100-300 cc/h until pigments have
cleared from the urine.</b><br />
<br />
<i><u>And THIS is it!!!</u></i><br />
<i><u><br /></u></i>
<br />
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<i><u><br /></u></i>
N°2)Experimental studies have
shown that induction of solute dyuresis with Mannitol and urine alkalinization
with Bycarbonate added to fluid resuscitation can contribute in prevention of
ARF:<br />
<br />
-<b>Before and during extrication:</b>Same as in N°1:<br />
1)Establish large bore IV
access in a free arm or leg vein.<br />
2)Obviously avoid Potassium
and Lactate containing IV solutions.<br />
3)At least 1 L prior to
extrication and up to 1 L/h (short extrication time) to a maximum of 6-10 L/d
in prolonged entrapments.<br />
<br />
<b>-Hospital care:</b><br />
1)<b>IV crystalloids aiming to
establish and mantain urine output between 100-300 cc/h</b> until pigments have
cleared from the urine.<br />
2)<b>Add Sodium bicarbonate to
the IV fluid (1 amp/L D5W)</b> to alkalinize the urine above a pH of 6.5.<br />
If unable to monitor urine
pH, put 1 amp in every other IV liter.<br />
3)Administer <b>Mannitol, 20%
solution 1-2 g/Kg over 4 hours (up to 200 g/d) in addition to IV fluids.<br /> </b><br />
In my personal point of view
I’d choose school N°1:<br />
on one hand I don’t like to
push amps of Bicarbonate, on the other hand there are few evidences in favor of
Mannitol use. Furthermore as I said above studies showed that crystalloids
infusion started early is sufficient to produce good solute dyuresis and to
mantain alkalotic urine.<br />
<br />
<b>ACUTE RENAL FAILURE:</b><br />
Despite adeguate
resuscitation and prophylaxis against Myoglobinuric renal injury, up to one
third of patients develop ARF.<br />
<b>Therapy is continuous HEMODIALYSIS.</b><br />
<b><br /></b>
<br />
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<b><br /></b>
<b>COMPARTMENT SYNDROME:</b><br />
When compartment syndrome is
suspected based on mechanism of injury and clinical findings, muscle
compartment pressure should be measured. Apart of specific devices, any
electronic arterial pressure monitoring device can be adopted to perform compartment
pressure measurements:<br />
Normal: 0-15 mmHg<br />
Muscle Ischemia: >30 mmHg<br />
<br />
<b>Therapy is Surgical fasciotomy</b>.<br />
<br />
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<br />
<o:p></o:p><br />
<i>Experimental studies have found that irreversible
muscle and nerve damage occur after 6-8 h of total ischemia.</i><br />
<i><br /></i>
....That's all for today.....I hope this will be useful to you...as always have a good day on the Edge!!!!<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<!--EndFragment-->docvpbhttp://www.blogger.com/profile/17349160261907900884noreply@blogger.com0tag:blogger.com,1999:blog-71150009730113568.post-42080535982111397612013-04-01T10:32:00.004-07:002013-04-01T10:59:59.623-07:00My David Letterman's List: Why it was worthy to be at SMACC 2013Hi Guys!!!!<br />
Recently I have been at the Best Conference in The world... and this is a list (David Letterman Style) on Why it was worthy to spend 23 hours of my life in the ass of a Plane to fly from Rome to Sydney!!!!<br />
<br />
<iframe allowfullscreen="" frameborder="0" height="281" mozallowfullscreen="" src="http://player.vimeo.com/video/53143958" webkitallowfullscreen="" width="500"></iframe> <br />
<a href="http://vimeo.com/53143958">SMACC-DOWN FALL</a> from <a href="http://vimeo.com/user7387816">Oliver Flower</a> on <a href="http://vimeo.com/">Vimeo</a>.<br />
<br />
N°10.<br />
The Venue:<br />
Sydney??! I had the possibility to explore the city in my Leisure time and..... I have to say it: I fell in love...this is one of the best, outstanding, awesome cities in the world!!!!<br />
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<br />
Sydney Convention Centre??!! Everything was great from the conference rooms to the expo and the E-posters Area, but overall the Wifi connection: free and available everywhere through the Convention Area.....Amazing.<br />
<br />
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N°9.<br />
The SMACC-down: As a Wrestling fan I enjoyed a lot when Prof. Stag(Stonecutter)horn did what everyone wish during a conference....: To smash on the stage the classic...conventional...boring...arrogant...FULLOFSTATISTICDATA....Speaker....(Still suffering of Back pain Oli??!!!).<br />
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<a href="http://www.youtube.com/watch?feature=player_embedded&v=Sq90u9Wkgqk">SMACC 2013 Epic Opening</a></div>
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N°8.<br />
Organization:<br />
Everything was Perfect!!! Everyday the Activities started on time and all the speaker respected the time frames....absolutely not easy as it seems...A great job by Roger Harris, Chris Nickson, Oli Flowers, (Keta)Minh Le Cong etc...<br />
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N°7.<br />
Best Critical care and EM lectures in the World:<br />
I enjoied so much all the lectures but especially "Crack to Cure" by Mr. Emcrit Scott Weingart:<br />
Now I know all the secrets to perform an Emergency Thoracothomy in 60 sec even with someone behind me yelling: "Come on Dude!!! Do it....Do it!!!!!...Fast.....Faster....".....I'm Looking forward (...or not!!!) to perform one soon!!!!.<br />
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But I don't forget even other Outstanding... Amazing lectures such as:</div>
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-"Airway clean kills" by (Keta)Minh Le Cong.</div>
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-"War what is it good for?" by Anthony Holley.</div>
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-"Trauma before and beyond the hospital" and "Always carry your scalpel" by Brian Burns.</div>
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-"Generalism: the MacGyver Dilemma" by Casey Parker.</div>
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-"All doctors are Jackasses" by Chris Nickson.</div>
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-"Wrestling with risk" by Simon Curley.</div>
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I learned great, up to date Critical care concepts and Techniques...I'll spread and share them in my Country where unfortunately there is still some certified instructor teaching people things as Pneumothorax decompression by needle in 2nd intercostal space and this is just an example!!!!!<br />
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N°6.<br />
SMACC piece of POETRY:<br />
Tuestday 12 March 2013....11.00 am. I was ready to listen a lecture on something such as: How to cric a children.....when Michelle Johnston amazed everyone with a truly poetic lecture......"Lessons from the Classics"....Just one word:.....TOUCHING......<br />
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N°5.<br />
SIMWARS and SONOWARS:<br />
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<iframe allowfullscreen="" frameborder="0" height="281" mozallowfullscreen="" src="http://player.vimeo.com/video/62129680" webkitallowfullscreen="" width="500"></iframe> <br />
<a href="http://vimeo.com/62129680">SIMWARS FINALS</a> from <a href="http://vimeo.com/user7387816">Oliver Flower</a> on <a href="http://vimeo.com/">Vimeo</a>.<br />
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As a Soldier I enjoied a lot the battle between teams St. Emlyns, Sydney Hems and RPA ICU Team to Seize the Sim Man..... Despite the spectacular entrance of Team Sydney Hems and the fantastic CAMO T-shearts of Team RPA ICU, finally the team from the Old Continent took home victory and established "the golden ERA of European domination" in the (SIM) resuscitation field.....!!!!!.....Great Job Guys!!!<br />
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Why it was worthy to attend SONOWARS too??!!......Just ONE world:......VAGINA..........<br />
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N°4.<br />
No more Just HASHTAGS:<br />
Before This conference the most of people in the Blogosphere or on Twitter were for me just Hashtags and Microphotos....now that I met them all, I discovered that they are not just real persons but fantastic Awesome persons.....Has been a pleasure to know you all: Minh Le Cong, Scott Weingart, Cliff Reid, Chris Nickson, Mike Cadogan, Roger Harris, Tim Leeuwenburg, Andre Bonny, Simon Curley, Natalie May, Roger Harris, Doug Linch and Michelle Johnston!!!!!!!!<br />
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N°3<br />
Italian FOAM:<br />
At SMACC I met my Italian collegue and now a friend Sean Scott: we spoke a lot and interacted with The GURU of Foam Mike Cadogan....<br />
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I think that in our country something is going to change!!!! Collaborating with other Italian Foam collegues and taking inspiration by our best FOAMites Carlo D'Apuzzo and Gemma Morabito I think we can do something of Great even in Italy especially for our young residents.....We are a small bunch of people and Spreading the Foam concepts is <br />
Our duty...!!!!!!<br />
I think with MalatoCritico 2013 we had a Great start!!!!<br />
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N°2<br />
GODS between us:<br />
In Italy we have the so-called "Baroni" very Old dogs Doctors, considered "best" in their sector that in any situation (doesn't matter if Conference, meeting or normal day-life work) always look to other poor doctors humans from a "pedestal" full of arrogance and haughtiness... At SMACC I saw True Gods of Critical Care like Scott Weingart, Cliff Reid and Joe Lex descending amid Humans and speaking and chatting with everyone like Old Friends.....Guys you are Truly the Best!!!....Someone in Italy should learn something from you.... and not Just Medicine!!!!!!<br />
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N°1.<br />
Finally Here we are!!!!.....the number 1 in my Lettermahn's List.....:<br />
SMACC Inspiration:<br />
Just three lectures....This is it!!! just Three lectures gave me THE inspiration.....The Let Motive of my future life as a Doctor:<br />
-"How to be an Hero" by Cliff Reid.<br />
-"Mind of the Resuscitationist" by Scott Weingert.<br />
-"Fortyfive years on the Frontlines" by Joe Lex.<br />
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I think that everybody from PG1 Residents to young Consultants should listen this Three Lectures and I hope them to be available in Future on the Web......<br />
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My Bullet Points:<br />
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-Team work: the Leader must EARN RESPECT of the team and colleagues thanks to his behavior (courtesy, punctuality, competence, mastery etc....).<br />
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-Always be Cool!!!:<br />
Think logic like Sherlock Holmes and not Instinctively like Dr. Watson.<br />
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-Be An HERO: Never be Afraid, Never find excuses...Always do what has to be Done, when it has to be Done!!!!<br />
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In Conclusion...remember: SMACC 2014 Brisbane (Queensland-Australia)....Whereever you are in the World this is your chance to fly along with the Best of the Best!!!<br />
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.....And for Today... that's ALL.....Have a good day on the EDGE!!!!......<br />
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<br />docvpbhttp://www.blogger.com/profile/17349160261907900884noreply@blogger.com0tag:blogger.com,1999:blog-71150009730113568.post-41946453949372593552013-02-16T03:01:00.001-08:002013-02-16T04:06:48.161-08:00Lives On The Edge: Retrieval Services - Video n°3<br />
Hi Guys!!!!<br />
<br />
<br />
....3rd Episode... BEST Retrieval Services in the World.....<br />
<br />
When you are working as Emergency physician or Paramedic In the most dangerous place in the world<br />
<br />
you have Just Two Tasks:<br />
<br />
N°1 - Take care of the Patient<br />
<br />
N°2 - Take care to not "Become" the Patient!!!!<br />
<br />
<br />
.....This time....The US Army PEDROS in Afghanistan!!!!<br />
<br />
Look at the YouTube video in the link: <a href="http://www.youtube.com/watch?v=CPtxxWIzea0" style="text-align: center;">US Army Medevac On The Frontlines (by Abc news)</a><br />
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<br />docvpbhttp://www.blogger.com/profile/17349160261907900884noreply@blogger.com0tag:blogger.com,1999:blog-71150009730113568.post-63517824078856762812013-02-03T01:26:00.001-08:002013-02-16T01:58:35.323-08:00Skin Wounds: Quick Guide to Management and Suturing<!--[if gte mso 9]><xml>
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<!--StartFragment-->
<br />
<div class="MsoNormal">
Hi Guys!!!!<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Which is the most common Traumatic Injury that you usually
encounter in the ED??....TBI??.... Chest concussion with Hypertensive
Pneumothorax ??!Cardiac Tamponade??...Limbs Amputation??....No it’s the usual,
simple, boring…superficial cutaneous wound….<o:p></o:p></div>
<div class="MsoNormal">
Every ED resident or Registrar across the world sooner or
later had to handle this kind of wound and suture it….<o:p></o:p></div>
<div class="MsoNormal">
For this reason I decided to post a Quick extremely simple
guide on superficial wound management and sutures…<o:p></o:p><br />
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjToxD3d_fZAPH7B8cznBwuHHeAup6dqra6t8jsa9T4_gAaUE7WC7aEHWjlZ21NXXOHonvpYRCzS21L-_NgVDTP1t6CQKKbbd1pLxHeSzv7RImJWfo6lo29RgfEXsfo-3omudH4bUpKyiI/s1600/hires_37845597370cf6a1d43c.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjToxD3d_fZAPH7B8cznBwuHHeAup6dqra6t8jsa9T4_gAaUE7WC7aEHWjlZ21NXXOHonvpYRCzS21L-_NgVDTP1t6CQKKbbd1pLxHeSzv7RImJWfo6lo29RgfEXsfo-3omudH4bUpKyiI/s1600/hires_37845597370cf6a1d43c.jpg" height="213" width="320" /></a></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="font-size: 14.0pt;">First and most important rule: never close gun-shot
wounds and extremely dirty wounds because they are at high risk of infection
and Abscess; so let them to heal by second intention!!!<o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="font-size: 16.0pt;">What you need:<o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]-->-<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span><!--[endif]-->Normal Saline (NaCl 0,9%) or Tap Water (YES tap Water - look at this study:<a href="http://www.ncbi.nlm.nih.gov/pubmed">Water is a safe and effective alternative to sterile normal saline for wound irrigation prior to suturing: a prospective, double-blind, randomised, controlled clinical trial.</a>) and a<span style="text-indent: -18pt;"> BIG Siringe</span><br />
<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]-->-<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span><!--[endif]-->At least 3 sterile drapes<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]-->-<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span><!--[endif]-->Surgical sterile gloves<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]-->-<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span><!--[endif]-->Disinfectant (Betadine)<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]-->-<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span><!--[endif]-->10 cc Siringe<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]-->-<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span><!--[endif]-->22G or 24G needle<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]-->-<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span><!--[endif]-->Kidney shaped basin<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]-->-<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span><!--[endif]-->Cup to put in the disinfectant<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]-->-<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span> Local
Anaestetic (Lidocaine 2%)<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]-->-<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span><!--[endif]-->Needle holder<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]-->-<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span><!--[endif]-->Clamp<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]-->-<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span><!--[endif]-->Scissors<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]-->-<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span><!--[endif]-->Haemostatic Clamp<o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]-->-<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span><!--[endif]-->Grasping forceps<o:p></o:p></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]-->-<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span><!--[endif]-->Sutures<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="font-size: 16.0pt;">How to do It:<o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>STEP 1: STOP BLEEDING</b><o:p></o:p></div>
<div class="MsoNormal">
press on the wound for at least 2-3 minutes.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIpSYAY3Y77l6Tv6Z5YfMveicKqL7BR9JT8ands1vnZIhR8k0FRssOS23bBbM8lFkkSr07QcOUc56uGECWbV9p14ZMoHwl0T-IF436WfUyv1bbIGE8zwN4iSrazj1fUOkJb5d_zRNgyDQ/s1600/sanguinamento.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIpSYAY3Y77l6Tv6Z5YfMveicKqL7BR9JT8ands1vnZIhR8k0FRssOS23bBbM8lFkkSr07QcOUc56uGECWbV9p14ZMoHwl0T-IF436WfUyv1bbIGE8zwN4iSrazj1fUOkJb5d_zRNgyDQ/s1600/sanguinamento.jpg" /></a></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>STEP 2: CLEANING<o:p></o:p></b></div>
<div class="MsoNormal">
<b> </b>Irrigate the wound with copious Normal
Saline or Tap Water in order to:<o:p></o:p></div>
<div class="MsoNormal">
Clean the wound,<o:p></o:p></div>
<div class="MsoNormal">
Remove clots, <o:p></o:p></div>
<div class="MsoNormal">
Move small foreign
objects to the edges of the wound, so will be easier to remove them,<o:p></o:p></div>
<div class="MsoNormal">
Explore the wound to establish the deepness<o:p></o:p></div>
<div class="MsoNormal">
And finally to identify bigger foreign objects and remove
them quickly.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>STEP 3:</b> <b>TRICHOTOMY</b> of the zone surrounding the
wound.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtnLpi32ySBkJANdYnc1dENQJ9-s9Jgi-zgfrH8Tco2iU1sWTKdIQwZc59Cme7DoQQp-xot1JvZsiCkIRMULolslRH_kDuEvbFNElGNpxAxVU15Uq1aNjfp6SReWRVDvEGPJao45e4R_s/s1600/rasoio-tricotomia.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtnLpi32ySBkJANdYnc1dENQJ9-s9Jgi-zgfrH8Tco2iU1sWTKdIQwZc59Cme7DoQQp-xot1JvZsiCkIRMULolslRH_kDuEvbFNElGNpxAxVU15Uq1aNjfp6SReWRVDvEGPJao45e4R_s/s1600/rasoio-tricotomia.jpg" height="110" width="200" /></a></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>STEP 4: DISINFECTION<o:p></o:p></b></div>
<div class="MsoNormal">
Disinfect the wound
and sorrounding tissues with abundant Betadine.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDAAhmr7b3xAxCUkEMKAT36v58k7gv5k9IFubQa1N4d8bNqnh85e407-uAJ3sNwIeCVGPpgpEhUCf6B0vZhqpUMwaYHd3TlHVijtMvbQrNXtYirlH46qyaYgGLo7gxKWSFXt780Gs9yHw/s1600/Betadine.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDAAhmr7b3xAxCUkEMKAT36v58k7gv5k9IFubQa1N4d8bNqnh85e407-uAJ3sNwIeCVGPpgpEhUCf6B0vZhqpUMwaYHd3TlHVijtMvbQrNXtYirlH46qyaYgGLo7gxKWSFXt780Gs9yHw/s1600/Betadine.jpg" height="196" width="200" /></a></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>STEP 5: BE STERILE</b><o:p></o:p></div>
<div class="MsoNormal">
if you are in the ED is MANDATORY; <b><o:p></o:p></b></div>
<div class="MsoNormal">
of course if you are in a tent in the mid of the desert do
the best as you can;<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Wash your hands accurately and wear sterile gloves;<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Border the sterile zone with sterile drapes….from now
everything from suture instruments to gauzes </div>
<div class="MsoNormal">
must be passed to you in a sterile
way.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Look at the you tube links below:</div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.youtube.com/embed/OCQiR5Dv6FU?feature=player_embedded' frameborder='0'></iframe></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.youtube.com/embed/CgP1fXxOAj8?feature=player_embedded' frameborder='0'></iframe></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>STEP 6: LOCAL
ANAESTHESIA<o:p></o:p></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The best option is Lidocaine 2% (is cheap and available
everywhere):<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Feautures:<o:p></o:p></div>
<div class="MsoNormal">
Onset time 2 min.<o:p></o:p></div>
<div class="MsoNormal">
It lasts for 1.5-2 hours<o:p></o:p></div>
<div class="MsoNormal">
Do not use more than 280 mg; maximum dose in 70 Kg man: 14
ml.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Sistemic Adverse effects come from OVERDOSAGE and
INTRAVASCULAR INJECTION:<o:p></o:p></div>
<div class="MsoNormal">
-CNS: tongue numbness, eyebrows shivering, seizures.<o:p></o:p></div>
<div class="MsoNormal">
-Cardiovascular App: Arhytmias.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Local Adverse effects are allergic reactions: Urticaria,
Hives, rush, Oedema, Anafilactic shock.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>THE TECHNIQUE:<o:p></o:p></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
aspire 10 cc of Lidocaine 2%;<o:p></o:p></div>
<div class="MsoNormal">
Change the needle provided with the 10 cc siringe with a 22G
or 24G needle;<o:p></o:p></div>
<div class="MsoNormal">
Irrigate the wound with the local Anaesthetic.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
REMEMBER: ALWAYS ASPIRE BEFORE INJECTING THE ANAESTHETIC SO
YOU ARE SURE THAT YOU AREN’T PERFORMING AN INTRAVASCULAR INJECTION.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Look at the you tube link below:</div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.youtube.com/embed/jDYwvn1AgU8?feature=player_embedded' frameborder='0'></iframe></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>STEP 7: SUTURE<o:p></o:p></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Which needle and
thread:<o:p></o:p></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Thread:</b> For
superficial cutaneous wound always use <b>non
absorbable sutures</b>; </div>
<div class="MsoNormal">
usually the most common available are:<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>-NYLON<o:p></o:p></b></div>
<div class="MsoNormal">
<b>-PROLENE<o:p></o:p></b></div>
<div class="MsoNormal">
<b>-NOVAFIL<o:p></o:p></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Needle:</b> For
superficial cutaneous wound: <b>cutting curved needle.</b><o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Which size:<o:p></o:p></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
-Scalp: 3/0<o:p></o:p></div>
<div class="MsoNormal">
-Face: 5-6/0 <o:p></o:p></div>
<div class="MsoNormal">
-Other body parts: 4/0<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Which Technique:<o:p></o:p></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Single interrupted
suture</b> is the best choice;<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQ6XDK1mn7lEzUdojCfrqbIdWjq26bYj2o7Y5HC1C021YrY91WZ-aB0GfQQ0l18530s-uwzXmnJ6stBB0ljFEuP9Zg_rx-tfX2tthjU6p7KoVxCIvIGROVH2GIQh6M6zZ7nu7Fx1wfGzY/s1600/punti+staccati.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQ6XDK1mn7lEzUdojCfrqbIdWjq26bYj2o7Y5HC1C021YrY91WZ-aB0GfQQ0l18530s-uwzXmnJ6stBB0ljFEuP9Zg_rx-tfX2tthjU6p7KoVxCIvIGROVH2GIQh6M6zZ7nu7Fx1wfGzY/s1600/punti+staccati.jpg" height="320" width="274" /></a></div>
<div class="MsoNormal">
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<o:p>Look at the you tube link below:</o:p></div>
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<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.youtube.com/embed/nY1EqzJ8pjY?feature=player_embedded' frameborder='0'></iframe></div>
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Just for face wounds aiming to minimize the residual scar<b> Intradermic continuous suture </b>is
better.<o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhT-w6IT4SsaV3YDPv6L4MS1rXa-jhXTtnC6StOJGqLcGRN5-ZUDIZuWPapUEQGCsnyukSEbnKeqSqVnpdtAgl-afghvMF41SVkFGzDp_ygIPh6mmYZgWPBP_ZkuF7zJXoFOz-G0hG_T6g/s1600/intradermica.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhT-w6IT4SsaV3YDPv6L4MS1rXa-jhXTtnC6StOJGqLcGRN5-ZUDIZuWPapUEQGCsnyukSEbnKeqSqVnpdtAgl-afghvMF41SVkFGzDp_ygIPh6mmYZgWPBP_ZkuF7zJXoFOz-G0hG_T6g/s1600/intradermica.jpg" height="211" width="320" /></a></div>
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<b>FINALLY YOU DID IT:</b><o:p></o:p></div>
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Just dress the sutured wound and remove stitches
approximately after 7 days…<o:p></o:p></div>
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NOW you are ready for the next patient:<b><o:p></o:p></b></div>
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<br /></div>
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the shift especially at night is still very far from the end!!!!!!!!!!!!!!!<o:p></o:p></div>
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…AND…as alway have a good day or “NIGHT” on the EDGE……<o:p></o:p></div>
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<!--EndFragment-->docvpbhttp://www.blogger.com/profile/17349160261907900884noreply@blogger.com3tag:blogger.com,1999:blog-71150009730113568.post-16842312859956848992013-01-21T12:35:00.000-08:002013-02-15T12:21:01.459-08:00Lives On The Edge: Retrieval Services - Videos n°2Hi Guys!!!!<br />
<br />
It's time...2nd Episode... BEST Retrieval Services in the World.....<br />
<br />
When I think... Extreme Medicine, Harsh Environments, Very long evacuation distances and<br />
Mac Gyver Style Doctors....<br />
<br />
Obviously I think to ROYAL FLYNG DOCTORS OF AUSTRALIA!!!!<br />
<br />
<i><br /></i>
<br />
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<object class="BLOGGER-youtube-video" classid="clsid:D27CDB6E-AE6D-11cf-96B8-444553540000" codebase="http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0" data-thumbnail-src="https://ytimg.googleusercontent.com/vi/8ocpisE_CHg/0.jpg" height="266" width="320"><param name="movie" value="https://www.youtube.com/v/8ocpisE_CHg&fs=1&source=uds" /><param name="bgcolor" value="#FFFFFF" /><param name="allowFullScreen" value="true" /><embed width="320" height="266" src="https://www.youtube.com/v/8ocpisE_CHg&fs=1&source=uds" type="application/x-shockwave-flash" allowfullscreen="true"></embed></object></div>
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<i><br /></i>docvpbhttp://www.blogger.com/profile/17349160261907900884noreply@blogger.com0tag:blogger.com,1999:blog-71150009730113568.post-12158331248313105582013-01-19T11:27:00.001-08:002013-02-15T12:22:15.905-08:00...More on Intranasal Ketamine....Hi Guys!!!<br />
<br />
As you know I'm a great Fan of Ketamine and currently I'm trying to overcome the big diffidence that surrounds this great medication in Italy!!!!<br />
<br />
Just because I spoke a few time ago about Intranasal Medications I decided to search and go deeply inside the Intranasal use of Ketamine.....<br />
<br />
Ketamine Intranasal has been studied in the civilian setting as a sedative agent for procedural sedation in childrens and in the military setting by the US Army as an analgesic for battlefield casualties.<br />
<br />
1) Procedural sedation in childrens:<br />
<br />
Several studies compared Intranasal Ketamine alone or in combination versus other sedatives for procedural sedation with the aim to perform dental procedures, CT scans etc. in childrens:<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9wwt7vx-Syuj6ompacHvjsIMbaxf4yyaByCUrLihhC5-ac-aU1MIaStXlSvKDNTnJ5fFGETHz0L7iaJwjMH5PmX3HPUdtOSrSoOeEDsnRHHhcVk3QmoulxJqQz7qjApL-yMWz3ePXeU8/s1600/Unknown-2.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9wwt7vx-Syuj6ompacHvjsIMbaxf4yyaByCUrLihhC5-ac-aU1MIaStXlSvKDNTnJ5fFGETHz0L7iaJwjMH5PmX3HPUdtOSrSoOeEDsnRHHhcVk3QmoulxJqQz7qjApL-yMWz3ePXeU8/s1600/Unknown-2.jpeg" /></a></div>
<br />
<br />
Summary (Source: look at References):<br />
<br />
-Dosage: Ketamine IN 3-9 mg/Kg<br />
<br />
-Fast onset time and fast recovery (7+7 min.)<br />
<br />
-Good level of sedation (mean sedation score of 4 where 5 is ideal sedation)<br />
<br />
-Very safe: Desaturation and respiratory depression occurred in very few cases<br />
<br />
-Spray (Atomizer) better than drops: better patient compliance, faster onset of action and faster<br />
recovery from sedation.<br />
<br />
<br />
2)Analgesia for battlefield injured:<br />
<br />
Use of Ketamine IN has been recently implemented by US Army as an alternative to IM Morphine or o<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">ral transmucosal fentanyl citrate (OTFC) </span>for Analgesia in Battlefield casualties unable to continue to fight.<br />
<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDyAEE-tXh0JlRoNy_vLA-_hq9op9fb1VZWpK-NyhnvMRicnm_iNPsgZIxOzVosd9cR4cujJvc6GiGEZ2l8vM_sfCJlZfHrUrsHvC5eOSZIRke3psXRiSaLs1Tl-dYt0OKIjb3aVtW8z0/s1600/ImageViewer.aspx.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDyAEE-tXh0JlRoNy_vLA-_hq9op9fb1VZWpK-NyhnvMRicnm_iNPsgZIxOzVosd9cR4cujJvc6GiGEZ2l8vM_sfCJlZfHrUrsHvC5eOSZIRke3psXRiSaLs1Tl-dYt0OKIjb3aVtW8z0/s1600/ImageViewer.aspx.jpeg" height="320" width="320" /></a></div>
<br />
Summary ( source: PMI 100 Study):<br />
<br />
-Dosage: <span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">Ketamine 50 mg intranasal (using nasal atomizer device) - 0,10 ml metered nasal spray </span><br />
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;"> (10 mg/spray)</span><br />
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;"> Titration up to 5 sprays - interval of 90 seconds between sprays ; </span><br />
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;"> Mean titrated Effective dose 43,5 - 46 mg</span><br />
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;"> Dosing every 3 hours as required</span><br />
<span style="font-family: TimesNewRomanPSMT; font-size: 16px;"> 50 mg IN Ketamine are approximately equivalent to 7,5 mg Morphine IV</span><br />
<br />
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">-Onset time: 4 min. post dose</span><br />
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;"><br /></span>
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">-Duration of action: 2,0 - 2,5 hours</span><br />
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;"><br /></span>
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">-Avverse effects: Few events reported;for the most modest in severity such as Dizziness, fatigue, nausea</span><br />
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;"> changes in vision, feeling of unreality.</span><br />
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;"><br /></span>
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;"> No allucinations were reported.</span><br />
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;"><br /></span>
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">- Use of Ketamine not allowed in TBI (Traumatic Brain Injuries) and Ocular Traumas.</span><br />
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;"><br /></span>
<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjeLaSeROcOjj1TE8IXkQsbLvUTba6EbKNskU6ylCjwvELF7oTB1F22hXqJn_SrXOf0nCcGy8UH5EFTo01g_DWS2F4ZkuunbFFx8pifabGOy05FvAhmBLUrvQlca7jp6wMZ0nUwyKcmz18/s1600/Unknown-1.jpeg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjeLaSeROcOjj1TE8IXkQsbLvUTba6EbKNskU6ylCjwvELF7oTB1F22hXqJn_SrXOf0nCcGy8UH5EFTo01g_DWS2F4ZkuunbFFx8pifabGOy05FvAhmBLUrvQlca7jp6wMZ0nUwyKcmz18/s1600/Unknown-1.jpeg" /></a></div>
<br />
<span style="font-family: TimesNewRomanPSMT;">To summarize:</span><br />
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;"><br /></span>
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">-Use of Ketamine Intranasal for procedural sedation and Analgesia is very promising.</span><br />
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;"><br /></span>
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">-Unfortunately there are still very few studies on this topic and populations took onto consideration are very small.</span><br />
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;"><br /></span>
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">-Use of Ketamine Intranasal for analgesia in adults has been studied just in the military setting (PMI 100 study); I couldn't find anything about the civilian setting.</span><br />
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;"><br /></span>
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">-I couldn't find any </span><span style="font-family: TimesNewRomanPSMT;">study showing statistical frequency of the main two adverse effects of Ketamine ( Laringospasm; Emergence reaction) after its Intranasal use for procedural sedation and Analgesia;</span><br />
<span style="font-family: TimesNewRomanPSMT;"><br /></span>
<span style="font-family: TimesNewRomanPSMT;">In any case these are rare complications even after IV administration of Ketamine with Anaesthetic doses (1 - </span><span style="font-family: TimesNewRomanPSMT;"><span style="font-size: small;">In two large trials conducted in emergency departments, the risk of laryngospasm in </span>childrens<span style="font-size: small;">, who are recognized to have a higher incidence of laryngospasm than adults, was 0.4
percent and 0.07 percent. 2- Emergence reaction has been showed to be uncommon and generally </span></span><span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">associated with higher (anesthetic) doses of Ketamine).</span><br />
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;"><br /></span>
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">Conclusion:</span><br />
<br />
<span style="font-family: TimesNewRomanPSMT; font-size: 12pt;">For now Intranasal use of Ketamine for procedural sedation and Analgesia is still OFF-LABEL therefore BE CAREFUL </span><span style="font-family: TimesNewRomanPSMT;">when you opt for this technique;</span><br />
<span style="font-family: TimesNewRomanPSMT;"><br /></span>
<span style="font-family: TimesNewRomanPSMT; font-size: 16px;">More studies are needed in future;</span><br />
<span style="font-family: TimesNewRomanPSMT; font-size: 16px;"><br /></span>
<span style="font-family: TimesNewRomanPSMT; font-size: 16px;">However all the studies available at present showed that Ketamine by Intranasal route of administration is an easy, fast and effective way to perform short sedations and to relieve pain.</span><br />
<span style="font-family: TimesNewRomanPSMT; font-size: 16px;"><br /></span>
<span style="font-family: TimesNewRomanPSMT; font-size: 16px;">The future is very promising!!!</span><br />
<span style="font-family: TimesNewRomanPSMT; font-size: 16px;"><br /></span>
<span style="font-family: TimesNewRomanPSMT;">....As always have a good day on the edge....</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi1s2ljbNmc_fAk8JZnB3gKTGEFBkQtap54-9Ae3MEJSQ-NNTSh610vSRDWuGB7C6SIdqmyAiJyHirZsQ6saMl0dKhPa5MJFgi9j3t3sg2Z7Fwm5RlstJ6erD3_Xs8xp9vVAh8vWyoVe6E/s1600/images.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi1s2ljbNmc_fAk8JZnB3gKTGEFBkQtap54-9Ae3MEJSQ-NNTSh610vSRDWuGB7C6SIdqmyAiJyHirZsQ6saMl0dKhPa5MJFgi9j3t3sg2Z7Fwm5RlstJ6erD3_Xs8xp9vVAh8vWyoVe6E/s1600/images.jpeg" /></a></div>
<span style="font-family: TimesNewRomanPSMT;"><i><br /></i></span>
<span style="font-family: TimesNewRomanPSMT;"><i>References:</i></span><br />
<span style="font-family: TimesNewRomanPSMT;"><i><a href="http://intranasal.net/paincontrol/Military%20slide%20show%20regarding%20IN%20ketamine.pdf">US Army slide show on IN Ketamine</a></i></span><br />
<span style="font-family: TimesNewRomanPSMT;"><i><a href="http://www.health.mil/Libraries/120917_TCCC_Course_Materials/0758-DHB-Memo-120308-Ketamine.pdf">US Army Intranasal Ketamine protocol</a></i></span><br />
<span style="font-family: TimesNewRomanPSMT;"><i><a href="http://www.ncbi.nlm.nih.gov/pubmed/7645790">Safety and effectiveness of intranasal administration of sedative medications (ketamine, midazolam, or sufentanil) for urgent brief pediatric dental procedures.</a></i></span><br />
<span style="font-family: TimesNewRomanPSMT;"><a href="http://www.ncbi.nlm.nih.gov/pubmed/21292791">Case report: prehospital use of intranasal ketamine for paediatric burn injury.</a></span><br />
<a href="http://www.ncbi.nlm.nih.gov/pubmed/14640353">Ketamine as an analgesic: parenteral, oral, rectal, subcutaneous, transdermal and intranasal administration.</a><br />
<a href="http://www.ncbi.nlm.nih.gov/pubmed/22858745">intranasal ketamine for procedural sedation in pediatric laceration repair: a preliminary report.</a><br />
<a href="http://www.ncbi.nlm.nih.gov/pubmed/22900449">A comparative evaluation of drops versus atomized administration of intranasal ketamine for the procedural sedation of young uncooperative pediatric dental patients: a prospective crossover trial.</a><br />
<a href="http://www.ncbi.nlm.nih.gov/pubmed/8023666">Nasal midazolam and ketamine for paediatric sedation during computerised tomography.</a><br />
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docvpbhttp://www.blogger.com/profile/17349160261907900884noreply@blogger.com6tag:blogger.com,1999:blog-71150009730113568.post-56630900728019765532013-01-16T11:22:00.001-08:002013-02-15T12:08:11.627-08:00Hi Guys!!!<br />
Finally I MADE IT!!!!!!!!<br />
I registered for SMACC 2013 in Sydney (Australia).....The best and most Innovative EM and Critical care Conference in the world.........<br />
I'm going to post updates and pearls from the Conference via Twitter and on this Blog so from MARCH 11 to MARCH 13 stay tuned on this site or follow me on Twitter (@docvpb) and don't miss.... because the Revolution is just Began!!!!!!!!<br />
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