Rescue Management Research Articles

Wasserunfälle

Emergencies on and in the water are relatively rare in the rescue service. For this reason, the treatment does not receive much attention in the training of paramedics and emergency medicine physicians. On the other hand, emergencies on and in water mostly require special rescue management and medical treatment. The text will give an overview about typical water accidents and their special management.

Switching of donor cells after urgent second cord blood transplantation for suspected graft failure

Cord blood transplantation (CBT) is being increasingly performed in adults and is now becoming a standard therapeutic alternative to bone marrow transplantation; however, graft failure is one of the associated problems of CBT in adults. A 44-year-old woman with acute myelogenous leukemia in partial remission received an unrelated CBT. Suspected veno-occlusive disease developed, however, and hemopoietic recovery was delayed. A bone marrow examination on the 27th day revealed empty marrow with a relative increase in macrophages, and the serum ferritin concentration was extremely high. Impending failure of the graft due to a hemophagocytic syndrome-like condition was strongly suspected, although donor cells were dominant according to a fluorescence in situ hybridization analysis. A second CBT was performed on the 30th day after a preparatory regimen of methylprednisolone and low-dose fludarabine (total dose, 90 mg/m2). Unexpectedly, the the first donor's cells recovered on the fourth day after the second CBT; however, the cells to finally engraft were those of the second donor. This case is informative as an example of rescue management for suspected graft failure.

EUS-guided transmural cholecystostomy as rescue management for acute cholecystitis in elderly or high-risk patients: a prospective feasibility study

Although EUS-guided drainage procedures have been used to collect peripancreatic fluids, little is known regarding EUS-guided transmural gallbladder drainage for high-risk patients with acute cholecystitis. Our purpose was to evaluate the technical feasibility and outcomes of EUS-guided transmural cholecystostomy as rescue management in elderly and high-risk patients with acute cholecystitis. Single-center prospective study. Tertiary referral center. Nine elderly or high-risk patients diagnosed with acute cholecystitis. All inflamed gallbladders were drained by EUS-guided transmural cholecystostomy. Clinical resolution of acute cholecystitis. After the drainage procedures, there were no immediate complications such as bleeding, bile leak, or peritonitis, except for 1 patient who had pneumoperitoneum. After EUS-guided transmural cholecystostomy, all patients showed rapid clinical improvement within 72 hours. Small number of patients. EUS-guided transmural cholecystostomy may be feasible and safe as initial, interim, or even definitive treatment of patients with severe acute cholecystitis who are at high operative risk for immediate cholecystectomy.

Transjugular intrahepatic portosystemic shunt: A case report of rescue management of unrestrainable variceal bleeding in a pregnant woman

Liver cirrhosis complications in pregnant women are frequent and death rate secondary to variceal bleeding is relevant. Both sclerotherapy and banding ligation seem to be safe procedures in pregnancy; when bleeding is not arrested endoscopically an emergency transjugular intrahepatic portosystemic shunt should be considered, but data regarding pregnant cirrhotic women are scarce. We describe the case of a pregnant woman at 14 weeks of gestation who underwent management of acute variceal bleeding by transjugular intrahepatic portosystemic shunt. Transjugular intrahepatic portosystemic shunt may represent a rescue treatment for failed attempts of band ligation or sclerotherapy.

Partial ecological life table of immature Helicoverpa zea (Lepidoptera: Noctuidae) in an irrigated cotton cropping system in the Trans-Pecos region of Texas, USA

During the summers of 1996 and 1997 cotton bollworm, Helicoverpa zea (Boddie), life stages were sampled in insecticide-free, irrigated cotton, Gossypium hirsutum L., in the Trans-Pecos region of Texas. Partial ecological life tables were constructed for one generation of H. zea in each of the two growing seasons. Partial generation mortality (egg to fifth-instar) surpassed 97% in both years. The egg stage exhibited the greatest amount of real (r x ) and apparent (q x ) mortality followed by the third-instar. One hundred percent of the collected life stages consisted of H. zea. Egg parasitism ranged from 4.1 to 6% and egg predation by Orius tristicolor (White) was 4.1% in 1996 and 13.2% in 1997. Unexplained factors made the greatest contribution to H. zea mortality regardless of the life stage sampled. Each cotton bollworm generation monitored in 1996 and 1997 exhibited a Type III survivorship curve. As a result of the extensive early life stage mortality, rescue management tactics associated with contemporary H. zea control in the region appears to be generally unnecessary for cotton grown under irrigation in the Trans-Pecos region.

Major accidents dealing with the consequences

The history of accident investigation in the transport sector is outlined briefly, focusing on the development of the precautionary principle and new safety design principles. The distinction between juridical inquiries and accident investigation is highlighted, with the aviation sector as example. The main part concerns several major accidents in The Netherlands and Scandinavia that have occurred in the public sector, aviation, maritime shipping and railways, and the role and performance of rescue and emergency organisations. Such an expansion of scope is in line with international developments in Europe and elsewhere, with the concept of independent accident investigations as 'A Citizen's Right and Society's Duty'. Finally, the article indicates lessons learnt from these accidents, and extrapolates some of the findings towards a systems level of performance with respect to rescue and emergency management. The distinctive features characterising victims' organisations today are described.

A review of intermittent subcutaneous apomorphineinjections for the rescue management of motor fluctuations associated with advanced Parkinson's disease

Background: As Parkinson's disease (PD) progresses,despite optimized pharmacotherapy, patients experience more frequent fluctuations between symptomatic improvement (“on” times) and the return of motor features (“off” times). Apomorphine, the first injectable dopamine agonist available in the United States, is indicated for the acute treatment of “off” episodes (eg, endof-dose wearing-off episodes, unpredictable “on/off” episodes) in patients with advanced PD who are receiving medically optimal antiparkinsonian therapy. Objective: This article reviews the pharmacology,clinical efficacy, and tolerability of intermittent subcutaneous apomorphine injections for the management of “off” episodes in patients with PD. Methods: MEDLINE (1966–July 2005), the CochraneDatabase of Systematic Reviews, and International Pharmaceutical Abstracts (1970–July 2005) were searched for original research and review articles published in English. The search terms were apomorphine and Parkinson's disease. The reference lists of articles were also consulted, as was selected information provided by the manufacturer of apomorphine. All relevant identified studies on intermittent subcutaneous administration of apomorphine were included in the review; trials of continuous subcutaneous infusion and nonsubcutaneous administration of apomorphine were excluded. Results: Intermittent subcutaneous administrationof apomorphine produced consistent rescue from “of” episodes in patients with advanced PD, with a symptomatic motor improvement between the predose “off” state and postdose “on” state similar to that achieved with levodopa. The onset of effect occurred within 20 minutes, and the duration of effect was ∼100 minutes. The therapeutic rescue dose ranged from 2 to 6 mg. During the clinical development program for subcutaneously injected apomorphine, patients required a mean of ∼3 rescue doses per day. Common adverse effects occurring in ≥20% of patients were injection-site reaction, yawning, dyskinesias, drowsiness, nausea and vomiting, dizziness or postural dizziness, and rhinorrhea. Conclusions: The available clinical studies indicate that apomorphine is effective in providing prompt and consistent rescue from “off” episodes in patients with PD. Antiemetic prophylaxis and close medical supervision are recommended when initiating apomorphine therapy.

A patient with myelofibrosis complicated by refractory ascites and portal hypertension: to tips or not to tips?A case report with discussion of the mechanism of ascites formation

In patients with myelofibrosis, clinically significant portal hypertension is known to be predominantly presinusoidal; however, the exact mechanisms are still controversial. The pathophysiology is particularly enigmatic in those patients without histological and angiographic evidence of significant intra‐ or extrahepatic obstruction to portal blood flow, respectively. Moreover, ascites formation has been reported in such cases, but in general is rare in presinusoidal portal hypertension. Here we present such a patient in which ascites developed even in the presence of unchanged serum protein levels (oncotic pressure) and was refractory to sodium restricted diet and high‐dose diuretic treatment. A discussion on the parameters influencing fluid exchange and ascites formation particularly emphasizing the potential importance of the hyperdynamic circulation in this case is given. Finally, the patient was treated by implanting a transjugular intrahepatic shunt (TIPS), exerting a diuretic effect sufficient enough to avoid re‐formation of ascites for several months. However, ascites re‐accumulated potentially due to the appearance of ectopic peritoneal myeloid metaplasia and the patient died soon afterwards. In conclusion, TIPS may be considered as rescue management for refractory ascites secondary to portal hypertension, but caution in respect to the presence and/or development of peritoneal or other ectopic haematopoesis has to be taken.

Total Quality Management (TQM) in the Era of Globalization

Quality of educational Institution are judged by the quality of information provided by their Information Centres and Departments. For providing quality information, the quality of the system, behavior of management needs continuous improvement, which can be achieved by application of TQM techniques in libraries & Information Centres. IT revolution in the past few years has come to the rescue of management in improving the system quality. Hence come to the rescue of management in improving the system quality. Hence the application of TQM technique will not only help the institute to go to greater heights but also provide the information in a cost-effective manner.

坑内火災ガス温度の予測についてー坑内火災のシミュレーションに関する研究（１）ー

Japanese mining industry has experienced several major disasters caused by mine fires. One of the reasons for many fatalities in those fires is an unexpected change in airflow direction in the ventilation network which is produced by the fires. Therefore, the knowledge of the effect of mine fire on mine ventilation network is indispensable for the management of personnel escape, rescue and fire fighting activities. The simulation of mine fire is also necessary to perform effectively these activities and mine ventilation control under mine fire.A mine fire influences airflow in a mine ventilation network mainly in two ways, that is ,ventilation pressure created by a fire (natural draft effect) and throttling effect. Air temperature distributions in the network is required in order to estimate the strength of the two effects. The air temperature is changed by the mixing with the fire gas downwind of a fire. Therefore, the fire gas temperature in the network is indispensable to make reasonable mine fire simulation by a computer. However, there is not a simple and reasonable method to estimate the fire gas temperature suitable for mine fire simulation yet. This paper discusses the method to estimate the fire gas temperature based on the results obtained in the actual size mine fire experiments.It is concluded that Eq(22) is suitable for the prediction of the fire gas temperature in a roadway. Here, the fire gas is defined as the ventilation air which passed the fire zone, a mixture of the air and produced gases.

GIS plays key role in NYC Rescue and Relief Operation

New York City, Sept. 17—The posters of missing loved ones are pasted onto New York City walls and street signs six days after 2 hijacked commercial airlines destroyed the World Trade Center in lower Manhattan on September 11. Several miles uptown from “ground zero,” heightened security hovers around the city's Office of Emergency Management rescue and relief command center, an around‐the‐clock operation. Police, firefighters, military, officials with the Federal Emergency Management Agency, communications technicians, and a beehive of others work in controlled chaos in this cavernous, convention center‐sized hall, lined with computers and adorned with several American flags.After the original command center at 7 World Trade Center collapsed to rubble as an after‐effect of the plane strikes, city officials scrambled to recreate it. Alan Leidner, director of New York's citywide geographic information systems (GIS), and who is with the Department of Information Technology and Telecommunications, knew that maps would be an integral component of the rescue and relief efforts. Maps provide emergency workers and others with accurate and detailed scientific data in the form of visual aids upon which they can make informed decisions.

10.14322/publons.r2281905

10.14322/publons.r2281905

2 Cases of Tracheal Tumors

Two cases of Tracheal tumor are presented.47 year old male, complaining of intermittent dyspnea getting worse past 6 months, was admitted for removal of the tumor from tracheal wall.Under local anesthesia, patient was placed in supine position, and the Tracheotomy was carried out on 3rd through 6th tracheal Ring.The tumor which was well pedunculated was removed from posterior wall of trachea, and electrocautery was applied at steeled area.Tumor was proved to be adenoid cystic carcinoma histologically. The incision was well closed in usual maneuver.54 year old male was admitted to the Department of Chest Surgery on emergency base of acute dyspnea.Patient had had intermittent dyspnea past 1 year.Patient was prepared in same manner as former patient was done. The tumor, arising from right lateral wall, was removed without any disturbance of Respiration in quick procedure.Recurrence was noted 3 months after operation, and the patient is ready for resection of trachea.Literatures were reviewed together and the management of rescue of airway problems was discussed.