ABSTRACT
BACKGROUND: Penetrating trauma kills rapidly. Thorough and efficient examination and aggressive hemorrhage control is important to save lives. The aim of this study was to assess the skills of civilian Emergency Medical Technicians (EMTs) in bleeding examination and control compared to Army Medics. Our hypothesis was that civilian pre-hospital systems perform at a lower level compared to an expert group, and did not have sufficient focus on education and training in examination and treatment of penetrating injuries. MATERIAL AND METHODS: We included 60 volunteer Certified EMTs and Army Medics. First, the participants examined a wounded patient. Second, the participants were presented a patient with a penetrating injury on a pork side fixated to the thigh with an artificial arterial bleeding. RESULTS: The EMTs took significantly shorter time examining, median 1 min 5 s vs. 3 min 58 s (P < 0.001). 5/30 (17%) of EMTs and 28/30 (93%) of army medics did an approved gauze wound packing of the penetrating injury (P < 0.001). EMTs took (median) 18 s and army medics 8 s to hemostasis regardless of approved packing or not (P < 0.001). Time spent on the packing was (median) 1 min 50 s vs. 5 min 47 s respectively (P < 0.001). Increasing time spent on the procedure showed significantly better chance of a successful procedure. CONCLUSION: The EMTs had lower accuracy in examination but used significantly shorter time than the Army Medics. The treatment part of the study showed poor EMT performance compared to the Army Medics. This study indicates that more wound packing training needs to be incorporated into initial and ongoing civilian EMT training.
Subject(s)
Clinical Competence/statistics & numerical data , Emergency Medical Technicians/statistics & numerical data , Military Personnel/statistics & numerical data , Patient Simulation , Wounds, Penetrating/therapy , Humans , Norway , Prospective StudiesABSTRACT
Twenty-one psychiatrically hospitalized boys were studied while off psychoactive medication to determine if conduct disorder, solitary type, and abuse or neglect experiences correlated with low levels of dopamine-beta-hydroxylase (DBH) activity. Preliminary results supported earlier findings that undersocialized types of conduct disorder in boys were correlated with low DBH activity. Possible or definite neglect or abuse before 36 months of age was correlated with low DBH activity. Abuse or neglect was not correlated with low DBH activity when time of occurrence was not specified. Low serum DBH may be a biological sequela of seriously disrupted attachment.
Subject(s)
Antisocial Personality Disorder/physiopathology , Child Abuse/physiopathology , Child Behavior Disorders/physiopathology , Dopamine beta-Hydroxylase/deficiency , Norepinephrine/physiology , Personality Development , Adolescent , Antisocial Personality Disorder/psychology , Attention Deficit Disorder with Hyperactivity/physiopathology , Attention Deficit Disorder with Hyperactivity/psychology , Borderline Personality Disorder/physiopathology , Borderline Personality Disorder/psychology , Child , Child Abuse/psychology , Child Behavior Disorders/psychology , Depressive Disorder/physiopathology , Depressive Disorder/psychology , Dopamine beta-Hydroxylase/physiology , Humans , Male , Psychiatric Status Rating ScalesSubject(s)
Natural Childbirth , Parents/education , Prenatal Care , Exercise , Female , Humans , PregnancyABSTRACT
This paper presents the case of a 6.5-year-old girl with malignant astrocytoma of the left brain hemisphere. During the course of her chemotherapy treatment, severe vomiting developed to the degree that on several occasions she became dehydrated. Discontinuation of chemotherapy was being considered when she was referred for hypnotherapy. Despite severe neurological impairments which excluded many traditional techniques, hypnosis was successful in eliminating emesis. Hypnosis was also utilized to decrease pain and to improve sleep patterns. Drawings are presented to help show how this child resolved anxiety associated with treatment and fears surrounding the knowledge of her impending death.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/adverse effects , Astrocytoma/drug therapy , Brain Neoplasms/drug therapy , Hypnosis/methods , Vomiting/therapy , Child , Female , Humans , Vomiting/chemically inducedABSTRACT
Munchausen's syndrome by proxy is a relatively new diagnosis for a unique form of child abuse that involves a parent who creates or feigns illness in his or her child, and presents a "sick child" to the medical profession for assessment and treatment. Typically, while creating or feigning the child's illness, the parent usually appears to be "ideal" (i.e., especially attentive, caring, supportive, and close to the medical staff). The present study assessed the effects of a suspected case of Munchausen's syndrome by proxy on 20 pediatric nurses in a large midwestern children's hospital. After the child had left the hospital, the staff was given a ten-item open-ended questionnaire covering how they felt about the case, how the case affected their interactions with other parents, and how they professionally and personally coped with the physician's presumptive diagnosis. Only 10% of the staff had had previous experience with such a case, and 55% had not even heard of such a diagnosis. More than 70% of the staff felt they were professionally and personally unprepared for the case. Their initial reaction to the suspected diagnosis ranged from shock and disbelief to nausea and anger. The majority of the staff had perceived the parent as supportive, loving, and concerned. Yet, now they were confronted with information that suggested that the parent had nearly killed the child while on the unit, in order to keep that child in the hospital. Although almost every nurse eventually accepted the diagnosis, they felt their relationships with parents in general had changed.(ABSTRACT TRUNCATED AT 250 WORDS)