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Iserson - Improvised medicine: providing care in extreme environments

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Improvised medicine: providing care in extreme environments: summary, description and annotation

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Improvised Medicine is written for healthcare providers treating patients during a crisis situation or in a primitive environment, for diseases and disorders they have little or no hands-on experience with. The book begins with situational analysis and basic needs in a crisis, then moves on to cover specific triage, diagnosis, and stabilization efforts. It then provides medical interventions for surgical and non-surgical problems--Provided by publisher.;The situation -- What is improvised medicine? -- What are resource-poor situations? -- Basic needs -- Communications -- Preventive medicine/public health -- Basic equipment -- Cleaning and reusing equipment -- Patient assessment/stabilization -- Vital signs, measurements, and triage -- Airway -- Breathing/pulmonary -- Circulation/cardiovascular -- Dehydration/rehydration -- Medications/pharmacy/envenomations -- Analgesics -- Anesthesia: local and regional -- Sedation and general anesthesia -- Anesthesia: ketamine, ether, and halothane -- Transfusion -- Radiology/imaging -- Laboratory -- Patient transport/evacuations -- Surgical interventions -- Surgery/trauma -- Wounds and burns -- Dental: diagnosis, equipment, blocks, and treatment -- Dental: fillings, extractions, and trauma -- Otolaryngology (ENT) -- Neurology/neurosurgery -- Ophthalmology -- Obstetrics/gynecology -- Orthopedics -- Urology -- Non-surgical interventions -- Gastroenterology -- Infectious diseases -- Malnutrition -- Pediatrics and neonatal -- Psychiatry -- Rehabilitation -- Death and survivors -- Hospital disaster plan: generic all-hazard hospital disaster resource-allocation plan -- Medical kits.

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Copyright 2012 by The McGraw-Hill Companies Inc All rights reserved Except - photo 1

Copyright 2012 by The McGraw-Hill Companies Inc All rights reserved Except - photo 2

Copyright 2012 by The McGraw-Hill Companies, Inc. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher.

ISBN: 978-0-07-177001-9
MHID: 0-07-177001-1

The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-175497-2, MHID: 0-07-175497-0.

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NOTICE

Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.

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Preface: How the Book Is Organized

This book is divided into several sections, beginning with introductory chapters that describe resource-poor situations that may require medical improvisation. Subsequent sections discuss: Basic Needs, Patient Assessment/Stabilization, Surgical Interventions, and Non-Surgical Interventions. The Appendices provide useful information about preparing a hospital disaster plan and assembling medical kits for different activities.

The Basic Needs section begins with communication alternatives, since difficult communication is the most frequently cited problem in resource-poor situations. Improvised methods for preventive medicine/public health come next, since supplying clean drinking water and suitable waste facilities saves more lives (in a non-dramatic way) than all the interventional medical treatments combined. Finally, I discuss improvised basic equipment for health care and methods for cleaning and reusing medical equipment under resource-poor conditions.

Not all improvised equipment is discussed in this section, since most equipment improvisations are described in the chapter appropriate for their use. Reusing medical equipment is, rightfully, a controversial subject, since inadequate cleaning, disinfection, and sterilization lead to passing diseases from one patient to another. The best available information has been used to provide guidance for when supplies and cleaning methods are suboptimal.

The Patient Assessment/Stabilization section describes methods and improvised equipment to assess vital signs, and to manage airways, breathing, circulation, and dehydration/rehydration (vital to saving childrens lives). Also included are improvisations and alternatives for medications and medication delivery, imaging, laboratory testing, and patient movement/evacuation. Four chapters describe improvisations for analgesia, local and regional anesthesia, and general anesthesia. The Sedation and General Anesthesia chapter includes techniques for both non-anesthesiologists and anesthesiologists. The Ketamine, Ether and Halothane chapter describes the most common anesthetics used in developing countries, including unique administration methods. Younger anesthesiologists, as well as other practitioners who may be called upon to give ketamine or ether, may be unfamiliar with these medications or alternative administration techniques.

While not everything in the Surgical Interventions section is strictly surgical (e.g., there is a chapter on neurology/neurosurgery), dividing the chapters in this way provides a convenient method of locating information. The two Dental and the Orthopedics chapters occupy significant space, since health care professionals often need to apply these skills in resource-poor environments even if they have little training in these areas. All chapters in the Surgical Intervention section describe improvised equipment and techniques that can save lives. For instance, the Otolaryngology chapter describes the old, very basic, technique of placing posterior nasal packs, while the Obstetrics/Gynecology chapter describes balloon tamponade for peripartum and other vaginal bleeding.

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