Finally buy 125 mg sinemet overnight delivery medicine wheel, a regular exercise routine not aware of the nature of medical work to ensure that health care only enhances physical ftness but also promotes quality sleep buy generic sinemet 300mg online medicine 7253, polices and resource allocations promote sustainable practices cognitive function and stress tolerance buy cheap sinemet medicine wheel teachings. Renewal and revitalization are a fnal essential teracting fatigue, the most important by far is to sleep when ingredient. Vacation techniques include the judicious use of caffeine, avoiding other time should be planned and taken; it is wise to ensure that the drugs such as alcohol, taking breaks and naps, fnding ways to next vacation is booked by the time the current vacation is de-stress, exercising, and working in bright light. All professionals need time to de-stress and refect on their career and priorities, to renew their energies, and to focus Manage time effectively. These strategies deal about time management during medical education and are essential to preventing burnout and ensuring success and training, few programs take this issue seriously enough to make longevity. The good news is that a wealth of advice is available for those who Case resolution seriously want to acquire good time management techniques. The resident decides to talk to a staff member they respect The key competencies are knowing oneself, prioritizing and about this fatigue. They have a great conversation, and setting goals, following a plan, getting organized, and leverag- the resident feels hopeful. Becoming personally effective requires insight the weekend off medicine, spend some quality time with into one’s priorities, strengths, weaknesses and values. The resident will then can one set priorities in alignment with one’s fundamental also take some time to refect on how they organize their goals. Techniques to assist prioritizing include values clarif- week to see if they can “work smarter. Techniques in this domain include set- ting personal and professional goals (short-, medium- and Key references long-term) and using a personal organizer (e. Shiftwork, fatigue, and safety in emergency career trajectory are examples of roadmaps to success. Patient Safety in Emergency the most out of these priorities, a well-organized work space Medicine. Finally, it is important to manage available resources, whether assistants, colleagues, mentors, or technologies. Other forms of intimidation and • discuss the elements of intimidation and harassment and harassment reported by resident physicians have included inap- how they affect residents during training, and propriate physical contact, sexual harassment, the assignment • describe an approach to dealing with intimidation and of work as a punishment, loss of privileges and opportunities, harassment within the context of a residency program. Dealing with intimidation and harassment Case For intimidation and harassment to be tackled effectively, it is Your residency program is under accreditation next year. In some cases, it is faculty who may you will institute as a faculty administrator to prepare for be more concerned about the repercussions of reporting for this event? On the fip side, trainees should recognize that, in many cases, the individuals Introduction involved in bullying are not aware of the effect they are hav- Intimidation, harassment and workplace bullying have prob- ing. In many cases, individuals who intimidate and/or harass ably existed as long as the institution of medicine, but have others need education in effective communication as teachers started to be addressed by medical faculties only within the last and administrators, rather than disciplinary action. At a fundamental level, intimidation and harass- cal schools have now adopted directors or deans of equity to ment are defned not only by the behaviour and motivations deal with confict issues between faculty and trainees. Many of the perpetrator, but by the response of the individual who of these individuals directly report to the dean of medicine or is targeted. It should be seen as causing a negative effect on to “high-level” faculty committees with the ability to institute the victim (e. They focus on the content, psychological issues and or harassment is ever appropriate, such acts must be persistent procedures surrounding the issue of confict. Program directors, faculty members and importance of reporting such events, not only so that medical residents must be aware of these resources and deem them trainees can protect themselves, but also to help prevent their to be effective in dealing with such concerns. By taking action against bullying are unable to demonstrate such mechanisms may be put on behaviours, medical students and resident can help to change probation and risk losing their accreditation status. In tying such importance to this issue, the Royal College ensures Where intimidation and harassment leads that programs will endeavour to create a training environment Intimidation and/or harassment can lead to poor job satisfac- that limits intimidation and harassment, adequately deals with tion and psychological distress. It has been associated with issues that arise, and takes steps against the perpetuation of mental health problems and a desire to leave medical train- unacceptable behaviours, for the beneft of future generations ing. Where intimidation and harassment occur Physicians in training experience intimidation and/or harass- ment in all areas of medical training—that is, in the clinical, research, administrative and political realms. More than half of respondents to a recent Canadian survey reported that they had experienced intimidation and/or harassment while in residency training. Training status and gender were felt to be the two main bases for the intimidation and/or harassment. The happy docs teaching faculty are aware of policy and procedures for study: a Canadian Association of Internes and Residents well- dealing with intimidation and harassment (e. A meeting could be organized with the tion within and outside of residency training in Canada. This may be done with a teaching session using case examples or role playing from the director of equity. Residents should also be encouraged not to conceal, but rather report concerns around intimidation and harass- ment so that the accreditation team can make appropriate recommendations that will ultimately be addressed by the individual programs. Challenges to collegiality are dis- Collegiality involves certain rights and is tempered by specifc cussed with respect to disruptive physician behaviours, confict obligations. In academic contexts, it pertains to a commitment management, and gender-based and generational tensions. Collegiality allows physicians to educate one an- on the health care team are discussed. Physicians have an obligation to put restrictions Resident leaders, medical educators and program directors on their collegiality: in particular, they must give the welfare of should all endeavour to foster collegiality in professional rela- their patients priority over their collegial relationships. One method of doing so is to encourage the mentor- ing of residents by faculty members, and of medical students Although collegiality is highly prized by individual practitioners by residents, whether in person, by email or through websites. One cannot become an effective Scholar and Medical academic half-days), between supervisors and residents, and Expert without sharing information with peers. As a body, residents be an effective Health Advocate without the cooperation of can decide on a topic concerning physician health that could one’s supervisors and peers—which will itself be shaped by be mediated by increased collegial relations (e. One learns stress related to time pressures in training) and invite a faculty effective approaches through the wisdom and example of member who feels comfortable sharing personal experience to other practitioners. To fulfll the general observation, more formal methods include a 360 de- obligations of their Professional Role with respect to patient gree evaluation process by which residents are evaluated by all care, ethical behaviour and self-regulation, physicians cannot members of the health care team, including their peers. In addition to supporting these domains feedback is often perceived as less critical and constructive of competency, collegiality by defnition engenders the kind of in criticism, when discussing topics of communication with mutual respect and support that helps to prevent the intimida- colleagues. This kind of evaluation process can ensure that the tion and harassment of colleagues. Moreover, where healthy resident is evaluated fairly by all members of the team and collegiality exists, physicians will not only support one another removes pressure off of the physician preceptor who may during good times, but will also protect one another’s health by have challenges providing critical feedback. For the residents recognizing when colleagues are in trouble and helping them involved, it builds skills in giving feedback on professional to get the support they need. Ottawa: departments that do not foster collegiality suffer from poor The Royal College of Physicians and Surgeons of Canada. Collegiality is an important predictor of job satisfaction, and Bulletin of the New York Academy of Medicine.
Hence purchase cheap sinemet on line symptoms after embryo transfer, when physicians see one of their colleagues workforce generic sinemet 110mg with amex medicine 223, has led to the inclusion of physicians’ maintenance struggle with a personal or professional problem order 110 mg sinemet with mastercard 98941 treatment code, the inclina- of their own health and well-being as a necessary component tion is to say nothing. In Canada, the recognition that phy- of colleagues heightens the silence around physician illness sician well-being is essential to the effective practise of medi- and impairment. Being a member of the profession of medicine is a desir- able and highly rewarding accomplishment. It competent physician demonstrates a commitment to physi- is a physician’s duty to behave according to the high standards cian health and sustainable practice. This includes being diligent in attending to personal and professional priorities to ensure personal health one’s own health and well-being while also watching over one’s and a sustainable practice; (b) striving to heighten personal brothers and sisters in the community of medicine. Case resolution Refection The resident is shocked and states they are not their col- What physicians have been your models of medical league’s physician nor did they write the prescription. What is it about them that captures the are not sure what to do next and they call their provincial spirit of the profession? Physicians are also expected to be autonomous, and may not be encouraged to acknowledge their own health vulnerabilities or to seek help when they need it. We know that physicians, as a group, do not avail themselves of a regular source of health care. When feeling stressed and overwhelmed, physicians may turn to the use of substances as a means of coping. Physicians feel unable to access help—either for the originating problem, or for the resulting dependency—without feeling ashamed and humili- ated. Parsons emotional or mental health problem during residency, Objectives and This section will • 36 per cent reported that they did not have a family • examine the importance of physician health to the quality physician (Cohen 2004). This has come to the atten- pecting it all,” tion of the program director through preceptors, who have • excessive workload and too little control of work both been practising medicine for over 25 years. These threats can contribute to of Neurosciences, Mental Health and Addiction, showed the job stress. The risks for disease and injury are as high—or link between work organization and mental health problems higher—for physicians as for other workers. Brian Day has stated, “The health of Canada’s The economic benefts of promoting physician health should doctors is crucial to the provision of high-quality health care not be overlooked. In 2003–04, 34 per cent of the almost 2000 resident physicians Patient safety who participated in the Happy Doc pilot survey reported that Of obvious concern in relation to physician health and wellness their daily lives were “quite a bit” to “extremely” stressful. Physicians who are struggling with of respondents said they would pursue another career if they unmanaged mental or physical problems put both themselves could, and 53 per cent said that they had experienced intimida- and their patients at risk. Thus, an important stressor for physicians is The resident discussed with the program director family concern about their ability to provide optimal care for their stresses combined with a heavy clinical workload which patients (Wallace et al 2007). The director recommended a visit to the family management at McMaster University, “Exhaustion and illness doctor for assessment. No physical or mental illness was in the workplace can lead to errors in judgment, diffculty in detected. The family doctor recommended a balanced making decisions, increased social friction because of irritability diet, exercise and spending time with family. Andrew Padmos, chief executive offcer of the Royal of the Poststaff Health Organization). One month later College of Physicians and Surgeons of Canada, has stated that the resident is performing at their best and receives an “At the foundation of everything we do is one simple aim: to excellent evaluation on their rotation. According to the framework, is “the ability to achieve balance between work and personal the six core domains shared by all health care professionals are life. Younger physicians have indicated to: that they prefer to have good physical health rather than being • contribute to a culture of patient safety, stressed and tired out. For example, discussions with “new” physicians • optimize human and environmental factors, and highlight the value placed by this cohort on collegiality, open • recognize, respond to and disclose adverse events. Clear instructions Generational and gender differences during the orientation process help them to become more Recent research shows that “baby-boomer” and “Gen-X” effcient and confdent, translating into better teamwork and physicians work, on average, the same number of hours— encouraging collegiality. Young physicians also express a desire 61—per week and have a roughly equal level of commitment for a positive work culture, along with a wish to avoid being to patients. The biggest difference is that although Gen-Xers drawn into any existing pockets of cynicism. They agree that physicians feel that their medical careers are important, they any threat to their professional standards or that of a hospital “do not necessarily place [their work] at the forefront as the is potentially stressful and can affect their relationship with pa- only aspect of who they are. A culture of openness can help to mitigate these threats, younger cohort seeks a well-rounded and balanced life can be and a healthy sense of community among the physicians can interpreted by baby boomers as a lack of commitment (Jovic help physicians to cope with stressful situations. Bill Wilkerson, co-founder of the Global Business and The number of female physicians has increased 36. In the 2007 National Physician Survey, 80 per cent of physi- What is the solution in the workplace? Wilkerson puts it this cians indicated that the complexity of their patient caseload as way: “The solution is the cornerstone of good old-fashioned the biggest factor affecting their time. Given an ever-increasing management, which is based on human decency, clear think- proportion of our aging population is affected by chronic dis- ing, open communications. The other cornerstone is clarity of ease and comorbidities, the average physician’s workload will purpose and function. CanadianMedicalAssociation Of the medical students who responded to the 2007 National Launches First Check-up of Doctors’ Health. Society grants physicians status, respect, autonomy in practice, ability to self-regulate and fnan- cial compensation. In return, society has high expectations of Case physicians, including competence, altruism, ethical behaviour A physician is ill and chooses to take a day off from his and the delivery of a high standard of care. A number of patient visits are professional role physicians must make their patients’ well- rescheduled, and students and residents are assigned to being their frst priority, this commitment must include a caveat other supervisors. Physicians should bear in mind the advice ents the following week but begins the clinical encounter given to airline passengers in case of a depressurization: put by expressing dissatisfaction, anger and frustration that on one’s own oxygen mask before assisting others. We must the postponement of the appointment resulted in losing maintain our own health in order to be ft to care for society. The physician feels regretful and guilty at having taken the day off, but at the same time is frustrated by the patient’s demanding tone. Refection for educators At the beginning of your residents’ rotation, have them keep a journal of the challenges they encounter with Introduction respect to meeting the expectations of their patients and Society is quite aware of basic lifestyle choices that promote maintaining their own health. You may wish to provide good health, such as maintaining a healthy diet, exercising your own example of challenges you have experienced. In regularly, avoiding smoking and street drugs, and limiting addition, you can keep your own journal of such physician alcohol use. Most Canadians also recognize the importance of health challenges and have a formal discussion half-way working with their primary care physician for health concerns, through the rotation on how you and your residents dealt follow-up and appropriate screening at different stages of life. At their regular evaluation However, how often do patients consider the health needs of meetings program directors can discuss with residents the their own doctors? The journal will provide clear examples of how the residents understand Healthy physician, healthy patient the key issue. Residents may also consider incorporating Some patients infuence the mental health of their physicians such discussions into their half-day educational sessions by virtue of challenging personality traits, the denial of their or at their regular retreats. Physicians may choose to prescribe unneces- sary antibiotics for a viral illness to pacify the expectations of a patient who wants a quick resolution of their ailment.
Normal haemoglobin is made up of four polypeptide chains Clinical features each containing a haem group sinemet 300mg without a prescription medications used to treat schizophrenia. HbA is the main adult Sickle cell trait (the carrier state) is asymptomatic generic 300mg sinemet visa silicium hair treatment, but form comprising two α chains and two β chains cheap sinemet 300mg mastercard medicine 4839. Sickle cell also have a minor haemoglobin HbA2,which makes up anaemia is a clinical spectrum ranging from asymp- around 2% of the circulating haemoglobin and con- tomatic to severe haemolytic anaemia and recurrent sists of two α chains and two δ chains. Painful vascular occlusive crises typically haemoglobins result from: produce symptoms of bone pain and pleuritic chest pain r Abnormal globin chain production such as thalas- with a low-grade fever. Other patterns of crisis: r Acute sequestration (pooling of blood in liver and Sickle cell anaemia spleen) requires transfusion for apparent hypo- Deﬁnition volaemia. Autosomal recessive condition in which there is abnor- r Pulmonary infarction may occur in association with mal structure of the globin chain. Chapter 12: Haemoglobin disorders and anaemia 475 Complications syndrome or cerebral infarction require exchange blood Patients have a susceptibility to infections including transfusionstoremovesicklecells. Transfusionsmayalso streptococcal infections and osteomyelitis often due be indicated in patients with regular severe crises and to salmonella. Prognosis Retinal detachment and proliferative retinopathy may Thereismarkedvariationintheseverityofthecondition, result in blindness. See also complications of haemolytic some patients have a relatively normal life span with few anaemia (page 473). Blood ﬁlm shows a α-Thalassaemia high reticulocyte count and sickle shaped red blood cells. Deﬁnition r Sickle screening tests use a reducing solution, which Inherited haemoglobinopathy with defective synthesis causes HbS to precipitate. Aetiology r X-ray of the tubular bones may show destruction and α-Thalassaemia is caused by gene deletions. There are medullary sclerosis together with periosteal bone for- four copies of the α gene, two on each chromosome 16. Management Clinical features Treatment is largely symptomatic with prophylactic an- r Deletion of all four copies of the α gene (–/–) prevents tibiotics,folicacidandpneumococcalvaccination. This disorder agement of a painful crisis includes oxygenation, ade- is also termed haemoglobin Bart’s (γ4)hydrops syn- quate hydration and analgesia. Acute se- r Deletion of three genes (–/α-) causes HbH disease (a questration requires blood transfusion, as patients be- moderate anaemia with splenomegaly and the pro- comeshocked. Normal Investigations Full blood count shows microcytosis with or without Sickle Trait anaemia. These mutations may result in no β chain production Investigations (β0)orveryreducedproduction (β+). The reticulocyte count is noproductionofβ globinandhavetheclinicalpicture raised and there are nucleated red cells. Management Excess α chains precipitate in the red blood cells r Thalassaemiaminordoesnotrequiretreatment;how- or combine with δ resulting in increased HbA2, and ever, iron supplements should be avoided unless γ resulting in increased levels of fetal haemoglobin co-existent iron deﬁciency has been demonstrated. The partners of women with thalassaemia minor r If there are defects in both β and δ genes, patients shouldbescreenedtoallowappropriategeneticcoun- have thalassaemia intermedia (homozygous) or tha- selling. Homozygous combined β, γ and δ are in- r Thalassaemia major and symptomatic thalassaemia compatible with life. This Clinical features aims to suppress ineffective erythropoesis and pre- r Thalassaemia minor/trait is asymptomatic with a vent bony deformity, while allowing normal growth mild hypochromic microcytic anaemia. Iron overload is prevented by the r Thalassaemia intermedia causes symptomatic mod- use of the chelating agent desferrioxamine, which is erate anaemia with splenomegaly. Splenectomy should be considered in patients ure to thrive and recurrent infections. Bone the production of fetal haemoglobin ceases and the marrow transplantation has been used successfully patient becomes symptomatic with a severe anae- in young patients with severe β-thalassaemia major. Extramedullary haemopoesis causes hepato- Other treatments under investigation include gene splenomegaly, maxillary overgrowth and trabecula- therapy and drugs to maintain the production of fetal tion on bone X-rays. Random X inacti- vation (Lyonisation) means that some heterozygous fe- Glucose-6-phosphate dehydrogenase males may also have symptoms. Clinical features With such a wide variety of genes and enzymatic activity, Aetiology aspectrum of clinical conditions occur. Investigations Pathophysiology During an attack the blood ﬁlm may show irregularly IgMorIgG antibodies are produced, which bind to red contracted cells, bite cells (indented membrane), blister cells. Autoimmune haemolytic anaemia Deﬁnition Clinical features Acquired disorders resulting in haemolysis due to red The clinical features, speciﬁc investigations and manage- cell autoantibodies. IgM anti human globulin Red cells coated in antibodies Agglutination (visible) Figure 12. Splenectomy may be indicated if lymphatic leukaemia, haemolysis is severe and carcinoma and drugs such refractory. Cold haemagglutinin May be primary or secondary IgM antibodies agglutinate best Treat any underlying cause and disease to Mycoplasma at 4◦C, often against minor avoid extremes of temperature. Deﬁnition A pancytopenia due to a loss of haematopoetic precur- Investigations sors from the bone marrow. Full blood count and blood ﬁlm will demonstrate a pan- cytopenia with absence of reticulocytes. A bone marrow Aetiology/pathophysiology aspirate and trephine shows a hypocellular marrow with Aplastic anaemia can be either congenital or much more no increased reticulin (ﬁbrosis). This agents, supportive care (blood and platelet transfusions) is an autosomal recessive aplastic anaemia with limb and some form of deﬁnitive therapy. Otherdrugsmaycauseaplasticanaemia Immunosuppressive therapy is used as ﬁrst line treat- through dose dependent (e. Prognosis Clinical features The course is dependent on the severity of the dis- Patients present with the features of pancytopenia: ease and the age of the patient. In the United Kingdom, travellers to these ar- 3year survival but there is a signiﬁcant risk of developing eas who do not take adequate precautions are at greatest paroxysmal nocturnal haemoglobinuria, myelodysplas- risk. Transmission occurs predominantly by the bite of the female Anophe- Deﬁnition les mosquito although transmission may occur by blood Malaria is an infection caused by one of the four species transfusion or transplacentally. Incidence Worldwide there are 300–500 million cases of malaria Pathophysiology peryear with a mortality rate of up to 1%. In the United Parasites consume red cell proteins, glucose and Kingdom there are 1500–2000 cases per year, most of haemoglobin. They affect the red cell membrane making which are caused by Plasmodium falciparum. The inci- the cell less deformable and ultimately causing cell ly- dence in the United Kingdom is rising. Falciparum induces cell surface adhesion molecules on red cells causing adhesion to small vessels and un- Geography infected red cells. This leads to occlusion within the Endemic malaria is found in parts of Asia, Africa, Cen- microcirculation and organ dysfunction. Resistance to tral and South America, Oceania and certain Caribbean malaria is conferred by genetic variation: 1.
Have the patient bite down gently to ensure that the tooth is all the way back in buy 300mg sinemet visa medicine journal. If immediate replacement is not available purchase genuine sinemet on line symptoms mono, store the tooth in saline order sinemet canada symptoms 4 days before period, milk, or saliva. Injuries To Primary “Baby” Teeth – Normally these are not repaired unless needed for comfort care of the patient. Soft Tissue Injuries – The tongue, gums, and oral mucus membranes are often injured at the same time as the teeth. Laceration of ducts and glands can be difficult to repair and may cause ongoing problems – think in 3D when looking at facial injuries and considering what may have been injured. If unable to close the tissue within 12 hours, wait, and then close after 5 days when the wound bacteria counts have dramatically lowered. For wounds all the way through the cheek close the mucus membrane from the inside then close the muscle and skin from the outside in standard fashion. Use 2 sets of instruments if possible to minimize contamination of the wound with oral flora. There are several techniques to temporarily splint a tooth dislocation or fracture. Wire suture material (or reasonably heavy gauge fuse wire) can be used to splint the tooth. The wire is glued to the affected tooth and to the neighboring teeth to provide stability. Cotton fibers can be mixed in with temporary filling mix and the resultant fibrous mix can be molded to make a splint between the injured tooth and its healthy neighbors. For mandibular fractures or multiple involved teeth then full wiring of the jaw may be required 4-6 weeks. The technique is relatively straight forward: - Using small lengths of wire suture (or fine fuse wire) make a small loop in the center of the piece of wire. Wrap the wire in a figure 8 pattern around two teeth, with the small loop facing outwards, over the gap between the two teeth. Repeat this top and bottom – in at least 3-4 positions – so you have the loops top and bottom-lining up. Extractions: Before antibiotics this was the main treatment for dental infections. An infection in the root of the tooth could only be treated by pulling the tooth and allowing it to drain. The basic underlying principle of dental extractions is very simple: the tooth needs to be loosened from its attachments to the gum and jaw, and then the tooth is gently rocked backwards and forwards until loose enough to be removed. The key point is the gentle rocking rather than attempting to simply pull the tooth out. There are a number of very effective local anaesthetic blocks which are easily used. Secondly it can be difficult to grasp the tooth without the proper instruments although not impossible. The minimum instruments required to safely extract a tooth include a Maxillary Universal Forceps (150), Mandibular Universal Forceps (151), and a periosteal elevator. That said it is possible to remove a tooth with any solid grasping instrument – such a pair of pliers – with the tips wrapped in gauze or in some other way padded – although this is not recommended. Thirdly if the tooth’s root(s) breaks (which is more likely with decayed teeth and if the operator is inexperienced) then it can be impossible to remove and the broken root fragment will act as a focus for further infection. In some primitive societies when you lost your teeth to chew with then by nature of their diet you died – potentially a problem again. Your priority should be to prevent yourself or your families from getting to the point where you have no teeth. Porcelain is glorified clay, and is moulded, and then fired to produce a very hard material – there is varying recipes – one recipe consists of one part each of silica, clay, and kaolin, 2 parts of Nepheline syenite, and a small amount of talc. Before this time dentures had been manufactured out many substances including metal, bone, and animal and human teeth. The instrument numbers are considered standard numbers but many companies have their own numbers or variations so check if you are unsure. Note that all of this is obtainable at Wal-Mart, from many pharmacies, or similar stores. Level 2: Basic Dental Kit This is the minimum needed for basic dental work: temporary fillings and extractions. Where possible purchase supplies of high quality, they are reusable and will last for many years with proper care. Level 3: Advanced Dental Surgery Kit This is the advanced kit designed for those with some dental training and can do most needed dental work including fillings and extractions. Note: Extractors 53R & 53L are mirror images of each other if you get the model with the straight handle. If you are nimble with your weak hand and can change sides on the patient you can get by with one or the other of the pair and save money and weight. Note: Forceps # 18, 73, 75, 87, 201, and deep root elevators are of value also if you want to be really complete. This includes both the short and long term as well as the more urgent aspects of immediate care. Whether professionally trained or home-grown the person charged by circumstance or design with providing for the day-to-day care of others needs to be ready to address the ever-changing and continuing needs of their patients. There will also need to be an acceptance from family or group members of a more collective responsibility for caring for the sick and injured, and that delegating all of the care which a sick patient currently receives from trained nursing staff in modern hospital to one person isn’t practical or desirable. Family and friends will need to take a much more active role in helping the “nurse” look after their patient - assisting with companionship, bathing, and feeding the patient. The goal is to provide for the entire range of physical and emotional demands caused by the patient(s) illness or injury. Nursing care begins where urgent or immediate care leaves off once the patient is stabilized and any imminent threats or disabilities are addressed. Because the subject of nursing care per se is so vast it is not the intent of the authors to provide a complete how-to. In keeping with the general philosophy of the book this section is meant to provide an introduction only highlighting some of the factors involved in providing austere nursing care. You will need to be familiar with a large bag of tricks that will make recuperation not only more bearable but also more likely. Often whether or not someone recovers from a traumatic event or a significant illness depends on the care they receive beyond the emergent or acute phases. Without excellent nursing care a person may survive and also recover nearly fully intact from a fractured femur, for instance, only to succumb weeks later to the effects of being kept bedfast. Blood clots in the lower legs caused by inactivity, infected bedsores that result from laying on their back for too long, or even pneumonia resulting from the use of a simple anaesthetic agent such as ether, may claim them long after the fracture has been set and the road to recovery is being well travelled. Simple nursing measures can go a long ways towards preventing any of these from occurring, or addressing them if they should. On a more everyday basis there are also simple considerations to make austere nursing practical: how to properly assess a temperature using an old-fashioned mercury thermometer, how to administer a proper injection, reducing fever with - 144 - Survival and Austere Medicine: An Introduction simple measures that do not include medications, and ensuring proper nutritional support. Defining austere nursing practice Elsewhere in this work we address the various aspects of emergent care when “regular” health care is not available, a la’ where there is no doctor/clinic/emergency facility.
By X. Pyran. University of Rhode Island.