recognition of illness, delay in seeking and accessing care and delay in the provision of care once at a health facility . This three year review of neonatal surgical emergencies at a tertiary health facility in Nigeria is as- sociated with a high mortality rate of 62.2%. Neonatal surgical emergencies mortality rates in other tertiary hos- pitals in sub-Saharan African countries ranges from 24% in Kenya , 43.1% in Cameroun  and 30.5% - 39.2% in Nigeria [2,6-8]. The mean age at presentation was 47.5 ± 44.4 hours (range 1 - 216 hours). This delay in presentation may be due to the fact that 44 (97.8%) of the neonates were delivered outside the tertiary health facility. Absence of an efficient public emergency trans- portation system could also be a contributing factor. In- ability to recognise the urgency of the pathology espe- cially in neonates delivered in unorthodox health facili- ties (UOHF) may also have contributed to the delay. This may explain the significant difference in age at presenta- tion between neonates delivered in UOHF and orthodox health facilities (OHF) (p = 0.002). No neonate delivered in OHF presented later than 48 hours (range 1 - 48 hours). Delay in presentation as a risk factor for mortality in neonatal surgical emergencies has been reported by some authors in developing countries. Tenge-Kuremu et al.  in Kenya reported a median age of presentation of 3 days and Mouafo Tambo et al.  in Yaounde, Cameroun, a mean delay at presentation of 3.7 days. Osifo et al. in Nigeria reported that 65.5% mortality in neonatal surgi- cal emergencies was associated with delayed presenta- tion of which 7.5% were too ill on arrival and died dur- ing resuscitation . They attributed the delay to igno- rance, financial constraint, lack of adequate means of transportation among others [4,5,9]. Effect of delay in presentation on mortality is evident in neonates delivered
Sushruta Samhita is a beautiful composition of Acharya Sushruta, with sequential arrangement and detailed description of the topics in form of verses. The above discussion is very exemplary and is just a glimpse of the universal approach of ayurvedic Shalya Chikitsa and specifically, its contribution in the field of surgical emergencies. Acharya Sushruta has covered every branch of medical science, but has given more emphasis on surgery. This is why Sushruta is considered truly as the “Father of Sur- gery”. It is extremely essential that we put his prin- ciples into practice and preserve the dignity of our noble profession. That would be the ideal tribute to this legendary figure and our contribution to future generations.
I Dr. D. SURESH declare that, I carried out this work on, “ THE STUDY AND MANAGEMENT OF NON TRAUMATIC ABDOMINAL SURGICAL EMERGENCIES” at the Department of Surgery, Govt. Rajaji Hospital during the period of October 2008 to September 2009. I also declare that this bonafide work or a part of this work was not submitted by me or any others for any award, degree, diploma to any other University, Board either in India or abroad.
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This is a transversal, prospective type descriptive six months, from March 9 to September 9, 2015. We included all children aged 0 to s 15 years in which the diagnosis of shock has was retained and treated at the pediatric unit of the med- ical and surgical departments of the National Donka Hospital during the period.
Even in ancient times, surgeons were aware of the potential seriousness of a "painful abdomen". Surgical advances were scarce until the last part of the nineteenth century because of the absence of autopsies and clinico pathological correlation. Reluctance to perform abdominal exploration existed until a little less than 100 years ago. The long debates, disagreements of the leading surgeons of the period who assembled at the patients bed side have been described in a report "the cliniques delannelongue". Less than 100 year ago Lannelongue a surgeon, Cornil a pathologist demonstrated at autopsy that the starting point of a purulent peritonitis was a perityphilitis, convincing the contemporaries of its appendicular origin, Mondor 1974.
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Injuries are a neglected health problem in developing countries. In Ethiopia, trauma constitute about half of surgical emergencies (9,10). Every year nearly 2000 people die due to road accidents in Ethiopia. Of these, 48% are pedestrians, 45% passengers and 7% drivers. Over 400 to 500 Million Ethiopian Birr is lost yearly as a result. As stated by the Road Traffic Authority, the fatality rate is around 136 per 10,000 vehicles, which is very high compared to the 2 to 3 fatality rates per 10,000 vehicles in countries with highly developed road safety activities. The cost to the country’s economy is also significant (11). The issue of trauma in general and RTA in particular is likely to hamper national growth and development (12). Trauma is one of the most important causes of morbidity and mortality among the non- communicable diseases (13, 14).
The time to management of gynecological emergencies is the sum of four periods: time from symptom onset to arrival; time from arrival to the first medical assessment; time from the first medical assessment to the diagnosis, which usually required pelvic and endovaginal ultrasonog- raphy by a specialist ; (iv) and time from the diagnosis to the implementation of specific treatment, if any is needed. Our decision tree may diminish the time from ar- rival to the first medical assessment by helping the nurses to identify patients with suspected PLTEs. In a previous study, mean time from arrival to ultrasonography was 84 minutes in a gynecological emergency room, and far longer times were found in general emergency rooms . Then, this decision tree can speed up the use of ultra- sound examination that has proven to be reliable for the diagnosis of surgical emergencies .
The objective of the management of acute surgical dis- eases is to save lives by controlling bleeding or contam- ination, or by improving organ perfusion. This objective obligates the need for strong commitment and effective mechanisms for prioritizing patient management ac- cording to physiological and clinical parameters. Resource availability along patient physiological and clinical parame- ters in the acute care arena justifies the development of triage tools and agreed criteria for proper timing of emer- gency operations. Most studies on timing of surgery have investigated delays in operations. This may reflect prob- lems of resource availability, and indicate a need for all parties involved in surgical emergencies, both caregivers and their employers, to commit to high quality of care. Convenience for caregivers or administrators should not override patient safety. Investigations of the influence on patient outcomes of surgical delays due to constraints of resource utilization, must consider the availability of oper- ating theaters at any given time.
Airway management in Ludwig angina is controversial. Although there is a possibility of complete airway obstruction as the infection progresses, the process of securing the airway may cause complications, such as rupture of pus into the airway. Traditional direct laryngoscopy may be impossible to perform due to airway edema. Awake nasotracheal intubation with a fiberoptic scope may be the best method. 10 Should this fail, surgical airway
Among obstetric emergencies transported by ‘ 108 ’ in this analysis, only 4.5 % in Gujarat and between 13 % and 25 % in other states were inter-facility transfers. It appears that the pregnant women who developed com- plication while at home either called ‘108’ and left for higher level facility directly, or in case of inter-facility transfer they used other means of transport without waiting for a ‘108’ ambulance. The Chiranjeevi scheme in Gujarat could also have contributed to a low pro- portion of inter-facility transfers in the state. The Chiranjeevi scheme provides free normal and surgical delivery care to the poor close to their home, with pri- vate hospitals providing CEmOC services. This could possibly have reduced the need of referral and transfer in case of an emergency .
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legal complications which emphasizes the need for more focused training programs to increase their knowledge and skills in providing first aid. Though ambulance per- sonnel were trained the lack of confidence among them emphasizes the need for periodic remedial instructions to update them in the field of first aid. Significant num- bers of neurological injuries appear to be a result of the extrication process or victim transportation without ad- equate immobilization (13, 23, 24), generally by untrained people (25). In the current study, participants (68%) had knowledge on correct position of victim transportation but many did not know the correct method of bleeding control. In the current study, only half of the participants were aware of scene safety and nearly 90% were aware of common emergency number (n = 108). Several studies in LMICs especially in settings with a high burden of inju- ries, have demonstrated the effectiveness of training lay people in first aid (12, 22). In the current study, though the majority of participants had witnessed emergencies more than once and nearly half of them been called to help during emergencies, only 34% had undergone some sort of training which is less compared to the study in kampala (16) and only 13% had training in the last two years. Nearly 42% of first responders were not confident enough to provide any sort of first aid, stressing the im- portance of regular training programs for these first re- sponders. Limitations of the preliminary study include selection and interview bias that might have contributed to study results. More in-depth studies that focus on skills assessment among different categories of personnel are required to develop scientific and culturally appropri- ate lay first responder training programs along with strengthening other components of prehopsital care. There is no formal prehospital care system in the area under study. Lay people commonly witness emergencies and call for help, they are not having any formal training in first aid. Lack of knowledge in first aid and fear of legal complications is preventing them from providing first aid. A formal compulsory regular training of lay first aid providers may improve the practice of first aid.
Flexible endoscopy should be performed as an adjunct to CT in patients with suspected TIE (Grade 2A). En- doscopy provides direct visualization of the injury site and was shown to be useful in patients with equivocal CT findings. Other advantages include easy availability in most trauma centers and the possibility of use in intubated and unstable patients [114, 115]. In com- bination with contrast-enhanced CT, flexible endos- copy allows the accurate diagnosis of TIE in more than 90% of cases. The use of endoscopy has been shown to alter surgical management in 69% of pa- tients. In unstable patients rushed to the operative room, intraoperative endoscopy can be employed to rule out esophageal perforation. Under such circum- stances triple endoscopy (esophagoscopy, laryngos- copy, and bronchoscopy) is indicated as injury of one of these structures should raise the suspicion of dam- age to the adjacent organs. Insufflation during the procedure may promote mediastinal contamination by increasing the size of the perforation; for this reason low-flow insufflation and use of CO 2 rather than air
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I n addition to the natural and tech- nological hazards described in this publication, Americans face threats posed by hostile governments or extremist groups. These threats to national security include acts of terrorism and acts of war. The following is general information about national security emergencies. For more information about how to prepare for them, including volunteering in a Citizen Corps program, see the “For More Infor- mation” chapter at the end of this guide.
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Asthma is a signiﬁcant public health issue, impacting quality of life, morbidity, and health care costs nationally. Stock asthma rescue medication policies authorize school districts to maintain unassigned albuterol and enable trained staff members to administer the medication in response to asthma symptoms, exercise premedication, and asthma emergencies. Stock asthma rescue (or reliever) medication laws serve as an important fail-safe measure. Such laws provide districts with the ability to respond if a student has an asthma emergency at school but either lacks a diagnosis or does not have access to their own medication. As of September 2019, 13 states have enacted either a law or regulation authorizing the stocking of asthma rescue medication in schools: Arizona, Colorado, Georgia, Illinois, Missouri, New Hampshire, New Jersey, New Mexico, Oklahoma, Ohio, Texas, Utah, and West Virginia. Three additional states provide stock albuterol asthma guidelines but do not have legislation: Indiana, New York, and Nebraska. Some states have found that these policies reduce the need for 911 calls and emergency medical services transports as a result of asthma exacerbations. Initial data also demonstrate that these policies reach populations in need and improve health outcomes. This case study will describe the current state of asthma in Illinois, an innovative policy solution to address asthma emergencies in schools, and the steps taken to advocate for stock asthma rescue medication in Illinois. Legislation for stock albuterol in Illinois was signed into law in August 2018.
Children and adults might experience medical emergency situations because of inju- ries, complications of chronic health conditions, or unexpected major illnesses that occur in schools. In February 2001, the American Academy of Pediatrics issued a policy statement titled “Guidelines for Emergency Medical Care in Schools” (available at: http://aappolicy.aappublications.org/cgi/content/full/pediatrics;107/2/435). Since the release of that statement, the spectrum of potential individual student emergencies has changed significantly. The increase in the number of children with special health care needs and chronic medical conditions attending schools and the challenges associated with ensuring that schools have access to on-site licensed health care professionals on an ongoing basis have added to increasing the risks of medical emergencies in schools. The goal of this statement is to increase pediatricians’ aware- ness of schools’ roles in preparing for individual student emergencies and to provide recommendations for primary care and school physicians on how to assist and support school personnel. Pediatrics 2008;122:887–894
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Due to the limitations of our sample size, it is not possible to draw any definite conclu- sions. However, this result is compatible with previous studies on electively managed hydatid cyst patients. T-tube drainage is a safe method for treating intrabiliary ruptures of hydatid cysts (12, 13). In our study group, all emer- gency room patients who underwent t-tube drainage recovered perfectly. We think that t- tube drainage is a safe and relatively minimal- istic surgical option in patients with hydatid cyst-biliary system communication, even in emergency conditions.
anemia, surgical obstetric emergencies associated with blood loss in developing countries so the needs of blood transfusion services are increased  According to the WHO safe blood is a universal right, which means that blood has been fully screened and is not contaminated by any blood borne diseases and it will not cause any harm to the recipient, The prevalence estimating of TTI antigens or antibodies among blood donors can provide important data that can be used in formulating the strategies for improving the management of a safe blood supply and reveal the problem of unnoticeable infections in healthy looking members of the general population and also it can give us a guide to the magnitude of some sexually transmitted infections in the community [3,5,6,]. Implementation of more sensitive tests that detect infection earlier decreases risks of transfusion transmitted viral infection in developing countries .
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Analysing the available data, the breakdown of the various medical emergencies encountered in our study showed that syncope was by far the most frequent medical condition (5307 cases, 53.5%), followed by gastrointestinal disorders (926 cases, 8.9%) and cardiac conditions (509 cases, 4.9%), which are similar results to those seen in other studies [10,11]. One major problem that we encountered was a lack of stand- ardisation in terms of diagnostic categorisation and confirmed diagnostic data. This was reflected in the fact that only four out of 32 airlines were able to contribute to the study, only two of which could ultimately be enroled. Worldwide, it has been reported that only 17% of all IMEs are documented, most of them inconsistently, which would seem to indicate that legisla- tion for mandatory standardised documentation and the estab- lishment of an international registry is needed .
The vascular surgeon is trained in the management of diseases affecting all parts of the vascular system except that of the heart and brain whereas cardiothoracic surgeons manage surgical dis- eases of the heart and its vessels. Although vascular surgery is previously a field within general surgery, it is now considered a specialty on its own right in many countries such as the UK and the United States. Other countries such as Iraq have a mixed practice in which the cardiac or thoracic surgeon performs vascular surgery. Programs of training in vascular surgery are slightly different depending on the region of the world one is in. In the United States, a 5-year general surgery resi- dency is followed by 2 years training in vascular surgery. In Iraq, the time table allocated for the general surgical trainee in vascular surgery is unfortunately short (1 - 3 months). This period is hardly enough for the candidate to grasp the decision-making and technical skills of vascular sur- gery. We believe that general surgeons need to have adequate training and expertise in vascular surgery particularly in areas and situations lacking this facility to deal with the life- and/or limb- threatening emergencies. This review article aims to orient the general surgical trainee about the scope of vascular surgery and enable them to correctly diagnose and treat common vascular emergencies such as extremity and abdominal vascular injuries (AVI).
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The Jordanian hotels have experienced a wave of disasters and emergencies in the last two decades. Overall, the period from 2000 to date has been affected by natural and man-made disasters, with political instability in the Middle East which influence Jordanian hotels negatively . Since September 11, 2001, at least 18 major terrorist incidents targeted hospitality industry worldwide, including two conducted in Jordan . While, the Malaysian hotels were not immune from several disasters affecting Southeast Asia, arising broadly outside Malaysia with deep impact on hotels. This research aims to identify major emergencies that occurred in the hotel industry; investigating hotels preparation for emergencies in the past; and exploring how hotels manage and overcome such emergencies; and limitations that hotels encountered.