Sarin: guidelines on the management of victims of a nerve gas attack.

Sarin is now a weapon of the terrorist. Its acute effects are primarily due to unrestricted cholinergic activity at both muscarinic and nicotinic receptors. Treatment is based on the use of large doses of atropine and pralidoxime which may lead to practical problems of sufficient drug supplies for the average hospital. Ventilation may be necessary and present problems. Victim decontamination involves use of bleach, soap and water. Staff handling casualties need protection with respirators and butyl rubber boots and gloves.     

Sac attack

Although cardiac tamponade remains uncommon, morbidity and mortality from cardiac tamponade are high. EMS providers must understand the numerous causes and prehospital management of cardiac tamponade. Proper identification of its signs and symptoms, followed by correct management, may save lives.     

Nerve blocks

Local and regional analgesia, achieved by injecting a local anesthetic into tissues, or in proximity to certain parts of the peripheral nervous system, or into the epidural/subarachnoid space, to relieve pain has been used widely for many years. While nerve blocks no longer have the preeminent role as the pain management in cancer patients, they will remain useful tools in managing pain and increasing 'quality of life' of the cancer patients, only if they properly applied. The purpose of this chapter is to present an updated version of the regional analgesia in cancer pain management.     

Nerve Stimulator-Guided Occipital Nerve Blockade for Postdural Puncture Headache

Postdural puncture headache (PDPH) is one of the most common complications of spinal anesthesia, where adequate hydration with bed rest in the horizontal position is the initial recommendation. Epidural blood patch is to date the most effective treatment, but it is an invasive procedure that may result in serious complications. The aim of the current study was to conduct a prospective, randomized, single-blinded comparison between bilateral occipital blockade and conventional expectant therapy in adults suffering from PDPH. A primary hypothesis was that occipital blockade would result in better pain management and quicker return to normal activity. Fifty adult patients diagnosed with PDPH were randomly divided into two equal groups of 25 each. All patients in the block group received greater and lesser occipital nerve blocks, whereas the control group received adequate hydration, complete bed rest, and analgesics. Forty-seven patients entered into the final analysis as three patients withdrew from study. Complete pain relief was achieved in 68.4% of block patients after 1 to 2 blocks, with 31.6% ultimately receiving up to 4 blocks. Visual analog scales were significantly lower in the block group ( P  < 0.01), and the block group consumed significantly less analgesics in the follow-up period ( P  < 0.05) compared with control group. Block patients had significantly shorter hospital stays and sick leave periods ( P  < 0.001). The studied method is superior to expectant conservative therapy in the treatment of patients suffering from PDPH.