Biomedical subjects

Michael Halberthal

Publications and source records attributed to Michael Halberthal.

3 recordsLinked to original sources

PubMed2003

Managing mass casualties.

PURPOSE OF REVIEW: The issue of mass casualty associated with terrorism has gained tremendous public interest, but only modest medical interest, in the past 2 years. This review examines recent medical literature and outlines a practical approach to managing the mass casualty situation on the basis of a doctrine developed and extensively practised in Israeli hospitals. RECENT FINDINGS: A large portion of recently published articles deal with the preparedness for 'conventional', biological or chemical mass casualty situations. Accounts of past events reveal serious discrepancies between well-designed contingency plans and the disappointing management of actual mass casualty situations. The 'Israeli doctrine' is a general 'master plan' for managing mass casualty situations that is adjusted by every hospital to its specific characteristics. Its major principles and features, as well as practical 'tips' are described. SUMMARY: The world medical community, being in the forefront of any natural or man-made disaster, should prepare itself for its effective management. Contingency plans should be comprehensive, and should follow certain general guidelines, but should be specific for different causes of mass casualty situations and be adjusted to each medical system or hospital. Medical personnel should become familiar with these plans through repeated drills. Experience gained in actual mass casualty events should be analysed and published to improve contingency plans and their implementation.

Journal Article↗

PubMed2002

Survey of critical care management of severe traumatic head injury in Israel.

OBJECTIVE: To survey the current monitoring and treatment policies for patients with severe traumatic brain injury (STBI) in Israel, and to compare the management of pediatric and adult intensive care units (ICUs). DESIGN: Questionnaires were sent to the medical directors of all ICUs managing STBI patients. RESULTS: All 21 ICUs responded to the questionnaire. All of the units were within tertiary hospitals. An intracranial pressure (ICP) monitoring device was used in over 75% of the patients in 6 out of7 (86%) of the pediatric intensive care units (PICUs), compared with 11 out of 14 (79%) of the adults ICUs. Mannitol was used in all of the units for documented elevated ICP. Mild hyperventilation (4-4.6 kPa) was applied in 52% of the units. Mild hypothermia was routinely used in 4 out of 7 (57%) and hypertonic solutions (NaCI 3%) in 3 out of 7 (43%) of the PICUs, compared with only 2 out of 14 (14%) and none (0%) of the adults ICUs respectively. PICUs aimed for a lower ICP (< or =15 mm Hg) and cerebral perfusion pressure (> or =50 mm Hg) than adult ICUs (< or =20 mm Hg and > or =60 mmHg respectively). Barbiturates were used only in patients with refractory intracranial hypertension. CONCLUSION: This survey reveals a relatively high degree of homogeneity in the treatment of STBI patients in Israel. Most patients are treated in accordance with recently published literature. We attribute this uniformity to the fact that all patients are being treated within tertiary care, university-affiliated centers. PICUs are faster at implementing new modalities of treatment and tend to adopt more aggressive treatment strategies.

Adolescent↗

PubMed2002

Abdominal compartment syndrome in children: CT findings.

Abdominal compartment syndrome (ACS) is caused by pathological elevation of intra-abdominal pressure (IAP) leading to multiple organ dysfunction syndrome. Since the condition is highly lethal, early diagnosis is imperative. We evaluated the pre-operative abdominal CT scans of three children with proven ACS to identify signs of elevated IAP. Findings common to these patients included narrowing of the inferior vena cava (IVC), direct renal compression or displacement, bowel wall thickening with enhancement and a rounded appearance of the abdomen. The aim of recognising the CT findings in such cases is to plan emergency surgical decompression. Although these findings are not specific for increased IAP, radiologists should be aware of this life-threatening condition and, in the proper clinical setting, should communicate the presence and significance of these findings to the referring clinician.

Abdomen↗