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[Diagnosis, first aid and classification of muscle injuries in sports medicine].

Muscle injuries are, with 6 to 14%, the most common but neglected and under-estimated sport injuries. Certain muscle groups are predisposed to injury depending on the type of sport. There are many hypothesis as to the cause of muscular injury. The prognosis and the length of treatment are greatly influenced by the quality of the first aid administered at the accident site. Simple measures such as compression, elevation, ice and rest can easily be carried out at this site. The further rehabilitation includes bandages and accompanying measures, such as physical therapy and medication. An early functional and conservative therapy is the treatment of choice. The classification of the extent of injury should be carried out by an experienced sportmedic with regard to a differential diagnosis. Sonography and MRI can supply additional information when it is not clear as to the extent of injury. Resulting from an exact as possible classification can the further treatment and planning of the progress of the rehabilitation be established. The necessary length of the pause from sport and of the rehabilitation depend on the seriousness of the injury.

Athletic Injuries↗

[Ways to improve training of the populace for rendering medical first aid to casualties in extreme situations].

The article presents the results of population' training for rendering the first medical aid in the cases of extreme situations, fulfillment of the normative document requirements on the problem The study was conducted in All-Russian Center for Disaster Medicine "Zaschita" of Russian Health Ministry. It is shown that after publication of normative documents the rescuer and special contingent training has improved, at the same time the training of other population groups doesn't meet the requirements. The current programs and forms of population education, insufficient number of educational time and pore material and technical basis don't provide the necessary knowledge and skills on rendering the first medical aid in the cases of extreme situations. Basing on the study the following documents were developed: the unified program "The First medical aid", the test program to control the students' knowledge, the methodical manuals for teachers and students and the standards of class equipping.

Disaster Planning↗

[Conclusions of the first-aid treatment of emergency patients from a prospective study of 106 lethal outcomes (author's transl)].

To obtain an objective judgement on the efficiency of emergency help, 106 emergency patients who died during a six month period were subjected to an examination in which all aspects of their treatment, beginning at the scene of the emergency and lasting until their death were documented. It could be shown that 8.5% of the examined patients would have had a chance for survival if proper and optimal treatment had been given, despite the effects of their injuries. Only by improving knowledge of first-aid procedures can an increase in the efficiency of emergency measures be attained as will be proven in this paper. Intensive schooling is necessary not only for the layman and ambulance orderlies but for doctors who are to be employed in rescue work in particular. The present criteria (one-year clinical activity and competency are by no means sufficient as a foundation.

Adult↗

Intravenous propafenone for suppression of symptomatic atrial fibrillation and atrial flutter in a first aid hospital.

The efficacy and safety of propafenone (PPF) were prospectively evaluated in 20 patients (13 men and 7 women, age 39 +/- 14 years) with atrial arrhythmias (AA) (atrial fibrillation: n = 13; atrial flutter: n = 7). All patients had arrhythmias from 109 +/- 63 minutes, (iT) without clinical evidence of heart failure. Intravenous PPF was given as a 1 mg/kg bolus over 5 minutes, with a therapeutical possibility of a second bolus (1 mg/kg) after 10 minutes if sinus rhythm was not restored. The conversion time (cT) was 6.4 +/- 2.2 minutes (range 3 to 18 minutes). In 19 patients (95%) sinus rhythm was restored and no serious adverse and proarrhythmic effects were noted in each patient. We conclude that 1) PPF is effective and acted significantly faster in controlling AA; 2) PPF appears to be well tolerated and relative safe with a low incidence of adverse and proarrhythmic effects in patients in a first aid station.

Adult↗

An objective approach to antivenom therapy and assessment of first-aid measures in snake bite.

Treatment of systemic envenoming in snake-bite victims has, in the past, depended almost entirely on the individual clinician's experience in assessing the severity of envenoming. The efficacy of treatment is obviously related to the neutralizing potency of the antivenom used, the route by which it is administered and the dose. The development of enzyme immunoassays has permitted a more scientific appraisal, allowing estimation of circulating specific venom and antivenom concentrations at any time after the bite in the patient's blood. It is therefore possible to measure accurately the efficacy of antivenom in the neutralization and clearance of venom antigen. In Brazil, it appears that clinicians treat patients with excessive amounts of highly efficient antivenoms and this results in an unacceptably high incidence of reactions. In Sri Lanka, the use of imported, Indian antivenom is relatively ineffective in neutralizing the venoms of Sri Lankan snakes, demonstrating the real problem of venom variability within individual species. In West Africa, the improved clearance of venom following treatment of Echis victims with a monospecific as opposed to a polyspecific antivenom has been demonstrated, and new, smaller fragment, Fab antivenoms have been developed and are now under clinical assessment. Such clinically-based immunological studies should result in more efficient and controlled use of expensive antivenoms for treatment of systemic envenoming and the accurate assessment of newly designed products. Such studies also emphasise the importance of individual countries producing their own antivenoms for treatment of systemic envenoming. Likewise, the use of such objective systems now enables the use of first-aid measures such as tourniquets to be properly assessed.

Africa, Western↗

[First aid].

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First Aid↗