[The approach to patients susceptible to malignant hyperthermia].
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Genetic Predisposition to Disease↗
Biomedical subjects
R Ben Abraham
Publications and source records attributed to R Ben Abraham.
[Israel's ATLS program: summary and outlook].
In recent years a vigorous effort has been made to improve quality of primary trauma care in Israel. Advanced trauma life support courses (ATLS) were given to physicians throughout the country, regardless of their specialties. In 7 years 4229 physicians participated in 202 courses with an average success rate of 76%. In the future, issues such as mandatory vs. voluntary training, language barriers, and continuous decline of knowledge should be addressed if momentum is to be maintained.
Curriculum↗
[Propofol anesthesia for craniotomy in patients who are awake].
During craniotomy, the patient's cooperation is needed during procedures in which continuous neurological examination and mapping of crucial regions close to the area to be resected area are required. We report our experience in 9 patients who underwent such procedures under intravenous propofol as the main sedating agent. This short-acting hypnotic was administered prior to and during the painful stages of the procedure. Patients were fully asleep when the skull was opened and the dural flap raised or excised. During the rest of the operation patients were lightly sedated but remained responsive and cooperative. This enabled precise intra-operative mapping of the brain and surgery-related neurological deficits were avoided. Respiratory depression or hemodynamic compromise were not encountered. All patients were comfortable during the operation and there were no additional neurological deficits after operation. We believe that propofol should be the main sedating agent used for these procedures.
Aged↗
Structure and process components of trauma care services in Israeli acute-care hospitals.
In recent years a vigorous effort has been made to improve primary trauma care in Israel. The Ministry of Health and other authorities have invested in new facilities in various hospitals which are engaged in trauma care. A survey was conducted in order to identify deficiencies in organization, personnel and equipment required to provide optimal trauma care. A cross-country survey was conducted by using a questionnaire that dealt with structure and process components of trauma care. The questionnaire was submitted to medical directors of emergency departments in all 24 acute-care hospitals in Israel. Additional information was obtained by a telephone poll when required. Inter-hospital variation concerning structure of trauma services, protocols and qualification of manpower responsible for primary care of the injured was found. The conclusions are that an increase in homogeneity in the field of trauma care is still needed. A continuous effort should be made in order to structurally and functionally further develop independent trauma units in all hospitals in Israel. Methods should be found to encourage young physicians to enter the field of trauma care. The establishment of a nationwide trauma registry system will undoubtedly contribute to future improvement in the initial care of the injured in Israel.
Emergency Service, Hospital↗
Cognitive knowledge decline after Advanced Trauma Life Support courses.
OBJECTIVE: To assess the cognitive knowledge decline among graduates of the Advanced Trauma Life Support (ATLS) program in Israel, to compare the rate of decline between surgeons and nonsurgeons, and to recommend appropriate timing for refresher courses. METHODS: A prospective study based on multiple-choice question test results of 220 ATLS course graduates was conducted 3 to 60 months after course completion. These results were then compared with the examination results immediately after the course. A statistical model based on survival analysis was used to evaluate the decline pattern and extent and to compare the study groups. RESULTS: A significant decline of cognitive knowledge over time among ATLS graduates was demonstrated. This decline was significantly greater in the nonsurgical group. A critical point of 20% cognitive knowledge loss among 50% of the examined physicians was observed around the 180th week after completion of the course. CONCLUSION: Physicians taking the ATLS course lose a significant part of their acquired cognitive knowledge after 3.5 years. Surgeons retain their cognitive knowledge for longer periods of time. Based on the study results, the optimal timing for a refresher course is between 3 and 4 years after the initial ATLS course.
Adult↗
Malignant hyperthermia.
Malignant hyperthermia is a rare autosomal dominant trait that predisposes affected individuals to great danger when exposed to certain anaesthetic triggering agents (such as potent volatile anaesthetics and succinylcholine). A sudden hypermetabolic reaction in skeletal muscle leading to hyperthermia and massive rhabdomyolysis can occur. The ultimate treatment is dantrolene sodium a nonspecific muscle relaxant. Certain precautions should be taken before anaesthesia of patients known to be susceptible to malignant hyperthermia. These include the prohibition of the use of triggering agents, monitoring of central body temperature and expired CO2, and immediate availability of dantrolene. In addition, careful cleansing of the anaesthesia machine of vapours of halogenated agents is recommended. If these measures are taken, the chances of an MH episode are greatly reduced. When malignant hyperthermia-does occur in the operating room, prompt recognition and treatment usually prevent a potentially fatal outcome. The most reliable test to establish susceptibility to malignant hyperthermia is currently the in vitro caffeine-halothane contracture test. It is hoped that in the future a genetic test will be available.
Anesthesia↗
Advanced trauma life support versus Combat Trauma Life Support courses: a comparison of cognitive knowledge decline.
This prospective study was conducted to compare cognitive knowledge decline among graduates of the Advanced Trauma Life Support (ATLS) and Combat Trauma Life Support (CTLS) courses in Israel. The investigation was based on multiple-choice questions that tested the results of 211 ATLS and CTLS course graduates and was performed 3 to 66 months after completion of the courses. These results were then compared with the examination outcomes immediately after the course. A statistical model based on survival analysis was used to evaluate the decline pattern and extent and to compare the two courses. No significant difference was found in the rate of decline in knowledge gained from the two courses after a given period. Priority for refresher courses should be set regardless of type of course previously attended by physicians.
Adult↗
Malignant hyperthermia susceptibility: anaesthetic implications and risk stratification.
Malignant hyperthermia (MH) is a rare autosomal dominant trait that predisposes individuals to great danger when exposed to certain anaesthetic triggering agents, such as potent volatile anaesthetics and succinylcholine. Sudden hypermetabolic reaction occurs in skeletal muscle, leading to hyperthermia and massive rhabdomyolysis. Precautions must be taken before the anaesthesia of MH-susceptible patients. No triggering agents should be administered, central body temperature and ETCO2 should be carefully monitored, and dantrolene must be immediately available. In addition, the anaesthesia machine should be carefully washed to remove traces of halogenated agents, and the use of fresh disposable anaesthetic circuits is recommended. Early diagnosis of the syndrome by alert, informed anaesthesiologists, and the immediate administration of dantrolene and other supportive measures, has reduced mortality. Patients with MH susceptibility should be instructed to alert the anaesthesiologist about their condition whenever anaesthesia is needed. Although people diagnosed with MH susceptibility should not change their lifestyle in general, military service is limited.
Adolescent↗
The impact of advanced trauma life support course on graduates with a non-surgical medical background.
The aim of this study was to assess advanced trauma life support (ATLS) and combat trauma life support (CTLS) skills implementation among general practising physicians, its perceived utility in their routine daily practice as well as in their potential army combat assignments. One hundred and ten physicians, graduates of ATLS and CTLS courses, from the subspecialties of geriatrics, psychiatry and family medicine, were surveyed by telephone, to answer a specially designed questionnaire. The response rate was 82%. Professional distribution was: 6.6% geriatrics; 46.7% family physicians; and 46.7% psychaitrists. The number of trauma events treated by these physicians in their post-course practise was: geriatrics-three; family physicians-30; psychiatrists-18. We believe that a properly designed ATLS course, executed and applied to general practitioners, can be highly beneficial to trauma victims.
Adult↗
The accumulated experience of the Israeli Advanced Trauma Life Support program.
BACKGROUND: Between January 1990 and May 1995 one faculty in Israel taught Advanced Trauma Life Support (ATLS) courses to 3,700 physicians. Two types of courses were given to three subpopulations. We studied the influence of demographic variables on students' achievements in the course and compared students' achievements as a function of their course type. STUDY DESIGN: This study was conducted as a concurrent longitudinal study. RESULTS: Achievements of 3,700 students were analyzed. The precourse grade, type of course, and their interaction were found to have a significant effect on the postcourse grades. Physicians practicing surgical subspecialties, in general, did better, as did students educated in English-speaking countries. Students who took part in the Combat Trauma Life Support (CTLS) course, which included the entire ATLS course and additional lectures and exercises, also ended with better scores. CONCLUSIONS: Physician's country of origin and clinical subspecialty have a significant effect on the cognitive achievement in the ATLS course provided in Israel. An expanded ATLS course (CTLS), to include additional military trauma topics as well as additional skill station training, can improve the results of the postcourse grades.
Adult↗
Combat trauma life support training versus the original advanced trauma life support course: the impact of enhanced curriculum on final student scores.
BACKGROUND: Within a military framework, the trauma course student, a young medical officer, is trained to become a trauma team leader and the first provider of medical aid. By adding battlefield medicine-related subjects to the basic Advanced Trauma Life Support (ATLS) course, as well as exercises tailored to the distinctive demands of military medicine, we could develop a special teaching unit: Combat Trauma Life Support (CTLS). The curriculum is basically the complete unchanged ATLS course of the American College of Surgeons enriched with lectures and practicums to fill the gap between the essentially civilian emergency department character of the ATLS course and the military tasks of the medical officer. PURPOSE OF STUDY: To compare the cognitive knowledge achievements of trauma course participants in the Israel Defence Force Medical Corps and to delineate the impact of the course type on students' written test results. DESIGN: A retrospective comparison analysis of pre- and post-course written test scores of 2,614 physicians who had participated in the ATLS and CTLS courses in the Israel Defence Force School of Military Medicine between 1990 and 1993. RESULTS: The analysis indicated that students who undertook the CTLS course achieved statistically better results in written tests (87.9 +/- 8.7 vs. 79.6 +/- 11.4, R2 = 0.33). CONCLUSIONS: We conclude that the CTLS comprehensive curriculum provides an improved training basis for the complex task of army battlefield trauma care support.
Curriculum↗
The Israeli Diagnostic Center for Malignant Hyperthermia: 7-years' accumulated experience.
Malignant hyperthermia (MH), a rare pharmacogenetic trait, can be lethal when susceptible individuals are exposed to triggering agents during general anesthesia. We present our experience with the caffeine-halothane in vitro contracture test (IVCT) for the diagnosis of malignant hyperthermia susceptibility. Out of 75 patients that were referred for consultation to the MH diagnostic center over a period of 7 years, we performed muscle biopsies and IVCT in 21 patients. A total of 6 patients were found to be MH-positive. Appropriate recommendations for future anesthetic management, and additionally, for testing the immediate family were made following a positive diagnosis. Improved familiarity with the syndrome of MH, and performance of IVCT when family or clinical history suggest malignant hyperthermia susceptibility, are imperative measures to prevent the potential fatality associated with this syndrome.
Academies and Institutes↗
[Anesthesia and postoperative management management of patients with Duchenne's dystrophy].
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Anesthesia↗
[Transport of critically ill patients].
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Critical Illness↗