lunes, 25 de septiembre de 2017

México está de pie

Septiembre 22, 2017. No. 2819





No obstante la destrucción en muchos sitios de México por los huracanes y los sismos recientes, nuestro país sigue recuperándose gracias a millares de muestras solidarias de apoyo entre cada mexicano y personas allende de nuestras fronteras que, trabajando codo con codo, han ido rescatando a cientos de personas donde la muerte se hacía inminente.
Tenemos una sola meta y el camino para alcanzarla está lleno de sonrisas, apoyos y obstáculos. México está de pie, y en esta ocasión más unido que nunca. Mil gracias por darnos su apoyo.

Despite the destruction in many places of Mexico due to recent hurricanes and earthquakes, our country continues to recover thanks to thousands of solidarity samples of support between each Mexican and people beyond our borders who, working side by side, have been rescuing hundreds of people where death was imminent.
We have only one goal and the way to reach it is full of smiles, supports and obstacles. Mexico is standing, and this time more united than ever. Thank you for giving us your help.

Apesar da destruição em muitos lugares do México devido a furacões e terremotos recentes, nosso país continua a recuperar graças a milhares de amostras solidárias de apoio entre cada mexicano e pessoas além de nossas fronteiras que, trabalhando lado a lado, estão resgatando centenas de pessoas onde a morte era iminente.
Temos apenas um objetivo e a maneira de alcançá-lo é cheia de sorrisos, apoios e obstáculos. O México está de pé, e desta vez mais unido do que nunca. Obrigado por nos dar sua ajuda.

En dépit de la destruction dans de nombreux endroits du Mexique en raison des récents ouragans et tremblements de terre, notre pays continue de se remettre grâce à des milliers d'échantillons de solidarité entre chaque Mexicain et des personnes au-delà de nos frontières qui, travaillant côte à côte, ont sauvé des centaines des personnes où la mort était imminente.
Nous n'avons qu'un seul objectif et la façon de l'atteindre est pleine de sourires, de soutiens et d'obstacles. Le Mexique est debout, et cette fois plus unis que jamais. Merci de nous avoir donné votre aide.

Enlaces para donar / Links to donate
Utilización de los servicios médicos de emergencia de helicópteros en la respuesta médica temprana a incidentes graves: una revisión sistemática de la literatura.
Utilisation of helicopter emergency medical services in the early medical response to major incidents: a systematic literature review.
BMJ Open. 2016 Feb 9;6(2):e010307. doi: 10.1136/bmjopen-2015-010307.
Abstract
OBJECTIVE:This systematic review identifies, describes and appraises the literature describing the utilisation of helicopter emergency medical services (HEMS) in the early medical response to major incidents. SETTING: Early prehospital phase of a major incident. DESIGN: Systematic literature review performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Web of Science, PsycINFO, Scopus, Cinahl, Bibsys Ask, Norart, Svemed and UpToDate were searched using phrases that combined HEMS and 'major incidents' to identify when and how HEMS was utilised. The identified studies were subjected to data extraction and appraisal. RESULTS: The database search identified 4948 articles. Based on the title and abstract, the full text of 96 articles was obtained; of these, 37 articles were included in the review, and an additional five were identified by searching the reference lists of the 37 articles. HEMS was used to transport medical and rescue personnel to the incident and to transport patients to the hospital, especially when the infrastructure was damaged. Insufficient air traffic control, weather conditions, inadequate landing sites and failing communication were described as challenging in some incidents. CONCLUSIONS: HEMS was used mainly for patient treatment and to transport patients, personnel and equipment in the early medical management of major incidents, but the optimal utilisation of this specialised resource remains unclear. This review identified operational areas with improvement potential. A lack of systematic indexing, heterogeneous data reporting and weak methodological design, complicated the identification and comparison of incidents, and more systematic reporting is needed.
La reforma sanitaria en México: antes y después de los terremotos de 1985.
The health care reform in Mexico: before and after the 1985 earthquakes.
Am J Public Health. 1986 Jun;76(6):673-80.
Abstract
The earthquakes that hit Mexico City in September 1985 caused considerable damage both to the population and to important medical facilities. The disaster took place while the country was undertaking a profound reform of its health care system. This reform had introduced a new principle for allocating and distributing the benefits of health care, namely, the principle of citizenship. Operationally, the reform includes an effort to decentralize the decision-making authority, to modernize the administration, to achieve greater coordination within the health sector and among sectors, and to extend coverage to the entire population through an ambitious primary care program. This paper examines the health context in which the reform was taking place when the September earthquakes hit. After presenting the damages caused by the quakes, the paper analyzes the characteristics of the immediate response by the health system. Since many facilities within the system were severely damaged, a series of options for reconstruction are posited. The main lesson to be learned from the Mexican case is that cuts in health care programs are not the inevitable response to economic or natural crises. On the contrary, it is precisely when the majority of the population is undergoing difficulties that a universal and equitable health system becomes most necessary.
Los ciclones tropicales en un año de aumento de las temperaturas mundiales y un fortalecimiento de El Niño.
Tropical cyclones in a year of rising global temperatures and a strengthening El Niño.
Disaster Health. 2015 Nov 16;2(3-4):151-162. doi: 10.1080/21665044.2014.1111722. eCollection 2014 Jul-Dec.
Abstract
The year 2015 is notable for the coincidence of several strong climate indicators that having bearing on the occurrence and intensity of tropical cyclones worldwide. This year, 2015, is clearly on track to become the warmest on record in terms of global temperatures. During the latter half of 2015, a very strong El Niño has formed and is predicted to build impressively, perhaps rivaling the memorable El Niño of 1997/1998. Warm Pacific Ocean temperatures, coupled with a strengthening El Niño, have supported the proliferation of Western North Pacific basin typhoons and Eastern/Central North Pacific Hurricanes. Most notable among these, Hurricane Patricia formed on October 20, 2015 and experienced extremely rapid intensification to become the strongest hurricane in the history of the Western Hemisphere and then weakened just as abruptly before dissipating on October 24, 2015. Rather than an aberration, these climate patterns of 2015 represent an ongoing trend with implications for the disaster health of coastal populations worldwide.
KEYWORDS: ENSO; El Niño; accumulated cyclone energy (ACE); climate change; hurricanes; temperature anomalies; tropical cyclones; typhoons
Variabilidad Intrabasin de los Ciclones Tropicales del Pacífico Este durante el ENSO Regulado por los Vientos de Intervalo Centroamericanos
Intrabasin Variability of East Pacific Tropical Cyclones During ENSO Regulated by Central American Gap Winds.
Fu D1,2, Chang P3,4,5, Patricola CM6,7.
Sci Rep. 2017 May 10;7(1):1658. doi: 10.1038/s41598-017-01962-3.Abstract
Hurricane Patricia in 2015 was the strongest Pacific hurricane to make landfall in Mexico. Although Patricia fortuitously spared major cities, it reminded us of the threat tropical cyclones (TCs) pose in the eastern North Pacific (ENP) and the importance of improving our understanding and prediction of ENP TCs. Patricia's intensity and the active 2015 ENP hurricane season have been partially attributed to the strong El Niño in 2015, however there is still a lack of fundamental understanding of the relationship between El Niño-Southern Oscillation (ENSO) and ENP TCs. Here, we demonstrate that ENSO drives intrabasin variability of ENP TCs, with enhanced (reduced) TC frequency in the western portion of the ENP during El Niño (La Niña), but reduced (enhanced) TC frequency in the eastern nearshore area, where landfalling TCs preferentially form. This intrabasin difference is primarily driven by the Central American Gap Winds (CAGW), which intensify (weaken) during El Niño (La Niña), producing low-level anticyclonic (cyclonic) relative vorticity anomalies and thus an unfavorable (favorable) environment for TC genesis. These findings shed new light on the dynamics linking ENP TC activity to ENSO, and highlight the importance of improving CAGW representation in models to make skillful seasonal forecasts of ENP TCs.

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Medwave edición septiembre 2017

Medwave edición septiembre 2017
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ESTUDIO PRIMARIO
Etiquetas prediseñadas para prevenir errores de medicación en pacientes hospitalizados: estudio cuasi-experimental
Etiquetas prediseñadas para prevenir errores de medicación en pacientes hospitalizados: estudio cuasi-experimental
María Fernanda Morales-González, María Alejandra Galiano Gálvez (Chile)
Medwave 2017 Sep;17(8):e7038
REPORTE DE CASO
Proteinosis alveolar pulmonar: a propósito de un caso
Luis Alberto Concepción-Urteaga, Luis Alejandro Rodríguez-Hidalgo, Jorge Luis Cornejo-Portella, Oscar Neri Alquizar-Horna, Daniel Anderson Aguilar-Villanueva, Marcio José Concepción-Zavaleta, Mario Gustavo Azañero-Luján (Perú)
Medwave 2017 Sep;17(8):e7040

 Proteinosis alveolar pulmonar: a propósito de un caso
PRÁCTICA CLÍNICA
Problemáticas de salud bucodental en personas con trastornos mentales
 Problemáticas de salud bucodental en personas con trastornos mentales
Julio Torales, Iván Barrios, Israel González (Paraguay)
Medwave 2017 Sep;17(8):7045

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Neumoperitoneo / Pneumoperitoneum

Septiembre 25, 2017. No. 2822



  


CTCT-20170914_102711 a.m.
Efectos fisiológicos del neumoperitoneo en la obesidad mórbida
The physiologic effects of pneumoperitoneum in the morbidly obese.
Ann Surg. 2005 Feb;241(2):219-26.
Abstract
OBJECTIVE: To review the physiologic effects of carbon dioxide (CO2) pneumoperitoneum in the morbidly obese. SUMMARY BACKGROUND DATA: The number of laparoscopic bariatric operations performed in the United States has increased dramatically over the past several years. Laparoscopic bariatric surgery requires abdominal insufflation with CO2 and an increase in the intraabdominal pressure up to 15 mm Hg. Many studies have demonstrated the adverse consequences of pneumoperitoneum; however, few studies have examined the physiologic effects of pneumoperitoneum in the morbidly obese. METHODS: A MEDLINE search from 1994 to 2003 was performed using the key words morbid obesity, laparoscopy, bariatric surgery, pneumoperitoneum, and gastric bypass. The authors reviewed papers evaluating the physiologic effects of pneumoperitoneum in morbidly obese subjects undergoing laparoscopy. The topics examined included alteration in acid-base balance, hemodynamics, femoral venous flow, and hepatic, renal, and cardiorespiratory function. RESULTS: Physiologically, morbidly obese patients have a higher intraabdominal pressure at 2 to 3 times that of nonobese patients. The adverse consequences of pneumoperitoneum in morbidly obese patients are similar to those observed in nonobese patients. Laparoscopy in the obese can lead to systemic absorption of CO2 and increased requirements for CO2 elimination. The increased intraabdominal pressure enhances venous stasis, reduces intraoperative portal venous blood flow, decreases intraoperative urinary output, lowers respiratory compliance, increases airway pressure, and impairs cardiac function. Intraoperative management to minimize the adverse changes include appropriate ventilatory adjustments to avoid hypercapnia and acidosis, the use of sequential compression devices to minimizes venous stasis, and optimize intravascular volume to minimize the effects of increased intraabdominal pressure on renal and cardiac function. CONCLUSIONS: Morbidly obese patients undergoing laparoscopic bariatric surgery are at risk for intraoperative complications relating to the use of CO2 pneumoperitoneum. Surgeons performing laparoscopic bariatric surgery should understand the physiologic effects of CO2 pneumoperitoneum in the morbidly obese and make appropriate intraoperative adjustments to minimize the adverse changes.
Paro cardiaco asociado con embolismo gaseoso por bióxido de carbono durante cirugía laparoscópica para cáncer colorrectal y metástasis hepáticas. Informe de caso
Cardiac arrest associated with carbon dioxide gas embolism during laparoscopic surgery for colorectal cancer and liver metastasis -A case report-.
Korean J Anesthesiol. 2012 Nov;63(5):469-72. doi: 10.4097/kjae.2012.63.5.469. Epub 2012 Nov 16.
Abstract
Clinically apparent carbon dioxide (CO(2)) gas embolism is uncommon, but it may be a potentially lethal complication if it occurs. We describe a 40-year-old woman who suffered a CO(2) gas embolism with cardiac arrest during laparoscopic surgery for colorectal cancer and liver metastasis. Intra-abdominal pressure was controlled to less than 15 mmHg during CO(2) gas pneumoperitoneum. The right hepatic vein was accidentally disrupted during liver dissection, and an emergent laparotomy was performed. A few minutes later, the end-tidal CO(2) decreased, followed by bradycardia and pulseless electrical activity. External cardiac massage, epinephrine, and atropine were given promptly. Ventilation with 100% oxygen was started and the patient was moved to the Trendelenburg position. Two minutes after resuscitation was begun, a cardiac rhythm reappeared and a pulsatile arterial waveform was displayed. A transesophageal echocardiogram showed airbubbles in the right pulmonary artery. The patient recovered completely, with no cardiopulmonary or neurological sequelae.
KEYWORDS: Carbon dioxide gas embolism; Laparoscopic surgery; Transesophageal echocardiography
La eficacia de la dexmedetomidina intravenosa en la hemodinámica perioperatoria, requerimientos de analgésicos y perfil de efectos secundarios en pacientes sometidos a cirugía laparoscópica bajo anestesia general.
The Effectiveness of Intravenous Dexmedetomidine on Perioperative Hemodynamics, Analgesic Requirement, and Side Effects Profile in Patients Undergoing Laparoscopic Surgery Under General Anesthesia.
Anesth Essays Res. 2017 Jan-Mar;11(1):72-77. doi: 10.4103/0259-1162.200232.
Abstract
BACKGROUND: There is an upward surge in the use of laparoscopic surgeries due to various advantages when compared to open surgeries. Major advantages are, due to small incisions which are cosmetically acceptable and most of them are now daycare procedures. Problem of economic burden and hospital bed occupancy has been overcome with laparoscopic surgeries. All these advantages are not free from disadvantages, as hemodynamic changes such as hypertension; tachycardia and other surgical-related complications are commonly observed intraoperatively. Dexmedetomidine is one of the α2 agonist drugs which acts at both supraspinal and spinal level and modulate the transmission of nociceptive signals in the central nervous system. The basic effect of dexmedetomidine on the cardiovascular system is to decrease the heart rate and systemic vascular resistance with additional feature of opioid sparing effect. This drug has become an ideal adjuvant during general anesthesia, especially when stress is expected. Hence, the drug was studied in laparoscopic surgeries. AIMS AND OBJECTIVES: (a) To study the effect of dexmedetomidine on hemodynamic parameters during perioperative period in patients undergoing laparoscopic surgery. (b) To study the postoperative sedation score and analgesic requirement. (c) To study the side effect profile of dexmedetomidine. SETTINGS AND DESIGN:
Randomized double blind controlled trial. SUBJECTS AND METHODS: After obtaining the Institutional Ethical Clearance, the study was conducted. Forty patients of American Society of Anesthesiologists Class I and II were enrolled in this randomized study. The patients were randomly divided into two groups; group normal saline (NS) and group dexmedetomidine. Patient received either NS or dexmedetomidine in group NS and group dexmedetomidine, respectively, depending upon the allocation. The infusion rate was adjusted according to; loading dose (1 μg/kg) over 10 min and maintenance dose (0.5 μg/kg/h) and perioperative hemodynamics was recorded. Routine general anesthesia was administered in all the patients with conventional technique without deviating from institutional protocols. Postoperatively, Rasmsay sedation score, time taken for request of first analgesic dose, and side effects if any were recorded. STATISTICAL ANALYSIS USED: The categorical factors are represented by the number and frequency (%) of cases. The continuous variables are represented by measures of central frequency and standard deviation. The statistical analysis was done by using unpaired t-test and Chi-square. P < 0.05 was considered statistically significant. RESULTS: Significant hemodynamic changes are observed in NS group during laryngoscopy, intubation, during pneumoperitoneumformation, and during extubation. Hemodynamic stress response in dexmedetomidine group was significantly attenuated. Analgesic requirement during postoperative 24 h were much less in dexmedetomidine group when compared to NS group. No significant side effects were noted except for bradycardia; which was observed in two cases of dexmedetomidine group. CONCLUSION: Dexmedetomidine infusion in the dose of 1 μg/kg body weight as bolus over 10 min and 0.5 μg/kg/h intraoperatively as maintenance dose controlled the hemodynamic stress response in patients undergoing laparoscopic surgery. Use of dexmedetomidine extends the pain free period postoperatively and thereby reducing total analgesic requirement. Thus, dexmedetomidine can be utilized as an ideal anesthetic adjuvant during laparoscopic surgeries.
KEYWORDS: Analgesia; dexmedetomidine; laparoscopic surgery; sedation; α2 agonist

XIV Congreso Virtual Mexicano de Anestesiología 2017
Octubre 1-Diciembre 31, 2017
Información / Information
XXVII Congreso Peruano de Anestesiología
Lima, Noviembre 2-4, 2017
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domingo, 24 de septiembre de 2017

Libros sobre desastres naturales / Books on natural disasters

Septiembre 24, 2017. No. 2821





Los huracanes Katia, Irma y José han sido devastadores en los países del Caribe, y su fuerza destructiva ha llegado al continente americano afectando a México y Estados Unidos de Norteamérica. María es otro de los 27 huracanes que se esperan en México para este 2017.
Nuestro país está ubicado en una zona de riesgo sísmico al estar sobre cuatro placas tectónicas: Caribe, Norteamérica, Nazca y Cocos por lo cual cada día se registran más de 15 temblores de magnitud superior a 2. La combinación de los desastres por los ciclones y los sismos frecuentes nos ha puesto a prueba, prueba que vamos superando gracias a nuestra forma de ser, al cariño entre mexicanos que nos brindamos apoyo total aun sin conocernos y desde luego, al gran apoyo internacional que México ha recibido.
Con este envío agradecemos las muestras de empatía y los apoyos que los mexicanos hemos recibido durante esta crisis nacional. ¡Dios les bendiga!

Hurricanes Katia, Irma and Jose have been devastating in the Caribbean countries, and their destructive force has reached the American continent affecting Mexico and the United States of America. María is another of the 27 hurricanes expected in Mexico for this 2017. Our country is in an area of seismic risk because it is on four tectonic plates: Caribbean, North America, Nazca and Cocos, whereby every day more than 15 tremors of magnitude higher than 2 are registered. The combination of cyclone disasters and frequent earthquakes has tested us, proves that we are surpassing thanks to our way of being, to the affection among Mexicans that we give ourselves full support even without knowing ourselves and of course, the great international support that Mexico has received.
With this e-mail we are grateful for the signs of empathy and support that Mexicans have received during this national crisis. God bless you!

Os furacões Katia, Irma e José foram devastadores nos países do Caribe e sua força destrutiva atingiu o continente americano afetando o México e os Estados Unidos da América. María é outro dos 27 furacões esperados no México para este ano de 2017. Nosso país está localizado em uma zona de risco sísmico porque está em quatro placas tectônicas: Caribe, América do Norte, Nazca e Cocos, onde todos os dias são registados mais de 15 tremores de magnitude superiores a 2.
A combinação de catástrofes e terremotos freqüentes nos testou, prova que estamos superando graças ao nosso modo de ser, ao afeto entre os mexicanos que nos damos todo o suporte, mesmo sem nos conhecer e, claro, o grande apoio internacional que O México recebeu.
Com este envio, agradecemos os sinais de empatia e apoio que os mexicanos receberam durante esta crise nacional. Deus os abençoe!

Els huracans Katia, Irma i José han estat devastadors en els països del Carib, i la seva força destructiva ha arribat al continent americà afectant Mèxic i Estats Units d'Amèrica del Nord. Maria és un altre dels 27 huracans que s'esperen a Mèxic per a aquest 2017. El nostre país està ubicat en una zona de risc sísmic a l'estar sobre quatre plaques tectòniques: Carib, Amèrica del Nord, Nazca i Cocos per la qual cosa cada dia es registren més de 15 tremolors de magnitud superior a 2.
La combinació dels desastres pels ciclons i els sismes freqüents ens ha posat a prova, prova que anem superant gràcies a la nostra manera de ser, a l'afecte entre mexicans que ens brindem suport total i tot sense conèixer-nos i per descomptat, al gran suport internacional que Mèxic ha rebut.
Amb aquesta tramesa agraïm les mostres d'empatia i els suports que els mexicans hem rebut durant aquesta crisi nacional. Déu els beneeixi!
Enlaces para donar / Links to donate
Investigación y Análisis de Sismos - Estudios Estadísticos, Observaciones y Planificación
Earthquake Research and Analysis - Statistical Studies, Observations and Planning
Edited by Sebastiano D'Amico, ISBN 978-953-51-0134-5, 470 pages, Publisher: InTech, Chapters published March 02, 2012 under CC BY 3.0 license
DOI: 10.5772/2461
Edited Volume
The study of earthquakes plays a key role in order to minimize human and material losses when they inevitably occur. 
Chapters in this book will be devoted to various aspects of earthquake research and analysis. The different sections present in the book span from statistical seismology studies, the latest techniques and advances on earthquake precursors and forecasting, as well as, new methods for early detection, data acquisition and interpretation. The topics are tackled from theoretical advances to practical applications.
Investigación y Análisis de terremotos - Sismología, Sismotectonica y Geología de terremotos
Earthquake Research and Analysis - Seismology, Seismotectonic and Earthquake Geology
Edited by Sebastiano D'Amico, ISBN 978-953-307-991-2, 416 pages, Publisher: InTech, Chapters published February 08, 2012 under CC BY 3.0 license
DOI: 10.5772/1117
Edited Volume
This book is devoted to different aspects of earthquake research. 
Depending on their magnitude and the placement of the hypocenter, earthquakes have the potential to be very destructive. Given that they can cause significant losses and deaths, it is really important to understand the process and the physics of this phenomenon. This book does not focus on a unique problem in earthquake processes, but spans studies on historical earthquakes and seismology in different tectonic environments, to more applied studies on earthquake geology.
Avances en la Investigación de Huracanes - Modelado, Meteorología, Preparación e Impactos
Advances in Hurricane Research - Modelling, Meteorology, Preparedness and Impacts
Edited by Kieran Hickey, ISBN 978-953-51-0867-2, 206 pages, Publisher: InTech, Chapters published December 05, 2012 under CC BY 3.0 license
DOI: 10.5772/3399
Edited Volume
This book provides a wealth of new information, ideas and analysis on some of the key unknowns in hurricane research. 
Topics covered include the numerical prediction systems for tropical cyclone development, the use of remote sensing methods for tropical cyclone development, a parametric surface wind model for tropical cyclones, a micrometeorological analysis of the wind as a hurricane passes over Houston, USA, the meteorological passage of numerous tropical cyclones as they pass over the South China Sea, simulation modelling of evacuations by motorised vehicles in Alabama, the influence of high stream-flow events on nutrient flows in the post hurricane period, a reviews of the medical needs, both physical and psychological of children in a post hurricane scenario and finally the impact of two hurricanes on Ireland. Hurricanes discussed in the various chapters include Katrina, Ike, Isidore, Humberto, Debbie and Charley and many others in the North Atlantic as well as numerous tropical cyclones in the South China Sea.
Desastres naturales
Natural Disasters
Edited by Sorin Cheval, ISBN 978-953-51-0188-8, 166 pages, Publisher: InTech, Chapters published March 02, 2012 under CC BY 3.0 license
DOI: 10.5772/1373
Edited Volume
The crossroads between a more and more populated human communities and their changing environment pose different challenges than ever before. 
Therefore, any attempt to identify and deliver possible solutions is more than welcome. The book Natural Disasters addresses the needs of various users, interested in a better understanding of hazards and their more efficient management. It is a scientific enterprise tackling a variety of natural hazards potentially deriving into disasters, i.e. tropical storms, avalanches, coastal floods. The case studies presented cover different geographical areas, and they comprise mechanisms for being transferred to other spots and circumstances. Hopefully, the book will be beneficial to those who invest their efforts in building communities resilient to natural disasters.
Trastornos de estrés postraumático en un contexto global
Post Traumatic Stress Disorders in a Global Context
Edited by Emilio Ovuga, ISBN 978-953-307-825-0, 298 pages, Publisher: InTech, Chapters published January 20, 2012 under CC BY 3.0 license
DOI: 10.5772/1281
Edited Volume
If, as a health care or social service provider, one was called upon to help someone who has experienced terror in the hands of a hostage taker, an irate and chronically abusive spouse or parent, or a has survived a motor vehicle accident, landslide, earthquake, hurricane or even a massive flood, what would be one's priority response? 
What would be considered as the most pressing need of the individual requiring care? Whatever the answer to each of these questions, people who have experienced terror, suffer considerable psychological injury. Post-Traumatic Stress Disorder in a Global Context offers some answers to meet the needs of health care and socials service providers in all settings, whether in a hospital emergency room, at the war front, or natural disaster site. The take home message is, after providing emergency care, there is always a pressing need to provide mental health care to all victims of traumatic stress.
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Anestesiología y Medicina del Dolor

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