[A physician-staffed heart ambulance in a rural district. A 1-year trial]. / En laegeassisteret hjerteambulance i et landdistrikt. En etårig forsøgsordning.

A trial period of one year in which the ambulance service for patients with acute cardiac disease was improved is described. This trial took pace in the County of Vestsjaelland in a mixed urban and rural district with five general practices and with more than fifteen kilometres (9.4 miles) to the county hospital. Two ambulance stations were equipped with defibrillators and the staff were trained in their use. The recommendations made by a subcommittee appointed by the Danish Board of Health were thus fulfilled, but, in addition, the general practitioners/doctors-on-duty were connected with the arrangement. They were equipped with radios by which they could communicate with the ambulance stations. If the leader of the ambulance station considered, on the basis of the alarm, that a patient with acute cardiac disease was involved, the doctor-on-duty in the district concerned was contact so that he could come and participate in the treatment unless prevented by other work. An attempt was made to assess the effect of an arrangement such as this on survival of patients, the extent to which medical assistance can be obtained and the extent of the actual medical assistance. During the trial period, 158 turn-outs occurred to the approximately 30,000 population in the district concerned. The total number of emergency ambulance turn-outs was 1,200, 41 of these were patients with clinical cardiac arrest and 56 to patients with other forms of acute cardiac disease. Sixty-one patients were found to have conditions other than cardiac diseases. It proved possible to provide medical assistance in 79% of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pre-hospital care]. / Praehospital behandling.

Organisatory and therapeutic characteristics for selected pre-hospital medical treatment systems are described. It is emphasized that all of the links in the therapeutic chain must function optimally to achieve effective treatment of acute disease and injuries. The importance of rapid decision-making by highly qualified medical staff is emphasized. On the basis of experience from Denmark and from abroad, a model for up-to-date pre-hospital treatment in Denmark is outlined.

Does oral premedication increase the risk of gastric aspiration? A study to compare the effect of diazepam given orally and intramuscularly on the volume and acidity of gastric aspirate.

In a clinical study including 40 patients, who all underwent elective gynaecological surgery, the quantity and acidity of the gastric contents were compared for patients premedicated with diazepam (Apozepam) intramuscularly and orally, respectively. A significant difference was found with regard to both the quantity and acidity of the gastric fluid. The volume of gastric fluid was smaller after oral than after intramuscular premedication with diazepam (1.5 ml and 20 ml, respectively). The acidity of the gastric fluid was also less after oral than after intramuscular premedication (pH 2.4 and 1.8, respectively).

Central haemodynamics during induction of neurolept anaesthesia in patients with arteriosclerotic heart disease.

The haemodynamic changes occurring during induction of neurolept anaesthesia and intubation in patients with reduced cardiac reserve were compared with the haemodynamic changes observed prior to operation during the stress of moderate physical exercise in the same patients. Anaesthesia consisted of droperidolum NFN (Dehydrobenzperidol), fentanyli citras NFN (Haldid) and nitrous oxide-oxygen with suxamethonium for intubation. The haemodynamic parameters measured were mean arterial blood pressure, central venous pressure, pulmonary artery mean pressure, pulmonary capillary wedge pressure and cardiac output. Blood volume was also measured, as were arterial blood-gas tensions and pH. The haemodynamic changes observed during induction with intubation were significantly smaller than those observed preoperatively during exercise.

Anaesthesia for cystoscopy. A comparative study of 3 methods of intravenous anaesthesia: diazepam-fentanyl, thiomebumal and althesin.

Three different methods of anaesthesia for diagnostic cystoscopy are compared in randomly divided series of 100 males each. Group I received diazepam-fentanyl supplemented with Althesin in case of therapeutic transurethral procedures. Group II had thiomebumalnatrium-N2O-O2 and group III had althesin-N2O-O2. Group I had no premedication while the two others were premedicated with morphine-scopolamine mixture. The period during and after anaesthesia was observed independently by the urologist, the anaesthetist, the nurses on the ward and by interviewing the patient the day after the cystoscopy. The anaesthetist was the only one who knew the method to be used. Diazepam-fentanyl proved to give sufficient analgesia. This combination offered the shortest and most uncomplicated period of recovery. Five patients given diazepam-fentanyl remembered the cystoscopy as being painful. All these cases could be related to insufficient coordination of anaesthesia and cystoscopy, which seems to be of major importance for this method.