Exertional heat stroke (EHS) is one of the most common causes of sudden death in athletes. It also represents a unique medical challenge to the prehospital healthcare provider due to the time sensitive nature of treatment. In cases of EHS, when cooling is delayed, there is a significant increase in organ damage, morbidity, and mortality after 30 minutes, faster than the average EMS transport and ED evaluation window. The purpose of this document is to present a paradigm for prehospital healthcare systems to minimize the risk of morbidity and mortality for EHS patients. With proper planning, EHS can be managed successfully by the prehospital healthcare provider.
The purpose of this study was to compare the electromyographic (EMG) behavior of the triceps surae (TS), tibialis anterior (TA), quadriceps and hamstring muscles of the lower limbs during self-initiated free gait in a group of patients (n = 15) with Parkinson's disease (PD), when OFF and ON L-Dopa, with that of normal controls. When OFF L-Dopa, we observed qualitative disturbances in muscle activation patterns, such as an absence or extreme reduction in TA activations in early stance or during the early and late swing phases. Other disturbances included flatter profiles of the TS activation burst at push off, and temporal alterations that included prolonged activation of the proximal muscles during the stance phase. Statistical analysis showed that the TA was the most affected muscle in most of the patients particularly during the activation burst in late swing (p < .0004). After medication (ON L-Dopa), the amplitude and timing of distal muscle activations became more similar to normal values, with the increase in EMG amplitude being dramatic in some patients. In the proximal muscles, the effects on EMG amplitude were less marked and prolonged activation often persisted even after the administration of L-Dopa.
Résumé
Fatigué d'une pratique hospitalière inefficace dans le traitement psychothérapique des psychoses, un psychiatre fonde avec des travailleurs de la santé une communauté thérapeutique où sont reçus de préférence des schizophrènes. L'auteur résume l'établissement, le fonctionnement, les difficultés et les résultats de cette entreprise vécue sur une période de dix ans. Il croit que le partage quotidien d'un même mode de vie est thérapeutique et favorise la réadaptation au monde extérieur. De plus c'est un enrichissement partagé où aidant et aidé apprennent l'un de l'autre.
The author describes the changing aspects of schizophrenia. It seems that the paranoid and atypical forms are more frequent while catatonia is decreasing in frequency. As a consequence, the prognosis seems to be better and the treatment has had to evolve. The author feels that the greater knowledge of the psychology of the ego that psychiatrists have and the better understanding that is imparted to the family members, plus the physiological effects of the new drugs are responsible for this better prognosis.
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