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90Update in Anaesthesiareducing intracranial pressure. Head injured patients nearlyalways require intravenous fluids (especially after mannitolwhich will dehydrate them), but dextrose will worsencerebral swelling and should not be used. ICP can also bereduced by placing the patient slightly head up (about 20-30 degrees) and avoiding compression or obstruction ofthe neck veins which will worsen intracranial congestion.(Having said that it is important to secure the endotrachealtube well - try taping it in)14. TTFFFNoting pupil size is crucial in the assessment of head injuryso do not dilate the pupils with atropine.15. FFFFTAutoclaving does not work if the instruments have not beengiven a thorough “social” cleaning beforehand. Foreignmatter must be removed from the instruments beforeautoclaving.16. TTTTT17. TTTTT18. FTFTTVentilation of the patient is more important than preventingaspiration - so if cricoid pressure is preventing ventilation,remove it! Decide early that intubation has failed andconcentrate of ventilating the patient until they recoverspontaneous ventilation.19. TTTFT20. TFTTTHigh or low potassium will cause cardiac arrhythmias anddisturbances in balance can occur after a variety of drugsand conditions.
Update in Anaesthesia 91ARTICLE REPRODUCED BY KIND PERMISSION OF IASPPAIN ClinicalUpdatesINTERNATIONAL ASSOCIATION FOR THE STUDY OF PAINVolume VI, Issue 2 July 1998EDITORIAL BOARDEditor-in-ChiefDaniel B. Carr, MDInternal Medicine, Endocrinology,AnesthesiologyUSAAdvisory BoardLars Arendt-Nielsen, PhDNeurophysiologyDenmarkKay Brune, MDPharmacologyGermanyJames R. Fricton, DDS, MSDentistry, Orofacial PainUSAVictoria R. Harding, MCSP, SRP,GradDipPhysPhysical TherapyUnited KingdomAlejandro R. Jadad, MD, PhDAnesthesiology, Evidence-BasedMedicine and Consumer IssuesCanadaIrena Madjar, RGON, PhDNursingAustraliaPatricia A. McGrath, PhDPsychology, Pediatric PainCanadaBengt H. Sjolund, MD, PhDNeurosurgery, RehabilitationSwedenMasaya Tohyama, MD, PhDMolecular BiologyJapanProduction EditorLeslie N. BondUPCOMING ISSUESPain and MemoryPhysiotherapy of PainHeadache SyndromesPain and Rehabilitation from Landmine InjuryInternational pacts such as the Geneva and Ottawa Conventions forbidweapons that cause indiscriminate, unnecessary mutilation 1 . Still, theseweapons are used worldwide and create victims long after peace agreementshave been signed.Pain, particularly phantom limb pain (PLP), is highly prevalent in landminevictims. These victims, often poor and rural, have much to lose from injury anddisability. Relief agencies such as the Red Cross are ill equipped to deal with painproblems, and specialist pain relief organizations such as Douleur Sans Frontièreshave limited resources. The worst-hit countries lack IASP chapters. Healthprofessionals, particularly members of IASP, have a responsibility not only totreat these victims but also, under the ninth item of the IASP constitution, toinform governments and the public about the suffering caused by these weaponsand the measures needed to prevent their use 2–10 .Medical needs are divided between initial acute care and long-term rehabilitationand pain management, particularly of PLP. Many factors, however, may limitcare. Among these are extremes of geography and terrain; dangers of travelduring conflict; and looting of hospitals, sometimes with injury or death ofworkers. There may be great poverty, with poor education and social structures.Health care funding may be inadequate or limited by donor-derived constraints 3 .Medical needs are divided between initial acute care and long-termrehabilitation and pain management, particularly of phantom limb pain.EpidemiologyThe lack of quantitative data precludes a precise and complete account of thehealth effects of landmines, but estimates can be made. The InternationalCommittee of the Red Cross (ICRC) has collected data on immediate injuriesamong mine survivors 5 . Several demographic surveys have tried to document thesocial consequences and frequency of mine-related injuries 8–10 . All available datasuggest that the impact of landmines may be grossly underestimated, as only thefittest survivors reach treatment.Mine injuries. Between 1995 and 1996 the ICRC registered 9384 landminecasualties 3,5 . That accounted for 27 % of surgical patients seen by the ICRC inthree countries. Non-combatants (women, men >50 years, and children
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