Management of blast injuries and shock lung.

Purpose Of Review: Blast injuries have always occurred both in civilian life and as acts of war or terrorism. Nowadays, the risk of being involved in an explosion has increased even for those living in countries with no previous experience of such events. It is our intention that this review is of assistance to those providing emergency/critical care to patients who have sustained blast injuries.

Clinical review: communication and logistics in the response to the 1998 terrorist bombing in Omagh, Northern Ireland.

The Omagh bombing in August 1998 produced many of the problems documented in other major incidents. An initial imbalance between the demand and supply of clinical resources at the local hospital, poor information due to telecommunication problems, the need to triage victims and the need to transport the most severely injured significant distances were the most serious issues. The Royal Group Hospitals Trust (RGHT) received 30 severely injured secondary transfers over a 5-hour period, which stressed the hospital's systems even with the presence of extra staff that arrived voluntarily before the hospital's major incident plan was activated.

Optimum sedation and analgesia in critical illness: we need to keep trying.

Many studies have documented patients' distressing recollections of the intensive care unit (ICU). The study by van de Leur and colleagues, conducted in a group of surgical ICU patients with moderate severity of sickness, found that the frequency of such unpleasant memories was increased in those able to recall factual information about their stay in the ICU. The study did not include sedation scoring but it did use a simple tool to assess factual recall.