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An unstructured observation concerning low rates of observed psychological disturbance was explored by estimating rates of suicide, and psychotropic drug use. Recorded suicide, overdose, and ‘minor’ tranquilliser and antidepressant use were strikingly low on Tobago, when compared with the United Kingdom. Tobagonians were unlikely to medicalise distress by presenting with overt psychological symptoms. Most local doctors felt that patients preferred spiritual support, e.g. from charismatic religious groups and traditional healers (some using obeah). A rich network of social and recreational groups may also give important support, as may ‘liming’ (a local conversational pastime). Tabanka (a local culture specific syndrome) may also be a non-medical outlet.
The concept of using Intravenous Regional Analgesia (IVRA) in the mass casualty situation is potentially an attractive alternative to the use of general anesthesia in the management of limb fractures. The purpose of this paper is to outline the history and development of the technique and emphasize important guidelines designed to increase the safety of the method.
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