Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · Feb 2012
Review Comparative Study[Triage systems in the emergency department].
Emergency department (ED) triage systems facilitate the categorization of emergency patients according to their disease severity and determine both treatment priority and treatment location. Four different five-level triage systems are internationally accepted. The Australasian Triage Scale (ATS, Australasia) allows categorization based on symptoms using specific descriptors. ⋯ The Canadian Triage and Acuity Scale (CTAS, Canada) is based on the ATS, but also includes diagnoses. The Emergency Severity Index (ESI, USA) first excludes life-threatening and severe disease before stratification according to estimated resource utilization. The goal of all triage systems is to reduce the in-hospital mortality and to minimize time to treatment, length of stay, and resource utilization.
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Med Klin Intensivmed Notfmed · Feb 2012
Comparative StudyMicrobial diagnostics in patients with presumed severe infection in the emergency department.
Sepsis in the early stage is a common disease in emergency medicine, and rapid diagnosis is essential. Our aim was to compare pathogen diagnosis using blood cultures (BC) and the multiplex polymerase chain reaction (PCR) test.Methods. At total of 211 patients admitted to the multidisciplinary emergency department of our university hospital between 2006 and 2009 with suspected severe infection from any origin were studied. Blood samples for BC (aerobic and anaerobic) and multiplex PCR were taken for identification of infectious microorganisms immediately after hospital admission. Results of the BC and PCR correlated with procalcitonin concentration (PCT) and clinical diagnosis of sepsis (≥2 positive SIRS criteria) as well as with severity of disease at admission and with clinical outcome measures. ⋯ In patients admitted with suspected severe infection, a high percentage of positive BC and PCR were observed. Positive findings in the PCR correlate with elevated levels of PCT and high APACHE II scores.
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Med Klin Intensivmed Notfmed · Feb 2012
Review[Monitoring of organ functions. Dysfunction of kidneys, liver, gastrointestinal tract, and coagulation].
Monitoring of organ function is one of the core tasks of intensive care medicine. Although various monitoring devices and parameters have already been established for some organs, there are no or only few conditionally useful parameters or scores available for the kidneys, liver, gastrointestinal tract, and blood coagulation. Therefore, specific biomarkers and scores as well as combinations of both are currently investigated for better monitoring of these organs. This article gives a critical overview of currently used as well as investigational biomarkers, tests and scores in general, and shows some examples of the implications for common diseases, clinical situations and constellations in the intensive care unit.
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Cardiac biomarkers in intensive care medicine are an excellent complement to existing clinical and diagnostic information in specific diseases. Due to their lack of specificity, the diagnostic properties of common cardiac biomarkers, such as natriuretic peptides and cardiac troponins, remain ambiguous, while their prognostic value has already been proven. In addition, there are several promising new biomarkers that might contribute to a "multimarker strategy" in the critically ill patient in the future, but further evaluation is still required.
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Patients suffering from septic shock often present with not only severe reduction of afterload induced by vasodilation but are also affected by sepsis-induced cardiac dysfunction. Elevated troponin levels, which are typically not caused by coronary ischemia, may indicate septic cardiomyopathy which is characterized both by altered systolic function as well as by disturbances in the regulation of heart rate and heart rate variability. The latter findings are based not only on the dysfunction of the autonomous nervous system but are also the result of the direct interaction of endotoxins with cardiac pacemaker cells. ⋯ Therapy of septic shock (and thereby septic cardiomyopathy) is based on the well-known causative, supportive, and adjunctive strategies. Stabilization of cardiac function is assured by volume resuscitation (including blood transfusion) and inotropic support (dobutamine). Further specific therapeutic approaches have not yet been established.