Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · Apr 2012
Review Comparative Study[New treatment strategies for intraventricular hemorrhage].
The presence of additional intraventricular hemorrhage (IVH) in patients with intracerebral hemorrhage (ICH) is associated with a much higher mortality and worse functional outcome. Although evidence-based specific treatment options for this entity are still lacking, knowledge about the pathophysiology of IVH has grown in recent decades, leading to the development of promising treatment strategies. ⋯ The influence of these treatment modalities on functional outcome is currently being investigated in ongoing studies. The present article gives an overview of pathophysiological and clinical aspects of IVH, emphasizing novel treatment options.
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Med Klin Intensivmed Notfmed · Apr 2012
Review[Emergency trauma room management in severely and most severely injured patients. A multidisciplinary task].
The treatment of most severely injured patients represents a great challenge for the trauma room team. Besides the time factor, which is a crucial cornerstone of the treatment in general and of the appropriate treatment of life-threatening injuries in particular, minor injuries and non-life-threatening injuries must also be taken into account. ⋯ These concepts allocate the highest treatment priority to injuries that may be immediately fatal for the patient. Besides those life-threatening injuries that are commonly summarised under the term "deathly six", other minor traumas should also be assessed and treated in a structured manner as they may often considerably affect the quality of life after trauma.
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Med Klin Intensivmed Notfmed · Apr 2012
Review[Drug-induced long QT syndrome. Relevancy in intensive care medicine].
QT-prolonging drugs delay ventricular repolarization and, thus, favor the occurrence of Torsade de pointes (TdP). Intensive care patients are particularly endangered to suffer from this clinical picture as they often simultaneously exhibit multiple risk factors. In the following article, the most important risk factors for drug-induced long QT syndrome are described. ⋯ Potential explanations why prolongation of the QT interval is not the main or only factor for the proarrhythmic potential of QT-prolonging drugs are discussed. Furthermore, a summary of QT-prolonging drugs relevant in intensive care units is given and prevention of drug-induced long QT syndrome with consecutive TdP is discussed. Finally, recommendations for treatment of drug-induced TdP are reviewed.
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Non-invasive mechanical ventilation is the preferred method for the treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD). Primary contraindications and stopping criteria must be regarded to avoid delaying endotracheal intubation. The primary interface is usually a nasal-oral mask. ⋯ COPD patients can also benefit from preventive non-invasive ventilation in order to avoid re-intubation after a planned extubation. Domiciliary nocturnal non-invasive ventilation is an option for some patients with COPD in chronic hypercapnic respiratory failure. This treatment should be established in a specialised unit.
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Med Klin Intensivmed Notfmed · Apr 2012
Case Reports[Veno-arterial ECMO as bridge to recovery. Cardiogenic shock and suspected myocarditis in a 37-year-old patient].
We report a case of a 37-year-old patient presenting with fulminant cardiogenic shock, almost noncontractile ventricles, followed by electromechanical dissociation. During performance of cardiopulmonary resuscitation, a veno-arterial extracorporeal membrane oxygenation device (VA ECMO) was implanted, which became necessary for 13 days. ⋯ A rapid test for respiratory syncytial virus was positive, supporting the suspected diagnosis of myocarditis. Despite numerous complications, complete recovery was achieved.