Medizinische Klinik, Intensivmedizin und Notfallmedizin
-
Med Klin Intensivmed Notfmed · Mar 2016
Review[The supraglottic airway in the prehospital setting].
The supraglottic airway (SGA) is increasingly considered as a more effective alternative for emergency ventilation compared to bag mask ventilation and is propagated as an "easily" manageable method, compared to endotracheal intubation especially under the often adverse out-of-hospital conditions. Since the skill can easily be acquired during mannequin training, more and more rescue services train their personnel in the use of SGA devices and allow or even recommend their application also by nonphysicians. This recommendation, however, is not unequivocally supported by properly designed and conducted trials. ⋯ They may, however, be accepted as an addendum to other prehospital ventilation approaches. The SGA airway comprises various problems and inherited risks similar to other ventilation techniques. Randomized studies investigating different techniques for prehospital emergency ventilation are lacking, as are controlled studies comparing SGA devices.
-
Pulmonary embolism is a potentially fatal disorder and frequently seen in critical care and emergency medicine. Due to a high mortality rate within the first few hours, the accurate initiation of rational diagnostic pathways in patients with suspected pulmonary embolism and timely consecutive treatment is essential. ⋯ Special focus is put on a structured patient management based on the individual risk of early mortality. In particular risk assessment and new risk-adjusted treatment recommendations are presented and discussed in this article.
-
Med Klin Intensivmed Notfmed · Mar 2016
Review[Ventilation as a trigger for organ dysfunction and sepsis].
Both in the intensive care setting and during surgery, mechanical ventilation plays an important role in the treatment of critically ill patients with lung injury, but also in lung healthy patients. Mechanical ventilation is noncurative and is accompanied by various severe side effects. It is hypothesized that multiorgan failure can be induced by mechanical ventilation. ⋯ In particular, the activation of specific cells and cell programs in peripheral organs is an important step on the way to multiorgan failure. In addition to bidirectional connection between the lung and brain, nonprotective ventilation leads to cell apoptosis in the kidney and intestine and leads to an increase of biomarkers for organ dysfunction. It is believed that both inflammation mediators and pro-apoptotic factors are responsible for organ dysfunction.
-
Med Klin Intensivmed Notfmed · Mar 2016
Multicenter Study[End-of-life decisions and practices in critically ill patients in the cardiac intensive care unit : A nationwide survey].
Ethical and medical criteria in the decision-making process of withholding or withdrawal of life support therapy in critically ill patients present a great challenge in intensive care medicine. ⋯ In critically ill cardiac surgery patients, medical reasons which influence the decision-making process for changing the aim of therapy included cCT with poor prognosis, multi-organ failure, and failure of assist device therapy. Further studies are mandatory in order to be able to provide adequate answers to this difficult topic.
-
Med Klin Intensivmed Notfmed · Mar 2016
Comparative Study[Triage in emergency departments : Comparative evaluation of 4 international triage systems].
Facing increasing pressure emergency departments have to replace the previously unstructured approach used to document incoming patients by a standardized quick method, which allows easy documentation of the results. ⋯ In the current situation and circumstances in German emergency departments best usability and maximum safety seems to be promised by the Manchester Triage System. Legal and structural requirements are taken into consideration by this system. Of particular advantage of the system is the international and national networking, which enables the integration of international developments and experience.