Medizinische Klinik, Intensivmedizin und Notfallmedizin
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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.
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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.
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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.
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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.
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Med Klin Intensivmed Notfmed · Mar 2016
[Early mobilization : Competencies, responsibilities, milestones].
Early mobilization is an evident, interprofessional concept to improve the outcome of intensive care patients. It reduces psychocognitive deficits and delirium and attenuates a general deconditioning, including atrophy of the respiratory pump and skeletal muscles. In this regard the interdisciplinary approach of early mobilization, taking into account different levels of mobilization, appears to be beneficial. The purpose of this study was to explore opinions on collaboration and tasks between different professional groups. ⋯ There is no consensus regarding collaboration, competencies, and responsibilities with respect to early mobilization of intensive care patients. The approach to date has been characterized by a lack of interprofessional communication, which may lead to an inefficient use of the broad and varied base of knowledge and experienceof the different professions.