Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · Feb 2017
[Mild therapeutic hypothermia in cardiogenic shock : Retrospective analysis of 80 patients with preclinical cardiac arrest due to cardiac causes].
The mortality in patients with cardiogenic shock after out-of-hospital cardiac arrest (OHCA) remains high despite advances in resuscitation and early revascularization strategies. The use of mild therapeutic hypothermia (MTH) for improvement of survival and neurological outcome in patients with cardiogenic shock is currently subject to renewed discussion. ⋯ Changes in the course of serum creatinine, urea and NSE levels within the first 72 h after OHCA could provide valuable additional information for the early assessment of the neurological prognosis in patients treated with MTH.
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Med Klin Intensivmed Notfmed · Nov 2016
Cardiac monitoring always required after electrical injuries?
Controversy still exists regarding inpatient monitoring of patients exposed to electrical injuries. ⋯ Asymptomatic and stable patients without any risk factors and with a normal initial ECG need no inpatient cardiac monitoring after an electrical injury.
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Med Klin Intensivmed Notfmed · Nov 2016
Meta Analysis[Telemedicine in the ICU - the possibilities and limitations of an innovation].
Intensive care medicine is challenged by demographic changes and an increasing number of patient combined with existing shortage of doctors. Telemedicine is a promising approach to ensure patient care in the coming years. Due to a shortage of intensive care physicians in the USA, comprehensive telemedicine coverage has already been established. To date, 11 % of all hospitals are supported by a telemedicine center. The beneficial impact in terms of quality of care, patient safety and economic factors has been confirmed in numerous multicenter studies. ⋯ Previous data demonstrated that telemedical support can improve the outcome in critically ill patients, both during hospitalization as well as in the long-term result until the discharge home. Telemedicine is neither a magic bullet nor a replacement for a physician. Instead it is a new type of medical cooperation to further improve the outcomes of critically ill patients.
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Med Klin Intensivmed Notfmed · Nov 2016
Predictors of mortality in patients with cardiogenic shock treated with primary percutaneous coronary intervention and intra-aortic balloon counterpulsation.
Cardiogenic shock remains the most serious complication of patients hospitalized with acute myocardial infarction (AMI). Early revascularization is the cornerstone of invasive therapy, while mechanical support with intra-aortic balloon pump (IABP) is debatable. From our institutional shock registry we sought to determine predictors of in-hospital mortality-including the aspect of IABP timing-and to develop a clinical risk score for shock patients with AMI. ⋯ We identified age, vasopressor use, resuscitation before PCI, acute renal failure and IABP implantation after PCI as independent predictors of in-hospital mortality in patients with cardiogenic shock due to AMI. The timing of IABP insertion was the only modifiable factor predicting in-hospital mortality in our cohort. Consequently, balloon pumping should be started before PCI to improve outcome of cardiogenic shock patients.
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Med Klin Intensivmed Notfmed · Nov 2016
[Current recommendations for basic/advanced life support : Addressing unanswered questions and future prospects].
The revised guidelines for cardiopulmonary resuscitation were implemented by the European Resuscitation Council (ERC) in October 2015. There were few changes concerning basic and advanced life support; however, some issues were clarified compared to the ERC recommendations from 2010. The present paper summarizes the procedures of basic and advanced life support according to the current guidelines and highlights the updates of 2015. Furthermore, the article depicts future prospects of cardiopulmonary resuscitation that may improve outcome of patients after cardiac arrest in the future.