Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Drug use has changed dramatically in recent years. Classic drugs such as marijuana, heroin, and cocaine are being pushed progressively into the background. Consumer behavior has also changed and so-called designer drugs dominate the market. ⋯ A ban often follows a latency period. Estimating the risk is difficult, and the problem of intoxication increases. This overview presents the activity profiles and risks of classic and new drugs.
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Med Klin Intensivmed Notfmed · Sep 2013
Review[Dermal and inhalation poisoning. Rare guests in our intensive care units?].
Patients with dermal and inhalation poisoning are uncommon in intensive care treatment. We describe the diagnostics and specific toxicological treatment of patients with hydrofluoric acid burns. For inhalation poisoning, we focus on smoke inhalation, especially the management of cyanide and carbon monoxide poisoning. Special attention is given to the use of hyperbaric oxygenation for the treatment of carbon monoxide poisoning.
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This overview describes antidotes, and their clinical pharmacology, that have an established significance in the currently practiced clinical toxicology because of their proven effectiveness in the treatment of serious poisonings. For the proper, efficient, and targeted use of an antidote, pharmacological knowledge is required, which is a central subject of this article. Current data from the literature are used as reference along with the accumulated experiences about possible adverse effects in order to include them in therapeutic considerations. The dosage of antidotes is the subject of several other review articles and is therefore not included in this synopsis.
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Med Klin Intensivmed Notfmed · Sep 2013
Comparative Study[Cross sectional study of structural quality of German intensive care units. A reevaluation of the DIVI register].
Effectiveness of intensive care treatment is essential to cope with increasing costs. The German national register of intensive care established by the German Interdisciplinary Association for Intensive Care Medicine (DIVI) contains basic data on the structure of intensive care units in Germany. A repeat analysis of data of the DIVI register within 8 years provides information for the development of intensive care units under different economic circumstances. ⋯ The introduction of intermediate care units did not alter ventilation parameters of patients in 2008 compared with 2000. There is no obvious medical reason for the shift of intensive care beds towards private hospitals. The number of staff and patients varied considerably between the intensive care units. The average number of patients treated per bed was not different between the periods or between hospitals with different structures. Overall availability of medical staff and diagnostic procedures increased during the study period. An increase of availability of fully trained medical staff in intensive care medicine is desirable to increase the quality of treatment.
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Med Klin Intensivmed Notfmed · Sep 2013
[Methods for endotracheal tube fixation. Results of a survey of intensive care nurses].
There are a wide variety of strategies and methods used in securing and managing the oral endotracheal tube and mouth and oral care in German clinical intensive care nursing for mechanically ventilated patients. There are no nationally recognized guidelines or recommendations on this topic. ⋯ Following these discussions, there are recommendations for improving nursing care of orally intubated patients in intensive care, including the aspects of evidence identified, currently used methods and patient needs. Also included are aspects of patient safety, potential complications and quality-orientated nursing care within a system having limited overall nursing care resources.