Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · Apr 2013
Review[Appropriate diagnostics in emergency admission. Echocardiography].
Echocardiography is the central imaging modality for the diagnosis of myocardial, valvular and structural heart disease. Coronary artery disease can be detected by impaired left ventricular function. The rapid bedside application in unstable patients requiring immediate diagnostics and treatment is a decisive advantage of echocardiography. ⋯ Echocardiography also has an important impact in the differential diagnosis of chest pain symptoms. The application of echocardiography in the emergency department may set the course for understanding of the underlying disease processes as well as the required treatment strategy. Due to the operator dependency of the technique, a meaningful application of echocardiography requires an experienced investigator even in the emergency department.
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Med Klin Intensivmed Notfmed · Apr 2013
Case Reports[Hyponatremic encephalopathy with non-cardiogenic pulmonary edema. Development following marathon run].
This article presents the case of a 52-year-old woman who developed exercise-associated hyponatremia (EAH) complicated by non-cardiogenic pulmonary edema after a marathon run. The condition of EAH is a potentially life-threatening complication of endurance exercise. ⋯ Known risk factors are female gender, slow running pace and lack of weight loss. Emergency therapy is fluid restriction and bolus infusion of 3% NaCl solution to rapidly reduce brain edema.
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In primary and secondary brain diseases, increasing volumes of the three compartments of brain tissue, cerebrospinal fluid, or blood lead to a critical increase in intracranial pressure (ICP). A rising ICP is associated with typical clinical symptoms; however, during analgosedation it can only be detected by invasive ICP monitoring. ⋯ The most relevant parameter for brain perfusion is cerebral perfusion pressure (CPP), which is calculated as the difference between the middle arterial pressure (MAP) and the ICP. A mixed body of evidence exists for the different ICP-reducing treatment measures, such as hyperventilation, hyperosmolar substances, hypothermia, glucocorticosteroids, CSF drainage, and decompressive surgery.
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Med Klin Intensivmed Notfmed · Mar 2013
Review[Surface disinfection in the context of infection prevention in intensive care units].
The highest proportion of nosocomial infections occurs on intensive care units (ICU) and infections with multiresistant pathogens are an ever increasing problem. Preventative measures should consist of a bundle of different measures including measures that address a specific problem and standard hygiene measures that are relevant in all areas. Specific measures in ICUs primarily aim at the prevention of ventilator associated pneumonia, blood vessel catheter associated infections and nosocomial urinary tract infections. ⋯ The Commission on Hospital Hygiene (KRINKO) at the Robert Koch Institute (the German health protection agency) published recommendations regarding the cleaning and disinfection of surfaces. The frequency with which cleaning and/or disinfection is required varies according to defined areas of risk. The frequency and the disinfection agents used are documented in the disinfection plan.
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Med Klin Intensivmed Notfmed · Feb 2013
Review[Vertigo and dizziness. Diagnostic algorithm from the perspective of emergency medicine].
Vertigo and dizziness are common symptoms in the acute care setting and have a wide diagnostic range. The most deleterious diagnosis is vertebrobasilar disease with brain infarction in the posterior fossa. ⋯ The suspicion of a central cause of vertigo is ideally confirmed by a magnetic resonance imaging (MRI) scan. Most patients with a peripheral cause of vertigo can be discharged under symptomatic therapy with the advice to consult an ear nose and throat physician while patients with a central cause of vertigo are admitted for further neurological treatment.