Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · Jun 2012
Review[Prehospital cardiac arrest. Therapeutic hypothermia in adults].
Therapeutic hypothermia is one of the few advances in recent years that has improved survival and neurological outcome of survivors of cardiac arrest. Therapeutic hypothermia is part of current guidelines and, therefore, should be part of the routine procedure in postresuscitation care of patients still comatose after primarily successful resuscitation. ⋯ The optimal time point to start cooling is not well defined, even if theoretical considerations and animal experiments are in favor of beginning early. Another question is whether therapeutic hypothermia is of benefit for patients with cardiac arrest due to asystole and pulseless electrical activity in contrast to patients with ventricular fibrillation where it is of proven value.
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Med Klin Intensivmed Notfmed · Jun 2012
Review[Intensive medical care problems of hemato-oncological patients].
The life expectancy and prevalence of malignant diseases is continuously on the rise, which inevitably leads to an increase of critically ill cancer patients. This article explains why the prognosis of cancer patients in the intensive care unit has markedly improved over the last decades, what the reasons for admission are and which risk factors affect mortality. ⋯ Accordingly, acute respiratory failure for example is the most common organ dysfunction in these patients and has specific prognostic, diagnostic and therapeutic characteristics. The successful management of cancer patients in the intensive care unit requires specific knowledge of the intensive care physician and an excellent cooperation with the treating hematologist and oncologist.
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Med Klin Intensivmed Notfmed · May 2012
Review[Delirium in the intensive care unit : Overview for nurses and physicians].
Delirium is a severe but frequent organ dysfunction in intensive care units (ICU) affecting nearly 80% of mechanically ventilated patients and up to 50% of non-ventilated patients. Although guidelines for diagnosis and treatment of delirium exist it often remains underdiagnosed due to the lack of implementation of these guidelines. ⋯ Delirium results in longer mechanical ventilation, extended hospital stay, more nosocomial infections and an increased mortality. Measures which improve the frequency of diagnosis and increase the quality of treatment will only be successful if physicians, nursing staff and other medical staff on ICUs realize strategies together and raise their awareness on delirium.
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Med Klin Intensivmed Notfmed · May 2012
Case Reports[The palliative care team in the intensive care unit].
The aim of palliative care is to relieve suffering and stabilize or improve quality of life. Prolongation of life and focus on quality of life seem to be at first glance mutually exclusive. However, in daily clinical routine they occasionally do simultaneously occur, when further medical treatment to prolong life is not successful, not appropriate, or simply refused by the patient. ⋯ They also facilitate referral of seriously ill patients to a hospice or home. Palliative care consultation is recommended, if distressing symptoms can not be alleviated sufficiently or support for referral of terminally ill patients is sought. In addition, a PCT can provide support in discussions about withdrawal of life-prolonging treatments and the aims of therapy.
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Med Klin Intensivmed Notfmed · May 2012
[Occurrence and prevention of errors in intensive care units].
Recognition and analysis of error constitutes an essential tool for quality improvement in intensive care units (ICUs). The potential for the occurrence of error is considerably high in ICUs. ⋯ A system approach needs to consider human limitations and to design working conditions, workplace, and processes in ICUs in a way that promotes reduction of error. The development of a preventive safety culture must be seen as an essential task for ICUs.