Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Non-invasive mechanical ventilation is the preferred method for the treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD). Primary contraindications and stopping criteria must be regarded to avoid delaying endotracheal intubation. The primary interface is usually a nasal-oral mask. ⋯ COPD patients can also benefit from preventive non-invasive ventilation in order to avoid re-intubation after a planned extubation. Domiciliary nocturnal non-invasive ventilation is an option for some patients with COPD in chronic hypercapnic respiratory failure. This treatment should be established in a specialised unit.
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Med Klin Intensivmed Notfmed · Apr 2012
Case Reports[Veno-arterial ECMO as bridge to recovery. Cardiogenic shock and suspected myocarditis in a 37-year-old patient].
We report a case of a 37-year-old patient presenting with fulminant cardiogenic shock, almost noncontractile ventricles, followed by electromechanical dissociation. During performance of cardiopulmonary resuscitation, a veno-arterial extracorporeal membrane oxygenation device (VA ECMO) was implanted, which became necessary for 13 days. ⋯ A rapid test for respiratory syncytial virus was positive, supporting the suspected diagnosis of myocarditis. Despite numerous complications, complete recovery was achieved.
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Endocrine emergencies during pregnancy can become life-threatening for both mother and fetus. In addition to some pregnancy-linked endocrine disorders, several pre-existing forms of endocrinopathy, such as Grave's disease, type 1 diabetes and adrenal insufficiency might deteriorate acutely during pregnancy. ⋯ Laboratory tests are subject to altered physiological ranges and pharmacological options are limited while therapeutic goals are stricter than in the non-pregnant patient. This article focuses on endocrine emergencies complicating pregnancy.
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Med Klin Intensivmed Notfmed · Mar 2012
Review[Cardiopulmonary emergencies during pregnancy and the postpartum period].
The number of patients who develop cardiac problems during pregnancy are increasing and represent to date the major cause of maternal death in western countries. Pregnancy induces several changes which together increase the hemodynamic burden on the cardiovascular system and can also cause a prothrombotic state. ⋯ Due to potential fetal harm conventional diagnostic and therapeutic approaches are limited by the restricted use of radiogenic cardiac imaging and applicable medications. Therefore, knowledge about available therapeutic options is of greatest importance, since guideline recommendations have clearly been demonstrated to reduce morbidity and mortality in acute cardiac emergencies during pregnancy.
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Medical emergencies in pregnant patients pose a great challenge. Due to a lack of experience many emergency care providers are uncertain about which drugs can be used and the dosage. The following article reviews the physiological changes during pregnancy, general considerations about pharmacotherapy in pregnant patients and highlights typical emergency scenarios with the corresponding recommendations for which drugs to use in pregnant patients.