Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · Mar 2012
Review[Preeclampsia and HELLP syndrome as an obstetric emergency].
Preeclampsia and HELLP syndrome are multisystemic hypertensive disorders in pregnancy. A causative treatment is not yet available. ⋯ In this scenario a good interdisciplinary cooperation between obstetricians and intensive care physicians ensures an optimal outcome for the pregnant woman. This article gives an insight into both diseases and the clinical management.
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Acute kidney injury plays a pivotal role in intensive care medicine and exerts crucial adverse effects on the course of the disease and overall prognosis of the critically ill patient. Intensive renal support, including initiation of earlier dialysis or maximal uremic toxin removal by higher dosage and frequency of renal replacement therapy, and individualized selection of modality were not able to decrease excessive mortality in this population. Systemic acute inflammation, mediated, at least in part, by cytokines, and not secondary uremic side effects, seems to have a major impact on nonrenal organ damage. ⋯ The overall survival at 5 years in patients discharged alive after severe acute kidney injury necessitating renal replacement therapy is only 20-30%, comparable to cancer patients. In addition, acute renal damage was identified as an independent risk factor for progression of chronic renal insufficiency. Current research focuses on strategies for the prevention of acute kidney injury and on the establishment of effective biomarkers for the early recognition and accurate diagnosis of subclinical renal damage.
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Med Klin Intensivmed Notfmed · Feb 2012
Comparative StudyMicrobial diagnostics in patients with presumed severe infection in the emergency department.
Sepsis in the early stage is a common disease in emergency medicine, and rapid diagnosis is essential. Our aim was to compare pathogen diagnosis using blood cultures (BC) and the multiplex polymerase chain reaction (PCR) test.Methods. At total of 211 patients admitted to the multidisciplinary emergency department of our university hospital between 2006 and 2009 with suspected severe infection from any origin were studied. Blood samples for BC (aerobic and anaerobic) and multiplex PCR were taken for identification of infectious microorganisms immediately after hospital admission. Results of the BC and PCR correlated with procalcitonin concentration (PCT) and clinical diagnosis of sepsis (≥2 positive SIRS criteria) as well as with severity of disease at admission and with clinical outcome measures. ⋯ In patients admitted with suspected severe infection, a high percentage of positive BC and PCR were observed. Positive findings in the PCR correlate with elevated levels of PCT and high APACHE II scores.
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Patients suffering from septic shock often present with not only severe reduction of afterload induced by vasodilation but are also affected by sepsis-induced cardiac dysfunction. Elevated troponin levels, which are typically not caused by coronary ischemia, may indicate septic cardiomyopathy which is characterized both by altered systolic function as well as by disturbances in the regulation of heart rate and heart rate variability. The latter findings are based not only on the dysfunction of the autonomous nervous system but are also the result of the direct interaction of endotoxins with cardiac pacemaker cells. ⋯ Therapy of septic shock (and thereby septic cardiomyopathy) is based on the well-known causative, supportive, and adjunctive strategies. Stabilization of cardiac function is assured by volume resuscitation (including blood transfusion) and inotropic support (dobutamine). Further specific therapeutic approaches have not yet been established.
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Med Klin Intensivmed Notfmed · Feb 2012
Review Comparative Study[Triage systems in the emergency department].
Emergency department (ED) triage systems facilitate the categorization of emergency patients according to their disease severity and determine both treatment priority and treatment location. Four different five-level triage systems are internationally accepted. The Australasian Triage Scale (ATS, Australasia) allows categorization based on symptoms using specific descriptors. ⋯ The Canadian Triage and Acuity Scale (CTAS, Canada) is based on the ATS, but also includes diagnoses. The Emergency Severity Index (ESI, USA) first excludes life-threatening and severe disease before stratification according to estimated resource utilization. The goal of all triage systems is to reduce the in-hospital mortality and to minimize time to treatment, length of stay, and resource utilization.