Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · Oct 2011
Review Comparative Study[Radiology in pediatric intensive care units].
The role of diagnostic imaging in pediatric intensive care units (PICU) includes primary diagnosis, monitoring of the patient's progress, and the assessment of interventional procedures. Images should be acquired in the PICU, not only to minimize the time interval between image acquisition and image interpretation but also in order to avoid unnecessary and maybe harmful transportation of the patient. Portable, optimized equipment is warranted. ⋯ Thorough consideration of radiation protection based on optimized equipment also includes the protection of relatives and other children in the PICU room. Ultrasound is an expanding imaging modality adjunct or as alternative to conventional X-ray examinations, which allows the generation of functional information (color-coded duplex, elastography). Fluoroscopy, computed tomography, and magnetic resonance imaging are available as advanced diagnostic modalities in special circumstances, but require transportation of the patient.
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The clinical evaluation of the intensive care unit patient is based upon multiple parameters, including portable chest x-ray examination. Knowledge of the methods, capabilities, and limitations is prerequisite for a legally correct and medically reasonable approach. This report provides basic knowledge about pleural und pulmonary pathologies, e.g., pneumothorax, pleural effusion, atelectasis, aspiration, pneumonia, lung edema, and acute respiratory distress syndrome.
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Med Klin Intensivmed Notfmed · Oct 2011
Review[Acute kidney injury after cardiac surgery : early diagnosis with neutrophil gelatinase-associated lipocalin].
In current clinical practice, the diagnosis of acute kidney injury (AKI) is based on markers of renal function, e.g., an increase in serum creatinine or a decrease in urine output. Biomarkers for the early detection of structural renal damage are still not available. This dilemma may have considerably contributed to the delayed development of effective therapies and poor prognosis for the affected patients. ⋯ In addition, NGAL may also provide valuable information for patient management. Currently, no clear NGAL cut-off has been established, thus, impeding its clinical implementation. Prior to a change of guidelines, multicenter randomized studies, using NGAL as an entry criterion, should prove a benefit for the patients or a favorable cost-benefit ratio.
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In order to reduce mortality in severely injured patients, a rapid radiologic diagnosis is essential. Sonography plays a role only as a focused assessment with sonography for trauma (FAST) to clarify free intraperitoneal fluid immediately on admittance. ⋯ Based on the results of the CT scan, patients can be referred for laparotomy or safely classified for "wait and see" treatment. Although the reduction in injury-related mortality would outweigh the risk of radiation dose, the indiscriminate use of CT for patients with minor injuries is not justified and must be avoided.
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Therapy decisions in the care of critically ill and dying patients in intensive care and emergency medicine must reflect probably conflicting issues of medical indications, ethics and law. This is of particular relevance when treatment preferences of patients are not known or are in contrast to those of the carers. Difficulties regarding prognostication or with determining the beginning of an irreversible dying process may also lead to treatment situations that need ethical reflection. It is recommended to tackle medico-ethical issues by discussion of the meaning of relevant terms and medico-ethical principles, analyzing the professional self-image in intensive care and emergency medicine, consideration of options of palliative medicine and by use of an ethics case consultation.