Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · Feb 2020
Review[Triage, screening, and assessment of geriatric patients in the emergency department].
Geriatric patients are increasingly dominating the daily routine in German emergency departments (ED). With their typical characteristics multimorbidity, polypharmacy, vulnerability, frailty and cognitive impairment, especially delirium, they are a special challenge for the processes in the ED. Though some emergency physician might consider "the old patient" as not exciting, there is a broad consensus that pragmatic geriatric screening tools are required. This consensus exists not only among the medical societies but also within the German Society for Emergency Medicine itself. In this article the characteristics of the geriatric patient, the pitfalls of triage systems and the difficulties to screen geriatric patients in a sensible manner are described. ⋯ The common triage systems and the screening tools that have been developed for geriatric emergency patients have disadvantages. In Manchester Triage System (MTS) and Emergency Severity Index (ESI) geriatric patients are at risk of incorrect triage, though both systems, e.g., name acute cognitive impairment as a high-risk factor. The ESI has been validated for geriatric patients. The correct use of the triage algorithms is crucial, but for a triage nurse, acute cognitive impairment, e.g., might be difficult to identify. One reason for that is that many of the existing screening tools are not applicable in the ED or are without immediate benefit for the patient. More practical tools will have to be developed in the future.
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Injuries of healthcare workers with sharp instruments are considered among the most frequent occupational accidents in hospitals. In at least half of the cases, the instruments are contaminated with blood and therefore bear an infection risk with bloodborne pathogens, such as hepatitis B, hepatitis C and human immunodeficiency virus (HIV). Needlestick injuries require besides immediate medical intervention, such as rinsing and disinfection of the wound or skin contamination, a prompt clarification of the immune status and if necessary a postexposure prophylaxis. ⋯ Information about the infectious state of the index person considerably facilitates the procedure. All healthcare workers should know the management of needlestick injuries. Preventive measures refer to the reduction of the number of needlestick injuries by improving work organization and usage of needle devices with safety features as well as to the reduction of infection risk by hepatitis B vaccination and wearing safety gloves.
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Med Klin Intensivmed Notfmed · Nov 2019
Prediction of ICU mortality in critically ill children : Comparison of SOFA, GCS, and FOUR score.
The SOFA (Sequential Organ Failure Assessment), GCS (Glasgow Coma Scale), and FOUR (Full Outline of UnResponsiveness) scores are the most commonly used scoring systems to predict the risk of mortality and morbidity in intensive care units (ICUs). The aim of the current study was to compare the predictive ability of these three models for predicting medical/surgical ICU mortality in critically ill children. ⋯ The performance of the three predictive models SOFA, GCS, and FOUR score for predicting outcomes in children admitted to medical and surgical ICUs was good. The discrimination was moderate for all three models, and calibration was good just for GCS. GCS was superior in predicting outcome in critically ill children; however, further studies are needed to validate these scores in the pediatric population.
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Med Klin Intensivmed Notfmed · Oct 2019
Hyperlactatemia on ICU admission : Comparison between direct admissions and inpatient transfers.
Hyperlactatemia is associated with increased mortality. Possible differences between patients directly admitted via the emergency department to the intensive care unit (ICU) and inpatient transfers to the ICU have not yet been investigated. ⋯ Among medical ICU patients with admission hyperlactatemia, the median blood lactate was not significantly different between direct admissions and inpatient referrals. Inpatients with sepsis may have been referred to the ICU late.
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Med Klin Intensivmed Notfmed · Oct 2019
Review[Hepatic dysfunction in patients with cardiogenic shock].
Cardiogenic shock is a life-threatening condition that is frequently associated with acute hepatic dysfunction. Due to low cardiac output resulting in end-organ hypoperfusion and hypoxia, different types of liver dysfunction can develop, such as hypoxic hepatitis or acute liver failure. ⋯ Clinical management of acute hepatic dysfunction involves the stabilization of cardiac output to improve hepatic perfusion and the optimization of liver oxygenation. However, despite maximum efforts in supportive treatment, the outcome of patients with cardiogenic shock and concomitant hepatic dysfunction remains poor.