Wiener medizinische Wochenschrift
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Wien Med Wochenschr · Apr 1990
Review[Performance modification in sports by beta receptor blockers].
Beta-adrenoceptor-blockers modify the physical performance due to their haemodynamic and metabolic effects. Additionally, these substances influence the concentration of serum-potassium and the thermoregulation. The reduction in heart rate yields to a diminished cardiac output resulting in a restricted muscular blood flow at submaximal and maximal exercise. ⋯ Arterial peak lactate concentration usually is diminished. After beta-adrenoceptor-blockade, the concentration of serum-potassium increases slightly, and sweat production is enhanced. Beta-adrenoceptor-blockers influence the performance in different sports to a various extent, due to the multitude of the different effects they take.
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The cause of brain death must be known irreversible primary or secondary structural damage of brain and brain stem. The clinical signs and symptoms of the irreversible cessation of brain functions enable to diagnose brain death. An EEG at maximal gain reflects absence of cerebral electrical activity. ⋯ Angiographic, sonographic or other methods to assure cessation of cerebral blood flow but also other methods as the apnea test etc. are helpful but seem to be not necessary. Nearly in every case typical signs and symptoms of an acute midbrain- and bulbar brain syndrome can be diagnosed in the pre-stage of brain death. In about 60% medullary-initiated movements and spinal reflexes can appear and persist for prolonged periods in brain dead patients.
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Cerebral death occurs during reanimation as an isolated destruction of the entire brain. It is the result of a malignant and irreversible increase of the intracranial pressure. Continuous registration of the intracranial and systemic blood pressures which is done as a routine monitoring procedure in the majority of deep coma patients, allows to identify the moment when cerebral perfusion has come to a complete standstill, and also allows to confirm its irreversibility. ⋯ To be on the safe side, the expiration of a 15 to 20 minute period of complete circulatory arrest within the cranial cavity is recommended before further diagnostic measures, especially cerebral arteriography, are undertaken as final proof of dissociated brain death, permitting the explantation of vital organs for grafting. At present, due to possible technical difficulties, reliance upon epidural intracranial pressure measurement alone must still be discouraged. Nevertheless, this investigation method can be most useful in the early timing of the so-called terminal angiography in order not to delay the diagnosis of brain death and its medical consequences.
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Severely burned patients should be admitted to a burn center within 24 hours following the thermal trauma. Fluid therapy and emergency treatment of accompanying injuries has to start at the scene of the accident and must be continued at the primary hospital. During primary and secondary transport of the burn victim 3 key problems have to be considered: 1. adequate fluid resuscitation, 2. maintenance of oxygenation and ventilation, 3. prevention of burn wound contamination and iatrogenic hypothermia. Self limitation on therapeutic essentials and refraining from a polyphragmatic approach are the basis for a rational concept for the initial therapy of burn casualties.
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Sleep apnea and obstructive snoring are sleep related breathing disorders (SRBD). Nevertheless, there is only a quantitative difference between snoring and the obstructive form of sleep apnea. Snoring occurs in at least 20% of the population; 50% of the 50 year old male snore. ⋯ Most frequent symptoms and findings are: hypertension, loud and irregular snoring, daytime sleepiness and nocturnal cardiac arrhythmias. Especially hypersomnia has always to be taken seriously. In relation with other symptoms and findings associated with apnea it is always an indication for the examination for sleep apnea and obstructive snoring.