Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2024
Review[Gunshot and Blast Injuries from a Trauma Surgery Perspective].
The severity and extent of gunshot and blast injuries are often misjudged due to a lack of specialist knowledge. The aim of this article is to outline the characteristics of gunshot and blast injuries, including emergency diagnostics and initial surgical treatment. Due to multiple high-energy penetrating injuries, barotrauma, or blunt trauma, affected patients are usually polytraumatized, with multiple organ damage and an average Injury Severity Score (ISS) of > 36. ⋯ The procedure should be based on a standardized, internal hospital emergency medical and emergency surgical algorithm. Damage control surgery can then be used to treat acutely life-threatening complications of gunshot and blast injuries in order to prevent the fatal triad and the occurrence of further early complications. Examples of interventions include debridement and decontamination, fracture stabilization (external fixators and splints), surgical decompression (skull, thorax, compartment syndromes) and surgical hemostasis.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2024
Review[The Penny's Dropped - "Aha" Moments in Emergency Medicine Diagnostics].
Hardly any other speciality is as fraught with tension as emergency medicine. In addition to the need to have a broad spectrum of knowledge about illnesses and injuries, the time factor is particularly important. Emergency physicians have to quickly gain an overview of their patients' condition. ⋯ A detective-like approach is sometimes required here, particularly in order to confirm suspected diagnoses and rule out differential diagnoses by using focussed diagnostics. Clinical experience, training and the odd "trick" lay the foundation for skillfully using the diagnostic options at the right time for the right patient - i.e. point-of-care - and finding the right diagnosis. Aha!
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2024
Review[Preclinical Treatment of Gunshot and Blast Injuries in Germany].
Gunshot and blast injuries are extremely rare in the emergency services. However, in the context of the increasing threat of terrorist attacks, the possibility of these traumas is also coming into focus. This article provides an overview of the various entities and the corresponding treatment principles for penetrating injuries.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2024
Review[Thoracoabdominal Trauma Caused by Blast and Gunshot Injuries].
In Germany, blast and gunshot injuries are uncommon but complex injury entities. Due to the global political situation, terrorist attacks, accidents, or acts of violence, these injuries are potentially part of the reality of care for every anaesthetist, surgeon, and emergency physician. In principle, this type of injury should be treated in a trauma centre with appropriate expertise, but the knowledge of basic treatment principles is necessary for all practitioners. ⋯ Moreover, if chest injuries are ruled out, the resuscitative endovascular balloon occlusion of the aorta (REBOA) can be considered as a bridge to surgery. Whether projectiles, fragments, or shrapnels require removal depends on the location and the potential complications of tissue dissection. Penetrating injuries due to blasts and gunshots are always contaminated.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2024
Review[Reconciling Sustainability and Hygiene in the Healthcare Sector].
In the course of climate change, doctors will not only be confronted with heat-related consequences, but also with the emergence of infectious diseases caused by previously tropical pathogens in temperate climate zones. Fortunately, the topics of sustainability and climate change are also becoming increasingly important in discussions in the healthcare sector, which accounts for 4.4% of global greenhouse gas emissions. The topic of hygienically safe sustainability in healthcare facilities is highly complex due to the large number of possible adjustments, but also offers a great deal of potential. ⋯ It is not always the large investments that make their contribution to reducing CO2-emissions - many smaller measures can also be implemented without high costs, but with great sustainability potential. Similar to hand hygiene compliance, behavior modification by each individual plays a decisive role in the implementation of such projects. There is great practical savings potential, for example, in the indication-based use of disposable medical gloves, the hygienically safe handling of medication or the decision between reusable and disposable medical products, just to name a few items discussed in the article.