Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Thrombolytic therapy and "stroke units" are the main new concepts of stroke therapy that have been recently introduced into clinical practice. Although thrombolysis decreases the likelihood of disability by about 12% with regard to increased mortality and a tenfold increase of bleeding complications, debate over the value of thrombolytic therapy in acute ischaemic stroke continues. Local intra-arterial application of thrombolytic substances, however, is recommended for embolic occlusion of the basilar artery, since thrombolytic therapy reduces mortality in these patients from about 90% to less than 50%. "Stroke units" have been developed to enable rapid evaluation of stroke patients and to improve medical care of the patients. Several studies have shown that stroke unit care of the patients indeed improves outcome with decreased mortality, a better chance of the patient being discharged to home after hospital stay, shorter length of hospital stay, as well as fewer medical complications.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 1999
Case Reports[Horizontal deceleration trauma with diffuse decollement bleeding--a casuistry].
Treatment of severe haemorrhage caused by multiple trauma is a serious challenge to preclinical as well as clinical management. This is a case report of a motorcycle accident in which a patient sustained total amputation of both legs. Following adequate preclinical care, vital indication led to the patient's immediate surgical treatment. ⋯ Due to its extent, the bleeding could not be treated surgically, nor did it allow of haemodynamic stabilisation despite continuous massive transfusion. Retrospectively, the impressing amputation injury was treated successfully. In spite of all available surgical and intensive care efforts, however, the slowly demasking monstrous decollement with diffuse tissue bleeding proved to be an injury pattern leading to the patient's death.