Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2003
Review[Prehospital use of hypertonic solutions for traumatic brain injury].
Hypertonic solutions efficaciously lower increased intracranial pressure and improve cerebral hemodynamics in particular at the level of microcirculation. Therefore hypertonic solutions have been introduced to the in-hospital intensive care treatment of brain-injured patients. In view of the disturbed cerebral perfusion and oxygenation in the acute phase following traumatic brain injury, early initiation of treatment is desirable to improve long-term outcome and to minimize secondary brain damage. ⋯ Both solutions offer interesting therapeutic options for treatment of patients with increased intracranial pressure. Limitation of license to the treatment of shock in Germany does not allow routine prehospital use in isolated head trauma at the moment. In other European countries, the approval for the prehospital use of hypertonic isooncotic solutions has been modified.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2003
Review[Point of care (POC) monitoring in anesthesia and intensive care--an overview of available POC systems].
There is an increasing trend to have data rapidly ready at the patient's bedside. The general principle behind point-of-care (POC) testing is that "faster is better" ('from vein to brain'). The entire process for laboratory testing includes withdrawal of blood into special (pre-labelled) tubes, transportation of the sample to the central laboratory where the plasma is separated from the blood cells by centrifugation, carefully pippeting of a defined volume of plasma that is placed in the analyzer. ⋯ Direct costs (e. g. test cartridges, costs for the analyzers, cost for quality control) may constitute only a small percentage of the true costs. Hidden costs consist of overhead costs (e. g. transportation) and the consequences of delayed results. The present overview summarizes the available POC systems in Germany and may serve as a decision maker for those who are interested in introducing POC monitoring systems.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2003
[Integration of preexisting diseases and risk factors in the Abbreviated Burn Severity Index (ABSI)].
There is no doubt that underlying medical problems such as concomitant diseases or risk factors play a role in increasing patient morbidity and mortality. These factors are already integrated in trauma scores but preexisting diseases have no impact on burn scores yet. This study was performed to examine the predictive value of the classical burn variables that are integrated in the Abbreviated Burn Severity Index (ABSI). The preexisting diseases and risk factors in burn patients within our burn center were evaluated, with the aim of incorporating these evaluations into a new burn score. This modified burn score was used to optimize the predictive value of burn mortality. ⋯ The results of this study show that the Abbreviated Burn Severity Index is an appropriate burn score for estimating the risk of mortality after burn trauma. However, in addition to the classical variables, preexisting diseases and risk factors have a significant influence on the outcome and therefore should be incorporated into a new burn score to predict mortality more accurately.