Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 2005
Review[How to assess the severity of the multi-system trauma in the emergency-room -- a critical review].
For more than 30 years various scoring systems have been used as a method to asses the injury severity of multi-system trauma. They have been used as a tool for triage, for emergency-room quality management, for educational reasons or, nowadays, in order to evaluate the cost effectiveness of either a complete hospital or a single department. ⋯ Relevant examples like physiological trauma scores (GCS, RTS, MEES), anatomic, injury pattern based scores (ISS, NISS, ICISS), biological aspects, mixed scoring systems (PTS, TRISS, ASCOT) and future developments ("Rixen-pattern", RISC) are illustrated. These scores are explained in detail and discussed as to their practicability.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 2005
[Non-invasive determination of cardiac output by continuous wave Doppler in air rescue service].
Determination of cardiac output (CO) enables to assess the hemodynamic situation as well as to administer optimal catecholamine therapy especially in critically compromised patients with hemodynamic instability. Invasive determination of CO is possible via a Swan-Ganz-catheter with its associated risk of implantation in the hospital. Using the Doppler technique, we evaluated the feasibility of the USCOM-system for non-invasive CO determination in preclinical emergency medicine in air rescue service. ⋯ Using the USCOM system it is possible to determine the beat-to-beat cardiac output in air rescue service non-invasively. The emergency physician gains additional crucial hemodynamic information to diagnose and treat adequately by administration of volume load and catecholamines at the scene and during flight conditions. Further preclinical prospective trials are mandatory to elucidate the value of this novel device in emergency medicine.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 2005
Case Reports[Polytrauma with tension pneumothorax with inserted chest tube].
The authors report a case of a 25-year-old woman with a polytrauma, caused by a free fall of 12 metres in suicidal intention. Following endotracheal intubation and mechanical ventilation by an emergency physician at the scene, the patient was delivered to the emergency room of an university hospital. An ultrasonic check of the abdomen revealed free fluid in the abdominal cavity, and a rupture of liver and spleen was suspected. ⋯ Despite of open heart compression, application of adrenaline and noradrenaline and substitution of packed red blood cells and of crystalloid and colloid solutions, all resuscitation measures failed so that the patient died shortly after on the operation table. This case illustrates first the difficulties of an adequate thoracic trauma management, particularly, when clinical symptoms are discrete, second the problems of the insertion and control of a chest tube, and third risks associated with wrong position or secondary dislocation which may include - as in our case - "masking" of severe injury patterns and delay of life-saving measures such as an immediate thoracotomy. In order to improve prognosis of patients with poly-/thoracic trauma, establishment of spiral-CT in emergency centres, routine bronchoscopy and safe handling of chest tubes may be helpful.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 2005
[Advance directives in the prehospital setting -- emergency physicians' attitudes].
The German physician based emergency medical system (EMS) might confront physicians with advance directives in the field. A multi-question survey was used to evaluate emergency physicians' experience with advance directives in the prehospital setting and to assess their attitudes towards forms and statements of advance directives. ⋯ The high number of returned questionnaires shows the importance of the topic "advance directives" for emergency physicians. Despite some practical and legal problems, a big majority of the experienced emergency physicians in this survey thought the advance directives in the prehospital setting to be helpful. A clear statement on resuscitation as well as simplification of the many existing types of directives are the most essential requirements demanded by the emergency physicians. A solution could be the creation of an extra "emergency advance directive".
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 2005
[Characteristics of repeated emergency physician use].
Repeated use of emergency physicians might result in excessive costs and has discouraging effects on emergency department staff. To our knowledge, no data are available on the characteristic of repeated use of emergency physicians (EP) in the German emergency medical services. Accordingly, this retrospective survey focused on emergency cases on-the-scene, which necessitated EP intervention. ⋯ The rate of repeated inappropriate EP use in this middle sized town was low. More than four fifths of all repeated calls were for cardiovascular, respiratory, neurological, and psychiatric distress.