Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2008
Review[Microcirculation in sepsis and septic shock - therapeutic options?].
In severe sepsis and septic shock the severe impairment of the microcirculation is one of the main reasons for tissue hypoxia, multiple organ failure and death. Fast resuscitation of the microvascular blood flow to improve the reduced functional capillary density is necessary. Based scientific evidence, an early haemodynamic stabilisation directed by predefined haemodynamic and metabolic goals and the application of activated protein C (rhAPC) according to the guidelines could be recommended. The specific effects of dobutamine and rhAPC on the microcirculation as well as the effects selective inhibitors of iNOS or vasodilators may be therapeutic options in the future.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2008
Review[Optimization of hepatosplanchnic oxygenation in septic shock].
Microcirculatory dysfunction, reduced oxygen supply and thus impaired hepatosplanchnic organ function, play a pivotal role in the clinical manifestation of sepsis and septic shock. Early correction of the perfusion mismatch is essential to maintain end-organ and gut mu-cosa barrier function and thus to prevent bacterial translocation, bacteraemia and possible multiple organ failure. This review will outline the clinical tightrope-walk optimizing hepa-tosplanchnic oxygen supply while maintaining adequate end-organ perfusion pressure and highlight the diagnostic challenges and limitations faced in clinical practice.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2008
Review[Cardiovascular dysfunction in sepsis].
Besides adequate and early antimicrobial therapy, goal-directed haemodynamic in-terventions are crucial for survival of severe sepsis and septic shock. Although cardiac output often is restored in the early phase of sepsis syndrome significant left- and right ventricular impairment may already be present. Clinical presentation, invasive blood pressure tracing and echocardiographic evaluation are pivotal for early recognition, diagnosis and monitoring of therapeutic interventions.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2008
Review[Pediatric resuscitation. Current guidelines and treatment recommendations].
Cardiopulmonary resuscitation of a child is a rare, emotionally affective, challenging and potentially frightful event. Current guidelines have been largely simplified to facilitate teaching and retention, to encourage bystander resuscitation, and to improve the quality of resuscitation by healthcare professionals. This article is a practical approach to the current european guidelines (ERC), including basic and advanced life support algorithms, as well as recommendations on the post-resuscitation periode and parental presence.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2008
Review[Medical doctor in mountain rescue service - a profession's perspective].
Helicopter emergency services (HEMS) carrying doctors trained in emergency medicine represent a well established system for primary care with increasing professionalism since their implementation in the seventies until now. However, considerable differences persist in Europe concerning the structure as well as integration of the system in the entire organisation of area-wide demands. Based on the particular geographic conditions in the alps which are highly associated with challenges for man and material a dense network of helicopter airbases has been established. ⋯ Advanced all-season training is compulsory due to seasonal differences in casualties. Well harmonized training with cross-border validity is not available to-date. Hence, the development of obligatory standard operating procedures should be the major goal of medical associations and societies.