Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2008
Review[The role of patient flow and surge capacity for in-hospital response in mass casualty events].
Mass casualty events make demands on emergency services and disaster control. However, optimized in- hospital response defines the quality of definitive care. Therefore, German federal law governs the role of hospitals in mass casualty incidents. ⋯ To minimise inhospital patient overflow casualty surge principles have to be implemented in both, pre-hospital and in-hospital disaster planning. World soccer championship 2006 facilitated the initiation of surge and damage control principles in in-hospital disaster planning strategies for German hospitals. The presented concept of strict control of in-hospital patient flow using surge principles minimises the risk of in-hospital breakdown and increases definitive hospital treatment capacity in mass casualty incidents.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2008
Review[Prehospital management of geriatric patients].
The prehospital management of geriatric patients involves an understanding of the physiology of aging and necessitates the special acknowledgement of diagnosis and treatment of emergencies in the elderly. It is essential to keep in mind the prevention of an underestimation of the severity of disease and the necessity of an adequate therapy. The prehospital management of moribund patients gains special importance.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2008
Review Meta Analysis[Emergency medicine and myocardial ischaemia - thrombolysis during cardiopulmonary resuscitation - available data and recommendations].
Patients suffering cardiac arrest still have a poor prognosis. Up to the present, no drug therapy has shown to improve longterm survival after cardiac arrest. Acute myocardial infarction (AMI) or massive pulmonary embolism (PE) are the underlying causes for sudden cardiac arrest in 50-70 % of patients. ⋯ Thrombolysis during CPR today can not be recommended as a standard therapy in patients suffering cardiac arrest. However, it should be considered if a massive PE is supposed to be the cause of cardiac arrest or if conventional CPR has not been successful in a patient with presumed thrombotic cause of cardiac arrest. The expected bleeding risk is outweighed by the potential benefit of this therapy in selected patients.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2008
Review[Neurological diseases in pregnancy: implications for anesthesia care - part 2].
In the parturient as well as in the pregnant patient with neurological disease, surgery is necessary more frequently than in healthy pregnants. Most pregnancies of these patients will result in a slightly increased rate for cesarean section. The focus of anesthesia care is mostly to avoid damage to the fetus, in some pathologies to protect the mother. ⋯ Subarachnoidal hemorrhage and intracranial bleeding contribute to 65 % of maternal mortality. Finally, pregnancy induced conditions such as eclampsia and HELLP syndrome and its management are reviewed where the concerns for the nervous system have high relevance for anesthesiological management. Anesthesia care for the pregnant and the parturient presenting with a neurological disease requires 1.) expertise with neuroanesthesia and obstetric anesthesia care, 2.) accurate physical examination of the neurological system preoperatively, 3.) safe choice and conductance of the anesthesia technique (mostly regional anesthesia) 4.) avoidance of unfavorable drug effects for the fetus and the nervous system of the mother and 5.) intraoperative neuromonitoring together with the control of the fetal heart rate.