Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2008
Case Reports[Case report: severe hypothermia in a newborn infant - challenges in preclinical emergency medicine].
On the basis of a case report the prehospital management of a newborn child with deep accidental hypothermia (22oC) is discussed. The child was found in a garbage can. The continuous resuscitation during the transport into the clinic is done in an incubator and the child survives without neurologic damages. The used measures of the resuscitation are discussed on the basis of the therapy.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2008
Comparative Study[Heparin induced thrombocytopenia and anticoagulation in renal replacemant therapy].
The decision for an anticoagulant for renal replacement therapy (RRT) in patients with acute renal failure and heparin-induced thrombocytopenia (HIT) has to be made carefully. Based on results from the literature argatroban is favoured in patients without hepatic dysfunction, referring to its short halftime and easy feasable monitoring. In the case of coexsisting hepatic disorder, danaparoid provides a safe alternative therapy. ⋯ Bleeding complications and monitoring of the ecarin clotting time imposes limitations. Experiences with bivalirudin, fondaparinux and prostaglandines are limited and future trials will have to determine the significance of their application in RRT in HIT patients. Furthermore it has to be proven whether the combination of alternative anticoagulants with citrate prolongates circuit halftime of CVVH.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2008
Comparative Study[Non-invasive ventilation in prehospital emergency medicine].
Non-invasive ventilation has not yet been established in prehospital emergency medicine. This most likely due to missing technical prerequisites. ⋯ Recognizing the pathophysiology of acute respiratory insufficiency, treatment with NIV is superior in comparison to treatment with oxygen and medication only. The advantages of NIV may lead to reduced morbidity and mortality as long as attention is paid to possible contraindications.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2008
[Acute renal failure - how and when to treat?].
Acute renal failure is a common condition in intensive care units. The negative impact of acute renal failure on mortality has been demonstrated in recent studies. All critically ill patients should be regarded as a high risk population for renal failure. ⋯ Daily hemodialysis or continuous hemofiltration with a filtrate volume of 35ml/kg/h is regarded as a standard of care. There is still controversy whether continuous hemofiltration is superior to intermittent hemodialysis. Large meta-analyses could not show a difference in mortality with either one of the two therapy options.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2008
[Anesthesia and obesity - perioperative management of the obese patient].
The prevalence of obesity is increasing and a growing number of people with overweight present for surgery. For preoperative evaluation, the patients have to be checked for obesity-related diseases. The assurance whether the equipment can stand the increased stress needs a thorough check up. ⋯ Pulmonary function is deterioated and impaired for at least 48 hours after surgery, which also applies to renal, hepatic function and to coagulation and glucose hemostasis. The pharmacokinetics of most anaesthetics is altered in view of initial distribution, elimination and duration of effects. Obese people without significant impairments are suitable for ambulatory surgery.