Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2010
Review[If delirium is not monitored it will often be not detected].
The reported incidence of delirium in critically ill patients ranges widely - from 11% to 87%. Both in the recovery room as well as in the intensive care unit postoperative delirium is the most common psychiatric disease. ⋯ Recent studies could show that the use of a validated delirium assessment tool significantly improves the ability of physicians and nurses to detect delirium in ICU patients. The following article gives a review about different assessment tools of ICU delirium and focuses on the differences between validated delirium scores.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2010
Review Historical Article[First therapy of decompression injuries].
The diving accident is a rare incident for an emergency physician which requires special physical and patho-physiological knowledge. With increasing recreational activities and the fascination of diving also for older persons diving accidents are expected to occur more often. There can be several reasons for diving accidents such as the ignorance of the physics of diving, a trauma under water as well as internistical illnesses like heart attach, stroke or hypoglycaemia. ⋯ In order to receive information regarding the depth where the diving incident occured, the duration of the diving trip and the decompression stops, it is important to secure the diving computer of the victim for the hyperbaric chamber. Also outside diving, decompression illness can occur, for example working in a tunnel under hyperbaric conditions. These accidents have to be treated according to the same guidelines.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2010
Review[Postoperative delirium and cognitive deficit. Routine delirium monitoring in the intensive care unit].
Up to 92% of patients in ICU develop delirium, which may be missed without routinely monitoring. Delirium monitoring, though, is often deemed time consuming and dispensable, as mere clinical judgement is considered sufficient. This paper describes the general pitfalls during the introducing of a delirium screening tool and provides tips for daily delirium monitoring.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2010
Review[Postoperative delirium and cognitive deficit. Prevention and therapy].
To date, there are few studies available focusing on prevention and therapy of delirium in ICU patients. Monitoring during routine care is important because without using validated tools only one third of the delirious patients will be detected. A lot of non-pharmacological interventions like re-orientation and helping the patient to get back his autonomy, but also goal-orientated sedation support prevention and therapy of delirium. ⋯ For delirium prevention there are drugs available acting on different receptor systems (acetylcholine, dopamine, opioid, glutamate). For the use of this drugs, a strict risk-benefit-consideration is necessary due to the low level of evidence of the existing studies. Therapeutically causative and symptom-orientated approaches should be preferred.