Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2010
Review[Interdisciplinary treatment of severely injured patients in the trauma resuscitation room].
The trauma resuscitation room in emergency departments is an important link between preclinical treatment and clinical management of patients with multiple trauma. For the trauma team (Trauma Surgery, Anaesthesiology, Radiology) to respond adequately, a high degree of training and standardisation is required. With arrival of the patient, the trauma team starts with priority orientated resuscitation. ⋯ Anticipating and dealing with critical situations might reduce preventable errors in the treatment process and can be achieved by implementation of an algorithm-based structured workflow. In that context some elements of quality management are well established in clinical practice. In the presented paper we describe the effort that needs to be done to provide optimal care for multiple trauma patients after admission to a designed trauma centre.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2010
Review[Opioids in the management of chronic pain and driving ability].
Opioids are important in pain management of patients suffering from chronic pain. However, opioid use is associated with several concerns, such as opioid induced impairment of cognitive and psychomotor performance. Several studies could demonstrate that opioid treatment in stable doses does not necessarily impair complex activities such as driving ability. But due to intraindividual variability to opioid response and other confounding factors (e.g. pain intensity, co-morbidity) judgements have to be made on an individual basis only.
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The blast injury is characterized by 3 different patterns of injury: blast wave, splintered fragments and displacement of victim's body. Severe external and internal hemorrhage, tension pneumothorax and the lethal trios (hypothermia, acidosis, coagulopathy) require a rapid prehospital and inhospital trauma care according to a standardized protocol. The concepts of damage control resuscitation and damage control surgery have proven to be effective and should be integrated into the treatment.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2010
Review[Non cooperation and refusal during induction of anesthesia in children].
Induction of anesthesia can be very distressing for children. This may lead to a lack of cooperation and refusal. ⋯ Adequate preparation and the use of anxiolytic premedication are important modules. Non-pharmacological interventions are interesting and could be an alternative to sedative drugs in the future.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2010
Review[Training for real: simulation, team-training and communication to improve trauma management].
The focus on the role of non-technical skills such as communication, dynamic decision making, situational awareness and teamwork in emergency medicine has gained importance over the past few years. Especially during time-critical and complex treatment of severely injured patients in a multidisciplinary and interprofessional trauma-team these factors play an important role for patient-safety and process optimization and are a key factor influencing the perceived quality of a given scenario by the team members. ⋯ For the improvement of non-technical skills, particularly team communication and teamwork, a simulator-based training represents a valuable tool. The technical performance of portable manikin-based simulators has improved tremendously during the last decade, which facilitates realistic and true-to-life multidisciplinary team-training in trauma management.