Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2011
[Acute pain management in the elderly - Pharmaceutics and psychosocial approaches].
Post-operative pain management of elderly patients requires special attention. In addition to the organic functional impairments, age-related changes in psychological and social factors play an important role. Also life experiences, painful medical history and a range of different complaints of old age influence the expectations to the treatment of pain. Several factors have to be considered, so 1) age-appropriate preoperative assessment of organic, psychological and social factors, 2) a selection of regularly administered non-opioid, or combination of two different effective non-opioids, notably on the contra-indications and dose limits, 3) if necessary careful titration of the strong opioid with patient adjustment further doses in the recovery room ("start low, go slow"), 4) if necessary, supplement the non-opioid with a strong, not retarded opioid (subcutaneous or oral administration) on the ward, 5) restrictive indication for retarded opioids because of increased risk to fall and constipation, 6) more frequent control of side effects than for younger patients, 7) medical care with increased acceptance of autonomy, to allow trust to improve the often limited compliance and to achieve high patient satisfaction.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2011
[Coagulation Monitoring using ROTEM(®): Pro].
Coagulation and haemostasis in critical ill patients, either in massively bleeding patients in the emergency room and the operating theatre (TIC = trauma induced coagulopathy) or in septic patients suffering from multiorgan failure (DIC = disseminated intravascular coagulopathy) have to be identified and monitored promptly to initiate and monitor an effective therapy - either aggressive therapy using coagulation factor concentrates and blood products or a keen anticoagulation. Under this circumstances, standard coagulation monitoring using PT (INR), aPTT and fibrinogen (Clauss method) is limited. In critical ill patients, these parameters are neither able to predict risk of bleeding nor the risk of thrombosis. New viscoelastic methods like the ROTEM® may help to improve coagulation monitoring and management even in the emergency situation or under critical care conditions.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2011
[The intraosseous access in preclinical emergency medicine - indication, equipment and procedure].
The peripheral venous access remains the first-line method to administer drugs in emergency cases. The intraosseous injection, however, represents a good alternative in difficult situations. In this way the therapy-free period ? the "no flow time" ? and the preclinical rescue time are essentially minimised. ⋯ In principle, there are no absolute contraindications. The risks can be neglected in the acute emergency situation. Endobronchial and central venous routes for the administration of drugs have now lost their position in the primary preclinical management of emergency patients, except for a few exceptional circumstances.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2011
[Acute pain management in paediatrics and geriatrics - pain assessment: which scale for which patient?].
In the perioperative period acute pain is measured by one-dimensional scales concentrating on pain intensity. As part of a quality assurance procedure pain assessment is to be exercised during periods of rest and activity. Pain is a subjective experience. ⋯ Established scales are the visual analogue scale (VAS), the verbal rating scale (VRS), and the numerical rating scale (NRS) with a preference for the NRS. Scales that measure pain in children are the Faces-Pain-Scale and behavioural observation scales. The assessment of non verbal adults also has to rely on behavioural observation.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2011
[Retention management by means of applied human resource development: lessons from cardiovascular anaesthesiology].
At present, besides well-known financial problems, German hospitals are facing a serious lack of qualified medical staff. Given these facts, it is of great importance, especially in work load burdened disciplines, such as cardiovascular anaesthesiology, to retain highly qualified medical staff. ⋯ Surprisingly, financial aspects play a minor role in such concepts, in contrast to human resource development tools, such as mentoring, interviews, training and motivational activities. Especially, with regard to "Generation Y", an efficient retention management will play a key role to keep these physicians as hospital employees of long duration in the future.