Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2011
Review[In-hospital resuscitation--definitely better than in the field?].
Despite favorable conditions, in-hospital resuscitations do not lead to higher survival rates than those in the field. Recent studies show an average survival rate of 18%. One of the most important predictors for an unfavorable survival is a delay of defibrillation of greater than 2 minutes, which leads to a reduction of ROSC, 24-hour survival and survival to discharge. ⋯ A Medical Emergency Teams (MET) could intervene in such cases and thus decrease the likelihood of cardiac arrest. METs are more time-consuming and more labor-intensive than simple resuscitation teams, but these resources are well spent, as unexpected admissions to the intensive care unit can be avoided and patients receive treatment before their conditions deteriorate. Hospitals should therefore analyze and evaluate their internal emergency response plans.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2011
Review[Resuscitation of newborn infants].
Successful resuscitation of newborn infants depends on adequate preparation, exact evaluation and prompt initiation of support according to the recently updated recommendations by trained personnel. The key step in postnatal adaptation is the initiation of breathing with a subsequent increase in pulmonary blood flow and pulmonary gas exchange. Therefore, in compromised newborn infants, adequate ventilation is the most important step in cardiopulmonary resuscitation. ⋯ The compression ventilation ratio remains 3:1. The prevention of heat loss and maintaining a normal body temperature by adequate measures is an essential part of the care for healthy as well as asphyxiated infants. Therapeutic hypothermia should only be initiated after successful resuscitation and consultation with the regional neonatal intensive care unit.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2011
Review[Postpartum hemorrhage--an update].
Postpartum hemorrhage remains a major cause of maternal morbidity and mortality. The incidence of postpartum hemorrhage appears to be increasing in developed countries due to an increased number of placenta accreta or percreta after previous Cesarean deliveries. The initial therapy of postpartum hemorrhage consists of uterotonic drugs and inspection of the uterine cavum. ⋯ Tranexamic acid may be considered as a first line choice, followed by fibrinogen if necessary. If bleeding continues, fresh frozen plasma and packed red cells should be ordered in a ratio of 1:1, as this ratio has been shown to improve survival in trauma victims. All labor and delivery suites should have standard operating procedures for the management of postpartum hemorrhage in place with regular drills.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2011
Case Reports[Chest trouble and hemiparesis. A paradoxical emergency?].
The case of a young female patient with progressive chest trouble and dyspnea is reported. After development of a massive cerebral infarction, thrombolysis and afterwards decompressive craniectomy had to be performed. A patent foramen ovale (PFO) could be detected by transesophageal contrast-echocardiography accountable for a paradox embolism in existence with a deep vein thrombosis. The patient survived this situation but sustained persistent hemiparesis.