Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2019
Review[Focused Transthoracic Echocardiography in the Perioperative Setting].
With focused transthoracic echocardiography (TTE) we rapidly and non-invasively receive up-to-date information on a patient's hemodynamic status. These can subsequently influence our therapy and thus our risk management. Postoperatively, TTE has proved its worth as an examination method in the recovery room and in the intensive care unit to promptly diagnose life-threatening causes of circulatory depression. ⋯ In this article, we demonstrate the utility and relevance of TTE hemodynamic evaluation at every stage of patient care. We also present a possible algorithm for the care of critically ill patients, based on the main transthoracic and hemodynamic measurements. It is intended to provide assistance in the meaningful use of TTE in everyday clinical practice and especially for those on on-call duty.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2019
Review[Lung Ultrasound for Anesthesia, Intensive Care and Emergency Medicine].
Lung ultrasound is an underrated tool in preclinical emergency situations, intensive care units, ORs and emergency rooms. For certain clinical questions, there is a drastically higher sensitivity in comparison to chest X-ray examinations (sensitivity in pneumothorax diagnostics 86 vs. 28%, specificity 97 vs. 100%. ⋯ The article provides basic information on pulmonary ultrasound and aims to highlight the superiority of ultrasound over x-ray procedures for anesthesia, intensive care and emergency medicine in accordance to the international evidence-based recommendations for point of care ultrasound. Finally, we added a checklist for the "post-interventional exclusion of pneumothorax" and a checklist for the "diagnosis of dyspnea by sonography".
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2019
Review[Coffee, Cigarettes, Chewing Gum - Myths and Facts About Preoperative Fasting].
Consumption of clear liquids (including coffee and orange juice without pulp) up to 2 hours before the start of anaesthesia is unproblematic. Contrary to the recommendations of the professional societies, the intake of beverages containing milk (up to 50% of the total volume) in small quantities seems to be harmless. ⋯ Chewing gum has no effect on the pH of gastric juice, but the gastric fluid volume is slightly increased. Cancelling surgery because of preoperative chewing of gum by a patient is not justified despite increased gastric fluid volume.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2019
Review[Violence in the Emergency Medicine (Emergency Rescue Service and Emergency Departments) - Current Situation in Germany].
During the last years healthcare personnel is more often faced with different degrees of violence and aggression while doing their jobs. However, systematic data with respect to offender profiles, reasons, frequency and types of violence in emergency medicine in Germany has not been systematically analyzed. ⋯ Only a few German studies could be included. Data suggest that violence in emergency medicine is an underreported but ubiquitous, persistent problem. 90% of the participants in the surveyed rescue staff and 75% of the participants in the surveyed emergency departments had experienced occasional verbal or physical violence within the last months before survey started. Most participants felt poorly prepared to react on aggressive situations. There is a need for appropriate training in de-escalation skills and self defence. Moreover a constant presence of security services was demanded to reduce violence in emergency departments.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2019
Review[Focused Abdominal Ultrasound in Emergency, Perioperative and Intensive Care Medicine].
The rising impact of perioperative sonography is mainly based on mobile high quality ultrasound systems. Relevant bleedings or functional limitations of the abdomen are easy to identify with sonography. The FAST-Concept can be the first access to continue proceedings in ultrasound examination of the abdomen. ⋯ Just outside of the normal working time the ultrasound experts are often not promptly available. The demonstrated techniques allow in acute medicine to make a diagnosis and to decide fast in critical situations. Perspective in view of the many benefits and possibilities, point-of-care ultrasound will be a high-ranking skill in the field of anaesthesia, emergency medicine or intensive care.