Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2019
Case Reports[Acute Facial Swelling Following Dental Procedure - an Allergic Reaction?]
The most common cause of facial edema after dental or medical treatment is an allergic reaction. At our emergency department, a 58-year old female patient presenting with swollen right face after dental crown preparation, was initially treated with antiallergic medication. ⋯ Reported complications are pneumothorax and -pericardium, mediastinitis or air embolism, so early recognition is important. Our case report depicts diagnostic and therapeutic steps of this uncommon differential diagnosis.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2019
[Perioperative Bleeding Disorders: Diagnostics and Treatment].
Perioperative bleeding disorders leading to major blood losses have a severe impact on patient morbidity and mortality. Despite efficient communication with the surgical team, a profound knowledge concerning the underlying mechanisms, diagnostic possibilities and available therapeutic strategies is essential for the anesthesiologist in charge. ⋯ As anticoagulants and antiplatelet drugs are broadly established in everyday clinical practice, pharmacological profiles of the most common substances are highly relevant in order to provide the patient with a safe perioperative setting - including novel oral anticoagulants. Structured checklists, as introduced in this article, may help to facilitate clinical decision making during perioperative bleedings.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2019
[Blood Coagulation Disorders During ECMO and LVAD Therapy].
Extracorporal membrane oxygenation (ECMO) is used to stabilize severe cardiocirculatory and/or respiratory failure in emergency situations. Left ventricular assist devices (LVAD) are used for the treatment of severe chronic heart failure. ECMO and LVAD systems are increasingly employed and provide substantial benefit for respective patients. ⋯ In conclusion, the management of the ECMO- and LVAD-associated coagulopathy is based on the understanding of its contributing factors. Respective causes for thrombotic and/or hemorrhagic complications should be identified with coagulation assays including viscoelastic point of care tests and platelet aggregometry. Once the underlying reason for the observed coagulopathy has been identified further treatment measures should be individually tailored.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2019
[Role of Procalcitonin as a Sepsis Marker].
Adequate diagnosis and therapy of sepsis is of major prognostic relevance. Besides the gold standard (blood culture diagnostics) biomarkers, e.g. serum procalcitonin (PCT), are clinically increasingly used in the diagnosis and for guiding anti-infective treatment. Recent guidelines recommend early determination of PCT. ⋯ However, the existing body of literature emphasizes the value of PCT to shorten the duration of an antibiotic treatment. So far, different cut-off values for PCT for certain infections have been identified. While different treatment algorithms have been studied, PCT-guided treatment not only enables to reduce use of antibiotics but as shown most recently may improve outcome of critically ill patients.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2019
[Trauma-Induced Coagulopathy: Pathophysiology and Management].
Persistent, uncontrolled bleeding after trauma is one of the leading causes of fatalities in patients with severe injuries. 40% of trauma deaths are associated with massive haemorrhage. Hypoperfusion due to major loss of blood volume leads to tissue damage. ⋯ This leads to trauma-induced coagulopathy. A suitable, early treatment might lead to a significant reduction in morbidity and mortality.