Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2015
Case Reports[Unexpected drop in hemoglobin valueand acute renal failure after a routine laparoscopic cholecystectomy -an interactive case report].
An unexpected drop in hemoglobin value requiring immediate transfusion and an acute renal failure were noticed after a routine laparoscopic cholecystectomy because of symptomatic cholecystolithiasis in an 81-year-old woman on the second postoperative day. The management of these complications including the important differential diagnosis of anemia in combination with an acute renal failure are discussed in this case report.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2015
[Mechanically circulatory support devices - Management of typical emergencies].
The use of mechanically circulatory support devices (MCS) will become increasingly important as a therapy option in patients with end-stage heart failure, and emergency physicians will more frequently encounter MCS patients in the next few years. However, emergency management in MCS patients has not yet been standardized. In the following article, common MCS devices are presented and typical emergencies associated with MCS devices are discussed. Furthermore, we try to give recommendations for the management of MCS patients in an emergency situation and present an algorithm in order to facilitate a structured and timely efficient evaluation of the MCS patient.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2015
[Ethical challenge in palliative support of intensive care patients].
Intensive care medicine and palliative care medicine were considered for a long time to be contrasting concepts in therapy. While intensive care medicine is directed towards prolonging life and tries to stabilize disordered body functions, palliative care medicine is focused upon the relief of disturbances to help patients in the face of death. Today both views have become congruent. ⋯ In the course of illness or in respect of the patient's will, the aim of therapy may change from curative to palliative. Two examples are presented to illustrate the ethical challenges in this process. They follow from the medical indication, attention to the patient's will, different opinions in the team, truth at the bedside and from what must be done in the process of withdrawing therapy.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2015
[The current situation of palliative medicine in Germany - clinical implications, education and research].
Palliative medicine (or palliative care, referring to its multi-professional character) denotes a comprehensive care concept for patients suffering from incurable and progressive disease, and their relatives. Specialized support structures are necessary, including (inpatient) palliative care units, (inpatient) consultation services, and (outpatient) specialized palliative home care services. Further, research and education is mandatory in order to gain and to spread this particular expertise and attitude. This contribution focuses on the current situation and on the development of palliative care structures in Germany.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2015
[Conversations about end-of-life in the intensive care unit].
End-of-life decisions are frequently necessary in intensive care units. These decisions are made more difficult through rapidly changing disease dynamics, lack of continuity of care, differing expectations, as well as a lack of support. In these situations, structured communication concepts can help families and staff, e. g. through structured family conferences, the concept of family as the expert for the patient's preferences, and empathetic reactions to emotions. The article discusses concrete strategies how to communicate about end-of-life care.