Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2010
Review Historical Article[First therapy of decompression injuries].
The diving accident is a rare incident for an emergency physician which requires special physical and patho-physiological knowledge. With increasing recreational activities and the fascination of diving also for older persons diving accidents are expected to occur more often. There can be several reasons for diving accidents such as the ignorance of the physics of diving, a trauma under water as well as internistical illnesses like heart attach, stroke or hypoglycaemia. ⋯ In order to receive information regarding the depth where the diving incident occured, the duration of the diving trip and the decompression stops, it is important to secure the diving computer of the victim for the hyperbaric chamber. Also outside diving, decompression illness can occur, for example working in a tunnel under hyperbaric conditions. These accidents have to be treated according to the same guidelines.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2010
Review[Postoperative delirium and cognitive deficit. Routine delirium monitoring in the intensive care unit].
Up to 92% of patients in ICU develop delirium, which may be missed without routinely monitoring. Delirium monitoring, though, is often deemed time consuming and dispensable, as mere clinical judgement is considered sufficient. This paper describes the general pitfalls during the introducing of a delirium screening tool and provides tips for daily delirium monitoring.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2010
Review[Postoperative delirium and cognitive deficit. Prevention and therapy].
To date, there are few studies available focusing on prevention and therapy of delirium in ICU patients. Monitoring during routine care is important because without using validated tools only one third of the delirious patients will be detected. A lot of non-pharmacological interventions like re-orientation and helping the patient to get back his autonomy, but also goal-orientated sedation support prevention and therapy of delirium. ⋯ For delirium prevention there are drugs available acting on different receptor systems (acetylcholine, dopamine, opioid, glutamate). For the use of this drugs, a strict risk-benefit-consideration is necessary due to the low level of evidence of the existing studies. Therapeutically causative and symptom-orientated approaches should be preferred.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2010
Case Reports[Ambulatory pain therapy in penetrating rectal cancer via epidural anesthesia].
Treatment of cancer pain includes invasive techniques of pain therapy if necessary. Here we report the management of a 55-year-old female patient with penetrating rectal cancer using continuous lumbal epidural anesthesia. After placement and dose-finding our patient was discharged from hospital and further treatment occurred at home.