Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Emergency medical services (EMS) systems represent and important part within our health care system. However rapidly changing basic conditions define the need to reconsider current structures and objectives of the German EMS system and to implement appropriate modifications. The steadily decreasing number of emergency physicians advises to delegate more and more "technical" duties to paramedic personnel. ⋯ For a long period of time the role of the emergency physician has been restricted to the stabilisation of disturbed vital functions. To assure the competitiveness of the German EMS system it will be indispensible to expand our scope of practice. As anesthetists we should not hesitate to take over our new position as "managers in acute care medicine".
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2003
Review[Prehospital use of hypertonic solutions for traumatic brain injury].
Hypertonic solutions efficaciously lower increased intracranial pressure and improve cerebral hemodynamics in particular at the level of microcirculation. Therefore hypertonic solutions have been introduced to the in-hospital intensive care treatment of brain-injured patients. In view of the disturbed cerebral perfusion and oxygenation in the acute phase following traumatic brain injury, early initiation of treatment is desirable to improve long-term outcome and to minimize secondary brain damage. ⋯ Both solutions offer interesting therapeutic options for treatment of patients with increased intracranial pressure. Limitation of license to the treatment of shock in Germany does not allow routine prehospital use in isolated head trauma at the moment. In other European countries, the approval for the prehospital use of hypertonic isooncotic solutions has been modified.