Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2021
[Pain Management in Hospitals - Current Practice, Quality and Organisation in Non-surgical Medical Care].
For many years now, effective pharmacological and non-pharmacological treatment approaches for acute and chronic pain exist, as well as organisational strategies for their implementation in hospitals. Nevertheless, there remain considerable deficits in pain management and the portion of patients with severe or long-lasting pain in non-surgical units is often high. ⋯ This should not be seen as a signal that pain management is less important in non-surgical disciplines. On the contrary - it should raise awareness for more clinical and health services research to further develop and validate appropriate approaches and concepts to improve pain treatment in this field.
-
The burden of surgical site infections (SSIs) is increasing. The number of surgical procedures continues to rise, and surgical patients present increasingly complex comorbidities. Half of SSIs are deemed preventable using evidence-based strategies. ⋯ Normothermia should be targeted in all patients. The perioperative use of an increased fraction of inspired oxygen may reduce the risk of SSI. Using a surgical safety checklist during a team time-out immediately before surgery reduces the incidence of SSI.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2021
Case Reports[Ethical, Psychosocial and Legal Aspects of the Treatment of Pregnant Patients with Brain Death].
The therapy of brain-dead pregnant women is an extreme example not only of the possibilities in current critical care, but also of resulting ethical, social and legal controversies, an area not familiar to most clinicians. Based on the case of a patient with fatal traumatic brain injury, a previously unknown early pregnancy and stated will to donate organs, we will discuss several aspects using published case reports: therapeutic goals, especially palliative care vs. continuation; implications of brain death diagnosis; considerations on legal care; involvement of relatives, especially the child's father; dynamics within the care team; and finally the issue of putative organ donation. This complex case once more depicts that even facing such highly unfavourable framework and seemingly irreconcilable factors, pregnancy can prevail. The researched facts and considerations in this article are intended to give an overview of potential dilemmas and might serve as a starting point in similar situations.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2021
Case Reports[Pregnancy and Irreversible Loss of Brain Functions - Case Report].
A 29-year-old woman suffered major traumatic brain injury caused by a car accident. As diagnostic measures had revealed an early pregnancy (9th week), treatment on the intensive care unit was continued for 5 months, after unfavourable cerebral prognosis was followed by an irreversible loss of brain function in the 10th week of pregnancy. ⋯ Those measures served primarily to uphold the pregnancy und support the healthy development and delivery of the fetus and only in second instance the organ preservation aiming on organ donation. Necessary measures included maintenance of vital functions, hemostasis of electrolytes, nutrition, treatment of infection, prevention of adverse effects on the fetus, substitution of hormones and vitamins as well as the preparation of a planned or an unplanned delivery.
-
New atrial fibrillation is a risk factor for increased morbidity and mortality in the perioperative phase. The prevalence and incidence of atrial fibrillation depend on age, previous illnesses and the intercurrent diagnoses in the perioperative phase. Pathomechanisms for both permanent and acute forms of atrial fibrillation relate to electrophysiological, histopathological and other pathophysiological abnormalities. ⋯ It is indicated in cases of acute instability or symptomatic atrial fibrillation despite frequency control after cardiac thrombi have been excluded by echocardiography. A step-by-step concept for thromboembolism prophylaxis from initial parenteral and secondary oral therapy must take place up to four weeks after conversion to sinus rhythm or permanently in the case of permanent atrial fibrillation. The individual indication for thromboembolism prophylaxis results from the CHA2-DS2-VASc score.