Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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The anaesthesiological care of patients in the operating room involves many activities that can lead to an infection. Hand hygiene is the most effective single measure for the prevention of nosocomial infections. Hand disinfectant dispensers should be placed within easy reach. ⋯ There is no evidence for further measures to separate so-called aseptic and septic operations or of patients with multi-resistant pathogens. In order to be able to take the necessary measures for employee protection in corona-infected patients in the operating room, it is essential to know the current infection status. For example, when a patient is handed over to the OR, a current test result should be checked and documented on the OR checklist.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2021
[Infection Prevention in the Intensive Care Unit (ICU)].
Secondary to the underlying disease, the need for invasive devices and frequent drug-induced changes in immunocompetence and microbiota, critically ill patients have a high risk of suffering nosocomial infections. According to data from the European Centre for Disease Prevention and Control (ECDC) this affects 8,4% of patients treated in an ICU for more than 48 hours. ⋯ Functional building design and well organized logistics assist in achieving infection prevention goals by fostering adherence to basic hygiene procedure, esp. hand hygiene and risk-adjusted use of personal protective equipment. Daily interdisciplinary rounds following the principles of crew resource management strategies allow the structured check for unnecessary devices and inadequate use of antiinfective agents in particular and the discussion of all aspects of the patients' situation in general.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2021
Review[Levosimendan - a 20-Year Experience].
Levosimendan is a calcium sensitizer and opens adenosine triphosphate-dependent potassium channels. Since 20 years, it is approved for acute decompensated heart failure. It has been tested in many clinical trials for treatment of at-risk patients in cardiac surgery, right ventricular failure, pulmonary hypertension, weaning of extracorporeal systems, cardiogenic shock, septic shock, ARDS and others. ⋯ These positive effects were described in many small studies. Although this sounds like a promising drug for a variety of settings, results of several multicentre randomized placebo-controlled studies were frustrating. This review resumes some facts of levosimendan in different diseases.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2021
[Neuraxial Morphine for Postoperative Analgesia after Caesarean Deliveries].
The use of neuraxial morphine, in combination with nonopioid analgesic regimens for postoperative analgesia after Caesarean deliveries is common practice, especially in the Anglo-American world. Neuraxial morphine offers a longer-lasting superior analgesia than intravenous opioids or patient-controlled analgesia. ⋯ A low dose of neuraxial morphine in a healthy parturient bears a low morbidity and mortality risk. The optimal frequency, duration and modality of respiratory monitoring for patients at low risk for respiratory depression is dependent on the dose of morphine administered and the patient-specific and obstetric risk profile.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2021
[Acute Abdominal Pain in the Emergency Department].
Abdominal pain is a common leading symptom in emergency medicine. This symptom complex includes a variety of different causes, ranging from intra-abdominal to extra-abdominal and retroperitoneal pathologies, which can affect all age groups. ⋯ A rapid initial assessment and risk stratification is necessary in order to detect critically ill patients with an acute need for intervention at an early stage and to provide them with a suitable emergency therapy. A structured approach can identify the most important differential diagnoses.