Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2020
[Prehospital Strategies to Stop the Bleeding].
Seriously injured patients represent only a small group of patients in the emergency medical service with 0.5% (ground based) to 5% (HEMS), but they are associated with a high mortality rate. Among people younger than 45, trauma is the most common cause of death, mostly as a result of severe traumatic brain injury (TBI) and/or extreme hemorrhage. As the outcome of severe TBI prehospitally can only be influenced to a very limited extent, a majority of preventable deaths in prehospital setting are caused by "critical" bleeding. ⋯ These findings have found their way into the current version of the S3 guideline on treatment of multi system trauma by the German Society for Trauma Surgery (DGU). According to this "severely bleeding injuries that can impair vital functions should be treated with priority". Thus, this publication focuses on prehospital bleeding control.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2020
[Diagnostics and Invasive Techniques in the Treatment of Chest Trauma].
Chest Trauma is a complex injury pattern whose diagnostics and therapy demand everything from an emergency response team. Chest trauma subsumes thoracic injuries in all facets from the bounce mark of a seat belt to fatal rollover trauma with contusion or disruption of organs located in the thorax. Possible causes comprise blunt or penetrating trauma, as well as decelerations, chemical and thermal damage. ⋯ In case of traumatic cardiac arrest and under defined circumstances, resuscitative thoracotomy may be indicated. The out-of-hospital management may require transfusion of blood components. As with all procedures, which are performed seldomly but under emergency conditions, invasive techniques require clear communication, precise structured working procedures and especially continuous training, team briefing, and debriefing.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2020
[S3-Guideline Intensive Care Therapy of Cardiac Surgery Patients - a Practical Approach].
The current S3-Guideline for intensive care therapy in patients after cardiac surgery provides a wealth of information and recommendations ranging from monitoring to treatment options for various perioperative clinical situations. This article focuses on the most relevant information applicable to every-day critical care practice, covering important aspects of general and advanced monitoring, goal directed hemodynamic therapy and treatment principles for perioperative left and right heart failure.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2020
[Advanced Resuscitation Measures: Extracorporeal Cardiopulmonary Resuscitation].
An extracorporeal cardiopulmonary resuscitation (eCPR) is considered as a therapy option for cardiovascular failure that is refractory to therapy. It can significantly improve the survival rate with favourable neurological results in highly selected patients. The initially defibrillatable heart rhythm and the short low-flow time < 60 minutes are of particular prognostic value. ⋯ Both variants have advantages and disadvantages. With the out-of-hospital eCPR, the "collapse-to-start-eCPR-time" can be significantly reduced under certain conditions. With the in-hospital eCPR external negative influences can be greatly minimized.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2020
Review[Alcohol as a Means for the Prevention of Disturbances in Surgical Intensive Care Medicine].
Surgical treatment of patients with alcohol use disorder can lead to disturbances (withdrawal syndrome, delirium) which require intensive care treatment. In a surgical ward, the diagnosis of an alcohol related disorder is not always simple. Oftentimes patients conceal or trivialize the issue and as a result are admitted to the hospital in a non-abstinent or unstable state. ⋯ A literature review concludes that there is no secured evidence for the application of alcohol as prophylaxis or therapy of alcohol withdrawal syndrome in a surgical intensive care unit. The use of intravenous and oral alcohol in intensive care is an unnecessary risk to patients. There are more secure alternatives.