Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2020
[Update Resuscitation - In-hospital Cardiac Arrest].
The structure of emergency care is a key element for patients' safety in hospital. Early warning scores and the implementation of medical emergency teams (MET) can help to detect deteriorating patients early and prevent unexpected deaths. This article summarizes essential elements of a modern emergency management in hospitals.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2020
Review[SARS CoV-2/COVID-19: Evidence-Based Recommendation on Diagnosis and Therapy].
COVID-19, a new viral disease affecting primarily the respiratory system and the lung, has caused a pandemic with serious challenges to health systems around the world. In about 20% of patients, severe symptoms occur after a mean incubation period of 5 - 6 days; 5% of patients need intensive care therapy. Morbidity is about 1 - 2%. ⋯ In case of fulminant lung failure, veno-venous extracorporeal membrane oxygenation may be used as a rescue in experienced centres. New, experimental therapies evolve with ever increasing frequency; currently, however, there is no evidence based recommendation possible. If off-label and compassionate use of these drugs is considered, an individual benefit-risk assessment is necessary, since serious side effects have been reported.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2020
Review[Obstetric Anesthesia During the SARS-CoV-2 Pandemic - a Brief Overview of Published Recommendations for Action by National and International Specialist Societies and Committees].
The most common human corona viruses cause common colds. But three of these viruses cause more serious, acute diseases; Middle East Respiratory Syndrome (MERS by MERS-CoV), Severe Acute Respiratory Syndrome (SARS) by SARS-CoV and COVID-19 by SARS-CoV-2. The current outbreak was classified by the WHO as a "global public health emergency". ⋯ In summary, at present it must be stated that the general care recommendations that also apply to non-COVID-19 patients are initially valid with regard to obstetric anesthesia. Nevertheless, the special requirements on the part of hygiene and infection protection result in special circumstances that should be taken into account when caring for pregnant patients from an anesthetic point of view. These relate to both medical aspects, but also to a particular extent logistics issues with regard to spatial separation, staffing and material resources.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2020
[Update Resuscitation - Resuscitation 4.0].
The future of emergency medicine is determined by technical innovations. Besides virtual reality in education and training, the detection of a deteriorating patient and a cardiac arrest will become digital. The biggest milestone will be the individualized cardiopulmonary resuscitation (CPR). Maybe in future virtual intelligence will determine the CPR workflow more than standardized algorithm.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2020
[Out-of-Hospital Cardiopulmonary Resuscitation].
With an incidence of 50 - 70 resuscitations attempted per 100000 inhabitants and year Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of death in adults in the developed world. Thus, cardiac arrest is a common emergency situation attended by emergency medical services (EMS). Due to the pathophysiology it is one of the most time-critical emergencies: after 3 - 5 minutes of cardiac arrest without resuscitation efforts the likelihood of neurological impairments is significantly increased once the patient survives the initial event. ⋯ Advanced life support comprises defibrillation, if indicated, airway management, the application of selected drugs and the treatment of reversible causes. After return of spontaneous circulation (ROSC) a structured post-resuscitation care in EMS and in dedicated hospitals is essential to achieve the best neurological outcome for the patient. The universal resuscitation algorithm has to be adapted for special circumstances of OHCA (e. g. a traumatic cause, cardiac arrest in pregnancy, …).