Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2020
[The New DGEM Guideline - All the Clinician Needs to Know].
The German Society for Nutritional Medicine has recently updated its guideline on clinical nutrition in critically ill patients thereby cooperating with seven other national medical societies. This article provides readers with a concise overview on selected key aspects of this guideline relevant for clinical practice. We will discuss some issues in detail such as the determination of energy expenditure and of calorie and protein intake, the choice of the route of administration (enteral or parenteral), and the handling of micronutrients.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2020
[Penicillin Allergy - Deadly "Fake News" in the Medical Record?]
The note "penicillin allergy" in the medical record is given in the literature with a prevalence of 8 - 12% and represents the most frequently reported "allergy". However, there are a number of hypersensitivity reactions of which true anaphylaxis is only a small part. Therefore, a specific allergy history should be included in the file for patients with suspected penicillin allergy. ⋯ Any unclear history of antibiotic allergy should be followed by a stepwise allergological diagnosis. This is because suspected allergies are associated with an increased rate of postoperative wound infections when alternatives to preoperative prophylaxis are used and a general increase in mortality, presumably due to poorly effective therapies and increased side effects. The article explains the risk stratification for the evaluation of a penicillin allergy, shows reasons for insufficient clarification and incorrect documentation of allergy anamnesis and describes diagnosis and therapy of true anaphylaxis.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2020
[Anaesthesia in Children and Adolescents with Disabilities].
Children and adolescents with disabilities have the right of full and effective participation and inclusion in society. Disability includes a wide range of long-term physical, mental, intellectual and sensory impairments for various reasons. In addition to the basic illness many children with disabilities have concomitant diseases. ⋯ Induction of anaesthesia can be challenging and sometimes requires unconventional methods. Pain behaviour may be unusual. There are suitable scales that incorporate such behaviours.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2020
[Nutrition in Critically Ill Patients - Challenges in Special Patient Groups].
Medical nutrition therapy in daily intensive care often is challenging for the clinician. The severity of disease with possible compromises of conscience, hemodynamics, respiration, renal and gastrointestinal systems requires an individual adaptation of the nutrient-supply adjusted to the disease phase and secondary metabolic tolerance. ⋯ Close monitoring is necessary for a rapid response in case the medical condition changes or new medical or nutritional problems arise. This pragmatic educational article describes recommended nutrition therapies for different patient cohorts in intensive care medicine based on currently valid (inter)national guidelines.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2020
[When to Stop Oncological Treatment in Palliative Patients - an Increasing Challenge in Times of Immunooncology].
One third of oncological treatment costs per patient is allocated to the last phase of life. In the era of molecular oncology and immuno-oncology, patients benefit from new treatment options inducing durable and long-lasting responses. However, it becomes more difficult to estimate the prognosis of oncology patients. ⋯ Early integration of palliative medicine and advance care planning focus on the patient's medical perspective. Clinical trials investigating the integration of oncology and palliative care point to health gains: improved survival and symptom control, less anxiety and depression, reduced use of futile chemotherapy at the end of life, improved family satisfaction and quality of life, and improved use of health-care resources. Changes at the system level are necessary for implementation of advance care planning to improve the quality of the end of life of oncology patients.