Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2019
[Determining Patient's Wishes and Preferences].
It is legally required to determine and respect patient preferences and wishes as much as possible under the circumstances given. This also applies to emergency medicine and intensive care, particularly if a patient is unconscious and is not able to give his consent by him-/herself. According to German law, patients' explicit written statements (advance directive, living will) are mandatory. ⋯ The article explicates the role of legal proxies (legal guardians, patient representatives) in determining patients' wishes. Detailed instructions and recommendations are given to medical staff on how to support legal representatives and next of kin with respect to shared decision-making and the process of determining patient preferences. This way, patient autonomy and patients' rights can be protected best.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2019
[Legal Proxies in Medicine: Representatives and Legal Guardians].
Patients' rights need to be protected, particularly if the patient is unconscious or otherwise unable to consent. According to German law, a legal proxy is mandatory. Spouses and adult children do not automatically function as legal proxies. ⋯ Both representatives and guardians are obliged to support the patient and are only allowed to make medical decisions, if the patient is currently unable to give his/her consent. The legal proxy is obligated to take into account advance directives, other patient preferences and presumed wishes. Recommendations and examples are given on how to apply these documents in medical practice and how to deal with legal representatives and guardians.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2019
[Pharmacokinetics in Children - What is Important for Correct Drug Dosage?]
Under- or overdosage of medication can lead to severe side effects in children. To avoid this, precise knowledge of age-specific liberation, absorption, distribution, metabolism and excretion - LADME for short - is necessary. Absorption can take place intravenously, orally, rectally, intranasally, transdermally or epidurally/caudally and is associated with numerous special features in children, depending on age and route of application. ⋯ Reciprocal to this is the elimination half-life, which has to be considered especially with repetitive administration. Only with sufficient experience with pharmacokinetic variations or comedications within the different age groups, a patient-adapted, individually correct dose application is possible. The knowledge of the age-specific pharmacokinetics together with the knowledge of patient-specific peculiarities and comedications allow an individual drug application characterized by heuristics.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2019
Case Reports[Acute Facial Swelling Following Dental Procedure - an Allergic Reaction?]
The most common cause of facial edema after dental or medical treatment is an allergic reaction. At our emergency department, a 58-year old female patient presenting with swollen right face after dental crown preparation, was initially treated with antiallergic medication. ⋯ Reported complications are pneumothorax and -pericardium, mediastinitis or air embolism, so early recognition is important. Our case report depicts diagnostic and therapeutic steps of this uncommon differential diagnosis.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2019
[Perioperative Bleeding Disorders: Diagnostics and Treatment].
Perioperative bleeding disorders leading to major blood losses have a severe impact on patient morbidity and mortality. Despite efficient communication with the surgical team, a profound knowledge concerning the underlying mechanisms, diagnostic possibilities and available therapeutic strategies is essential for the anesthesiologist in charge. ⋯ As anticoagulants and antiplatelet drugs are broadly established in everyday clinical practice, pharmacological profiles of the most common substances are highly relevant in order to provide the patient with a safe perioperative setting - including novel oral anticoagulants. Structured checklists, as introduced in this article, may help to facilitate clinical decision making during perioperative bleedings.