Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2019
[Patient Blood Management: Preoperative Anemia and Case Reports from the Anemia Walk-In Clinic].
Preoperative anemia is independently associated with increased morbidity and mortality and represents the strongest predictor for transfusion of red blood cells. Iron deficiency anemia is the most frequent form of anemia and could easily be treated by supplementation with iron. Patient Blood Management (PBM) focusses on prevention and management of anemia to optimize the patient and reduce unnecessary allogeneic blood products.
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Re-infusion of washed autologous blood cell salvage from the operative field and wound drainages is used as part of blood conservation strategy within Patient Blood Management (PBM). Cell salvage is an effective method to reduce allogeneic blood transfusion. A main advantage of cell salvage is the prevention of storage-related damage to the erythrocytes. Cell salvage has wide applications in surgeries with expected blood loss higher than 500 ml like cardiac, vascular, orthopedic surgery, and by the use of blood irradiation also in cancer surgery.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2019
[Dysphagia in Tracheostomized Patients after Long-Term Mechanical Ventilation - Become Sensitive to Reduced Pharyngo-Laryngeal Sensitivity].
Independent of the type of critical illness, tracheostomized patients have a high risk of developing a dysphagia. This is potentially life-threatening as it can lead to aspiration and pneumonia. It is therefore essential to perform swallowing diagnostics by means of a bolus dyeing test and/or FEES before oral feeding. Since a physiological airflow through the larynx and adequate subglottic pressure are key components of an effective swallowing act, oralisation should be avoided as far as possible with a blocked tracheal cannula.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2019
Review[Focused Transthoracic Echocardiography in the Perioperative Setting].
With focused transthoracic echocardiography (TTE) we rapidly and non-invasively receive up-to-date information on a patient's hemodynamic status. These can subsequently influence our therapy and thus our risk management. Postoperatively, TTE has proved its worth as an examination method in the recovery room and in the intensive care unit to promptly diagnose life-threatening causes of circulatory depression. ⋯ In this article, we demonstrate the utility and relevance of TTE hemodynamic evaluation at every stage of patient care. We also present a possible algorithm for the care of critically ill patients, based on the main transthoracic and hemodynamic measurements. It is intended to provide assistance in the meaningful use of TTE in everyday clinical practice and especially for those on on-call duty.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2019
Review[Lung Ultrasound for Anesthesia, Intensive Care and Emergency Medicine].
Lung ultrasound is an underrated tool in preclinical emergency situations, intensive care units, ORs and emergency rooms. For certain clinical questions, there is a drastically higher sensitivity in comparison to chest X-ray examinations (sensitivity in pneumothorax diagnostics 86 vs. 28%, specificity 97 vs. 100%. ⋯ The article provides basic information on pulmonary ultrasound and aims to highlight the superiority of ultrasound over x-ray procedures for anesthesia, intensive care and emergency medicine in accordance to the international evidence-based recommendations for point of care ultrasound. Finally, we added a checklist for the "post-interventional exclusion of pneumothorax" and a checklist for the "diagnosis of dyspnea by sonography".