Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2019
Review[Coffee, Cigarettes, Chewing Gum - Myths and Facts About Preoperative Fasting].
Consumption of clear liquids (including coffee and orange juice without pulp) up to 2 hours before the start of anaesthesia is unproblematic. Contrary to the recommendations of the professional societies, the intake of beverages containing milk (up to 50% of the total volume) in small quantities seems to be harmless. ⋯ Chewing gum has no effect on the pH of gastric juice, but the gastric fluid volume is slightly increased. Cancelling surgery because of preoperative chewing of gum by a patient is not justified despite increased gastric fluid volume.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2019
Review[Violence in the Emergency Medicine (Emergency Rescue Service and Emergency Departments) - Current Situation in Germany].
During the last years healthcare personnel is more often faced with different degrees of violence and aggression while doing their jobs. However, systematic data with respect to offender profiles, reasons, frequency and types of violence in emergency medicine in Germany has not been systematically analyzed. ⋯ Only a few German studies could be included. Data suggest that violence in emergency medicine is an underreported but ubiquitous, persistent problem. 90% of the participants in the surveyed rescue staff and 75% of the participants in the surveyed emergency departments had experienced occasional verbal or physical violence within the last months before survey started. Most participants felt poorly prepared to react on aggressive situations. There is a need for appropriate training in de-escalation skills and self defence. Moreover a constant presence of security services was demanded to reduce violence in emergency departments.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2019
Review[Focused Abdominal Ultrasound in Emergency, Perioperative and Intensive Care Medicine].
The rising impact of perioperative sonography is mainly based on mobile high quality ultrasound systems. Relevant bleedings or functional limitations of the abdomen are easy to identify with sonography. The FAST-Concept can be the first access to continue proceedings in ultrasound examination of the abdomen. ⋯ Just outside of the normal working time the ultrasound experts are often not promptly available. The demonstrated techniques allow in acute medicine to make a diagnosis and to decide fast in critical situations. Perspective in view of the many benefits and possibilities, point-of-care ultrasound will be a high-ranking skill in the field of anaesthesia, emergency medicine or intensive care.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2019
Review Guideline[DGEM Guideline "Clinical Nutrition in Critical Care Medicine" - short version].
Variations of clinical nutrition may affect outcome of critically ill patients. Here we present the short version of the updated consenus-based guideline (S2k classification) "Clinical nutrition in critical care medicine" of the German Society for Nutritional Medicine (DGEM) in cooperation with 7 other national societies. The target population of the guideline was defined as critically ill adult patients who suffer from at least one acute organ dysfunction requiring specific drug therapy and/or a mechanical support device (e.g. mechanical ventilation) to maintain organ function. ⋯ The current short version of the guideline provides a concise summary of the updated recommendations for enteral and parenteral nutrition of adult critically ill patients who suffer from at least one acute organ dysfunction requiring pharmacological and/or mechanical support. The validity of the guideline is approximately fixed at five years (2018 - 2023).
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2019
Review[Diagnostic Approaches in Sepsis - Part 2: Pathogen Detection].
Despite the dissemination of innovative, molecular biology-based and commercially available devices for pathogen detection, culture-based methods with susceptibility testing remain the key principles for guiding antimicrobial treatment of patients suffering from sepsis or septic shock on the ICU. Culture-based methods are able to facilitate pathogen detection from a diversity of specimen (respiratory secretion, intraoperatively obtained smears, aspirates, and so forth). ⋯ Molecular biology-based methods like Polymerase Chain Reaction (PCR) and especially Next-Generation Sequencing (NGS) based methods promise faster pathogen and resistance detection, but are not used in clinical routine yet. With more clinical trials to come, these innovative diagnostic tools may have the potential to lead to a paradigm shift within the context of pathogen identification in sepsis.