Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2018
Case Reports[Emergency Care of Trauma Patients with the Bavarian "Rebel" Kit].
Due to the increasing threat by terrorism and the resulting range of operations for the emergency medical service, the equipment as well as the rescue strategies are being adapted and expanded. An example is the "Recommended Action for Emergency Medical Services in Special Operations" (REBEL, Handlungsempfehlung für Rettungsdienst bei besonderen Einsatzlagen) of the highest Bavarian rescue service authority. In the following article, three cases are presented using new tools such as hemostyptics, thoracic patches and tourniquet from the REBEL kit in everyday operations. ⋯ The most common causes of death besides bleeding that can be prevented in patients with severe injuries and multiple trauma are tension pneumothorax and airway obstruction. These diagnoses can be identified and treated properly using the
ABCDE algorithm. In these cases, the new tools such as tourniquet, hemostyptics, chest decompression needles and thoracic closure patches can be used, which are increasingly held as an additional equipment in the ambulance vehicle. The application of these adjuvants requires a critical indication, competent knowledge and training of medical and non-medical emergency service personnel in theory and practice. -
Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2018
Review[Point-of-Care Testing in Trauma Patients - Methods and Evidence].
In severely injured patients, trauma-induced coagulopathy (TIC) present at hospital admission is associated with increased transfusion requirements, morbidity and mortality. Early and effective treatment contributes to improved survival rates. Laboratory coagulation assays have long turn-around times and evidence for their usefulness, especially in the context of TIC, is weak. ⋯ Furthermore, impaired platelet function has been identified as a strong predictor for coagulopathy and massive transfusion in trauma patients. In other clinical settings, coagulation management based on VETs is associated with decreased transfusion requirements, incidence of acute kidney failure, and mortality, respectively. Data of the first small prospective randomised trial indicate superiority of VET guided coagulation management solely using coagulation factor concentrates, when compared to plasma transfusions in severe trauma.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2018
Review[Point-of-care Coagulation Testing in Neurosurgery].
Disorders of the coagulation system can seriously impact the clinical course and outcome of neurosurgical patients. Due to the anatomical location of the central nervous system within the closed skull, bleeding complications can lead to devastating consequences such as an increase in intracranial pressure or enlargement of intracranial hematoma. Point-of-care (POC) devices for the testing of haemostatic parameters have been implemented in various fields of medicine. ⋯ POC devices allow identification of increased bleeding tendencies and therefore may enable an assessment of hemorrhagic risks in neurosurgical patients. Although data regarding the use of POC testing in neurosurgical patients are limited, they suggest that coagulation testing and hemostatic therapy using POC devices might have beneficial effects in this patient population. This article provides an overview of the application of point-of-care coagulation testing in clinical practice in neurosurgical patients.