Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2018
Review[Respiratory Failure: Innovations in Diagnostics and Therapy].
Acute and chronic respiratory failures require immediate diagnosis and preferably individualized ventilation therapy. If possible, non-invasive ventilation should be considered to avoid complications of invasive mechanical ventilation. Especially in patients with ARDS and moderate to severe cases, non-invasive ventilation may not be suitable and should not be used uncritically. ⋯ So for today the best thing is to implement the current evidence consequently. This includes lung-protective ventilation with an adequate PEEP and a tidal volume between 6 and 8 ml/kg IBW and a limitation of peak pressure or driving pressure. According to this early mobilization and positioning including prone-position is important, same as a score-based sedation regime and an individualized volume therapy.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2018
Review[Respiratory Insufficiency: State of the Art - Diagnosis and Therapy].
The term "respiratory insufficiency" (RI) describes the inability of an organism to maintain the gas exchange between the ambient air and its peripheral organs. This causes a hypoxia and hypercapnia. The mechanisms that lead to RI are either an impaired gas exchange in the lung tissue or an alveolar hypoventilation caused by an insufficient ventilatory pump. ⋯ It relieves the exhausted respiratory muscles and improves respiratory situation. It can be used for hypoxic RI as well, but frequently invasive ventilation is required. If NIV is not able to improve the patient's condition, invasive ventilation (IV) is applied.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2018
Review[Competence-based Training in the "Protected Environment": From Sheltered Space to Real Life].
The idea of "learning in a protected environment" is frequently used within the framework of postgradual education in anaesthesiology. However it remains unclear and its exact meaning lies in the eye of the beholder. ⋯ We conclude with an attempt to classify the wide variety of Simulators and teaching methods in use including their individual problems transferred into real life situations. Concerning the fact that this paper is supposed to be a review in medical education, its structure differs from case related papers with more medical content.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2018
Review["Learning in Protected Environment"- Implementation in Continuing Medical Education].
Actual concepts in continuing medical education in acute or emergency medicine contain skill training as well as simulation training. Methods and mechanisms to reduce crisis, like human factor training, shared mental models or closed-loop communication are incorporated. It is unknown which training method is optimal for individual departments in hospitals or for the individual level of education of the healthcare provider. ⋯ The implementation of a multimodal team training has to be adopted for each institution individually - methods for an implementation should be standardized. We suggest the use of the "Kern cycle" for a structured approach to curriculum development. On this foundation the combination of "learning in protected environment" and crisis training is optimal to achieve an improved patient safety in acute care.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2018
Review[Advance Care Planning and its Relevance for Emergency and Intensive Care Medicine].
Like in other countries, advance care planning (ACP) is currently being implemented in Germany as a new concept to realise valid and effective advance directives. This concept comprises processes to explore and document individual preferences for future treatment, and to honour them at a time when the person is incapacitated. ACP aims to ensure that patients will be treated according to their preferences when they are no longer capable due to acute health crises or chronic diseases. This paper gives an overview of the concept of ACP with a focus on relevant issues for emergency and intensive care medicine.