Der Anaesthesist
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Trauma scores in emergency medicine quantitatively characterise the severity of trauma victims' injuries and physiologic derangements. They are used to detect and assess patients and have applications in guiding patient care and early therapeutic decisions. In the pre-clinical setting, an effective trauma index meets the following criteria: It is highly reliable with regard to identifying high- and low-risk patients. ⋯ Mortality and patient outcome do not strictly correlate with injury severity scoring. In addition, intubated or paralysed patients were excluded from outcome studies since the scoring systems lacked options for evaluation of pathophysiological conditions after therapeutic interventions. Thus, therapeutic efficacy could hardly be assessed, and subsequent scoring during time periods was impossible.(ABSTRACT TRUNCATED AT 250 WORDS)
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The frequency of postspinal headaches after accidental puncture of the subarachnoid space with 16-18 G Tuohy needles is reported at 59-85%. A case of postspinal headache syndrome persisting over a period of 6 weeks following epidural anaesthesia during labour is described. The treatment is discussed. ⋯ Careful monitoring for side effects is necessary with blood volumes larger than 10 ml. If there is no immediate relief, conservative therapy with 24-48 h of bedrest is recommended. If the headache persists a second blood patch should be performed, with the volume and the probable caudal spreading of the first taken into account.
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Despite major advances in knowledge and development of efficient techniques for pain control, many patients on surgical wards suffer from modest to severe pain following surgery or trauma. Therefore, in the University Hospital of Kiel, Germany, an anaesthesiology-based acute pain service (APS) was started in 1985 to improve this situation. Organization of an APS. ⋯ For other regional procedures (e.g., interpleural analgesia) no complications were recorded. PCA was performed using a standard protocol with tramadol or piritramide without background infusion (Table 6). The loading dose was titrated in the recovery unit.(ABSTRACT TRUNCATED AT 400 WORDS)
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Massive intraoperative embolism is a life-threatening condition that may lead to immediate death. Important for the survival of the patient are rapid diagnosis and prompt surgical embolectomy. Case report. ⋯ During closure of the sternotomy, heart function was monitored by TEE and we again noted large emboli in the right atrium (Fig. 1 c). To remove these, we reinstated CPB and then placed an inferior vena cava filter. The final TEE control showed free heart chambers with good contractility (Fig. 1 d).(ABSTRACT TRUNCATED AT 250 WORDS)
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Conventional treatment of the adult respiratory distress syndrome (ARDS) includes pressure-limited ventilation, permissive hypercapnia, posture changes, aggressive dehydration, selective lung ventilation, and extracorporeal gas exchange. New strategies such as nitric oxide inhalation, the implantation of an intravenous membrane oxygenator (IVOX), and surfactant replacement are currently under evaluation. Nitric oxide (NO) is an important endothelium-derived relaxing factor that is rapidly inactivated by binding to haemoglobin. ⋯ Furthermore, the surfactant surface tension-lowering activity is abnormal. Thus, administration of exogenous surfactant may have therapeutic benefits. However, the optimal surfactant preparation, the optimal amount required to restore lung surfactant activity, and the optimal method to deliver it to patients with ARDS are unknown and currently under evaluation.