Der Anaesthesist
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Hypovolemic shock is not a form of disease and can be subdivided into four special types with varying therapeutic demands. The decisive approach in the therapy of hypovolemic shock is to initially attain normovolemia by rapid administration of volume replacement agents in the sense of controlled hemodilution. This allows an adequate increase in the cardiac output resulting in delivery of sufficient oxygen to tissues. In the following article the limits of intervention will be described and the advantages and disadvantages of these measures for patients suffering from hypovolemic shock will be critically considered.
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For reimbursement via diagnosis-related groups (DRG), lump compensation-based payment of medical cases in German hospitals requires a case-related measuring and billing of resources that has to be consistent with DRG guidelines. Only through this, can the real costs be compared with the standard costs as calculated by the hospital reimbursment system (InEK) on a case-related basis and the DRG-specific break-even level be identified. ⋯ The online documentation of material costs via predefined anaesthesia standards accounts for nearly all material costs in anaesthesia and only a negligible documentation effort is necessary for the clinician. Nevertheless, a complex and time-consuming configuration of standards and a continuous iterative alignment of the modules with the actual processes are required. Due to its process-orientated character, method 1 can also be used for workflow optimisation in terms of standard operating procedures (SOPs). Allocation of material costs with data from the electronic anaesthesia record system is a method that can be easily implemented but only a partial case relation is rendered possible.
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Out-of-hospital airway management confronts emergency medical teams with complex challenges. To date no specific data are available on the qualifications of emergency physicians (EPs) and the quality of emergency equipment in northern Germany. ⋯ Neither the emergency equipment nor the physicians' knowledge and skills were sufficient to meet the special demands of out-of-hospital airway management, particularly among non-anesthesiologists.