Der Anaesthesist
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The illness and injury severity of patients in emergency situations is normally rated by the National Advisory Committee for Aeronautics (NACA) score. Different issues seem to limit the validity of the NACA score, therefore, the aim of the present investigation was to analyse the association between rescue experience of pre-hospital emergency physicians and the estimated jeopardy of patients' vital functions using the NACA score. ⋯ The results demonstrate that emergency physicians with less rescue experience rated the severity of illness or injury relatively lower in comparison to colleagues who had worked in the pre-hospital setting for many years.
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The success of an operation does not only depend on a perfect surgical technique, an appropriate anesthesia, convenient surgical instruments and functional technical equipment, but also on a proper operative positioning. Meeting the requirements of the surgeon, the positioning has also to be in accordance with the patient's individual needs. ⋯ The surgeon is in charge for the positioning, but the performance is done in a horizontal division of work between surgeon and anesthesiologist. This article describes standard positions, demonstrates their realization and special damages, and points out juristic aspects as well as technical items like operating table and positioning facilities.
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Scientific evidence is accumulating that non-invasive ventilation (NIV) may be beneficial for different patient groups with acute respiratory insufficiency (ARI). The aim of the new S3 guidelines is to propagate evidence-based knowledge about the indications and limitations of NIV in clinical practice. ⋯ Non-invasive ventilation is still not as widely implemented in clinical medicine as would be expected on the basis of the scientific literature. The aim of the present guidelines is to further propagate NIV for the treatment of ARI.
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Healthcare expenditure continues to grow and the demand for cost-cutting measures has increased. Critical care medicine is characterized by extremely high expenditure and thus appears to be a suitable candidate for rationing. Based on the hospital address book of Germany, a questionnaire consisting of 25 multiple choice questions was sent out to 1,000 intensive care units (ICU). ⋯ Rationing therapy in critical care appears to occur daily in German ICUs. Due to the high costs, intensive care therapy will represent a very important battleground in the inevitable healthcare spending limitations of the future. Rationing cannot be determined exclusively by ICU doctors, thus clear and probably unpopular decisions on this issue are expected to be announced by the politicians.