Der Anaesthesist
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The main target of treatment in patients with head trauma is to maintain the physiological parameters within the following normal limits: intracranial pressure (ICP) below 20 mmHg, cerebral perfusion pressure (CPP) between 50 and 70 mmHg, normoxemia (SpO(2) >90%), normocapnia (paCO(2): 35-38 mmHg), normoglycemia (80-130 mg/dl) and normothermia (36.0-37.5 degrees C). Space-occupying intracranial bleeding or edemas must be evacuated immediately. ⋯ Mild hyperventilation, therapeutic hypothermia, or decompressive craniectomy should be used solely in patients with a persistent ICP increase. Infusion of calcium antagonists or glucocorticoids is never indicated in patients with head trauma.
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The use of volatile anaesthetics in intensive care medicine has so far been limited by the lack of equipment suitable for daily routine use and the need for an anaesthetic machine. The new Anaesthetic Conserving Device (AnaConDa) enables the routine use of volatile anaesthetics for long-term sedation via intensive care ventilators. The Anaesthetic Conserving Device replaces the common heat and moisture exchanger in the ventilation circuit. ⋯ The expired anaesthetic gas is stored in the carbon filter and approximately 90% of the gas is resupplied into the breathing cycle. The current experiences suggest that volatile anaesthetics present an alternative for long-term sedation in intensive care units, providing optimised pathways, from a medical as well as from an economical point of view. It must, however, be emphasized that the use of volatile anaesthetics for longer periods of time is an off-label use and should only undertaken by medical professionals at their own risk.
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Time course, time necessary to achieve the target temperature and stable maintenance, as well as a controlled rewarming period are important factors influencing the outcome of patients after successful cardiopulmonary resuscitation. ⋯ Endovascular cooling offers the possibility to reach the target temperature significantly faster and a stable maintenance of therapeutic hypothermia. It is capable of a more controlled rewarming period and shortens the length of ICU stay.
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Efforts to improve the quality of undergraduate medical education are commonly hampered by limited human and financial resources. This deficiency may be offset by the development of well structured and innovative teaching concepts, which optimize available assets. The newly conceived modular course "Emergency Medicine" at the University Medical Center Freiburg was conducted for the first time in the winter semester 2006/2007. ⋯ Evaluation of the course revealed standardized patients to be the best of all teaching methods with an overall average grade of 1.1 (patient simulators 1.2, computer simulation 1.4). Of the students, 88% stated that the practical training encouraged their interest in the speciality emergency medicine. The excellent student evaluation results show that the new course "Emergency Medicine" for medical students constitutes a successful balance between the constraint of resource limitation and the goal of excellent medical education.