Der Anaesthesist
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Values of intramural or even transmural central venous pressure (CVP) as well as values of pulmonary artery occluded pressure do not correlate with the values of measured circulating blood volume or with responsiveness to fluid challenge. The veins contain approximately 70% of the total blood volume and are 30 times more compliant than arteries, therefore, changes in blood volume within the veins are associated with relatively small changes in venous pressure. The main reason for a lack of correlation between CVP values and blood volume is that the body does everything possible to maintain homeostasis and adequate transmural CVP is a must for cardiovascular function. ⋯ Stressed volume determines MCFP and directly affects venous return and cardiac output whereas unstressed volume is a reserve of blood that can be mobilized into circulation when needed. Both stressed and unstressed volume cannot be adequately measured. Therefore, considering the complexity of the physiologic feedback and clinical picture, robust reflexes and homeostatic mechanisms, CVP is insufficient as a surrogate parameter for assessing the volume status.
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After initial stabilization of burn victims at the scene and in the trauma room, a tight cooperation and communication between anesthesiologists, plastic surgeons and intensive care specialists is needed for further therapy. Interdisciplinary communication about preoperative planning, timing of necrectomy and intensive care therapy is vital regarding functional and aesthetic outcome and survival rate. During burn surgery attention has to be paid to excessive blood loss and the danger of hypothermia. The main problems of intensive care therapy involve the evaluation of volume status, high demands for analgesia and sedation, high incidence of septic multiorgan failure and therapy and prophylaxis of the effects of hypermetabolism.
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Case Reports
[Airway management in a patient with immobilized cervical spine. Preclinical use of the McGrath video-laryngoscope].
The McGrath video-laryngoscope was used in a patient with immobilized cervical spine and suspected difficult airway after a high level fall with traumatic brain injury and suspected cervical spine trauma. The airway was successfully secured in the preclinical setting using an oral endotracheal tube with full view of the glottis. Because video-laryngoscopy offers potential advantages compared to established airway management techniques, further studies are required to evaluate the significance of video-laryngoscopy in prehospital emergency medicine.
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Increasing specialization and growing mechanization in medicine have strongly supported the transfer of originally medical responsibilities to non-medical personnel. The enormous pressure of costs as a result of limited financial resources in the health system make the delegation of previously medical functions to cheaper non-medical ancillary staff expedient and the sometimes obvious lack of physicians also gains importance by the delegation of many activities away from medical staff. ⋯ The inclination towards risk of medical activities, the need of protection of the patient and the intellectual prerequisites required for carrying out the necessary measures define the limitations for the delegation of medical responsibilities to non-medical ancillary staff. These criteria demarcate by expert assessment the exclusively medical field of activity in a sufficiently exact and convincing manner.