Der Anaesthesist
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Ornithine transcarbamylase (OTC) deficiency is the most frequent innate disorder of the urea cycle and is X-chromosome linked. The disease normally manifests itself shortly after birth and is fatal when untreated. Due to the different expression and X-chromosomal inheritance the manifestation of symptoms can appear later particularly in girls and young women. The first symptoms are non-specific signs of elevated cerebral pressure as a result of a hyperammonemia, which range from nausea and headache up to cerebral herniation with fatal outcome. Measurement of plasma ammonia levels is a simple yet important screening test for patients with unexpected stupor or delirium. ⋯ In the clinical routine it is extremely important to consider a metabolic defect at an early phase and among others to determine the ammonia level so that the appropriate treatment can be instigated in time.
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Physicians have to demonstrate non-technical skills, such as communication and team leading skills, while coping with critical incidents. These skills are not taught during medical education. A crisis resource management (CRM) training was established for 4th to 6th year medical students using a full-scale simulator mannikin (Emergency Care Simulator, ECS, METI). ⋯ The effectiveness of applying the widely used ECS full-scale simulator in interdisciplinary teaching has been demonstrated. The training exposes students to crisis resource management issues and motivates them to develop non-technical skills.