Der Anaesthesist
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Timely establishment of venous access in infants and toddlers during emergency medical care can be a particularly challenging task. Alternative routes for drug and fluid administration, such as endobronchial, intramuscular, central venous or venous cut-down do not offer reliable solutions. Intraosseous infusion (IOI) has become established as an effective alternative intravascular access for rapid and efficient drug delivery. IOI was introduced in our local emergency medical service (EMS) in 1993 and was assigned a high priority in international guidelines for pediatric emergency medical care in 2000 and 2005. The aim of this study was to review the impact of the introduction of IOI on drug administration routes during prehospital emergency treatment of critically ill or severely injured pediatric patients (NACA index V-VII) in our tertiary medical care centre over a period of 20 years. ⋯ The IOI technique has not only been assigned a high priority in the guidelines for pediatric emergency care of critically ill children with difficult or failed venous access but has also significantly influenced current prehospital care. The introduction of the IOI technique in our prehospital pediatric emergency system has markedly reduced the number of critically ill or severely injured pediatric patients without vascular access or with less reliable alternative administration routes in the last 20 years.
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Central venous catheter placement can cause a variety of complications, such as catheter fracture, loss of the guide wire and embolization. In the case reported a large bore central venous catheter was used in a 32-year-old patient undergoing surgery for vertebral body fracture of the thoracic spine. ⋯ However, this possibility could be ruled out by the anesthesiologist who inserted the catheter. With an additional x-ray and CT scan of an identical catheter it could then be demonstrated that the abnormal finding was caused by polyurethane pins which are integrated in the catheter.
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At the end of life acute exacerbations of medical symptoms (e.g. dyspnea) in palliative care patients often result in emergency medical services being alerted. The goals of this study were to discuss cooperation between emergency medical and palliative care structures to optimize the quality of care in emergencies involving palliative care patients. ⋯ Prehospital emergency physicians are confronted with emergencies in palliative care patients every day. In the treatment of these emergencies there are potentially serious conflicts due to the different therapeutic concepts of palliative medical care and emergency medical services. This study demonstrates that there is a need for regulated criteria for the therapy of palliative patients and patients at the end of life in emergency situations. Overall, more clinical investigations concerning end-of-life care and unresponsive palliative care patients in emergency medical situations are necessary.
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Laryngeal tubes (LT) are increasingly being used for emergency airway management. This article reports on two patients in whom out-of-hospital intubation with a single-lumen LT was associated with massive pulmonary aspiration in one patient and gastric overinflation in the other. ⋯ It is therefore recommended that laryngeal tube suction (LTS) should be used in all cases of emergency airway management and a gastric drain tube be inserted through the dedicated second lumen. Apart from gastric overinflation, incorrect LT/LTS placement must be detected and immediately corrected, e.g. in cases of difficult or impossible gastric tube placement, permanent drainage of air from the gastric tube, decreasing minute ventilation or an ascending capnography curve.
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Lidocaine is commonly used for regional anesthesia and nerve blocks. However, recent clinical studies demonstrated that intravenous perioperative administration of lidocaine can lead to better postoperative analgesia, reduced opioid consumption and improved intestinal motility. It can therefore be used as an alternative when epidural analgesia is contraindicated, not possible or not feasible. ⋯ The lidocaine infusion is stopped in the recovery room 30 min before discharge or in the ICU at the latest after 24 h. Lidocaine is not used on normal wards. This overview summarizes the current evidence for the intravenous administration of lidocaine for patients undergoing different types of surgery and gives practical advice for its use.