Der Anaesthesist
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Comparative Study
[Postpyloric feeding tubes for surgical intensive care patients. Pilot series to evaluate two methods for bedside placement].
Bedside placement of postpyloric feeding tubes in surgical intensive care patients: a pilot series to evaluate two methods. Early enteral feeding is thought to be a key factor in maintaining the integrity of the gastrointestinal tract mucosal barrier associated with less bacterial translocation and decreased stimulation of the systemic inflammatory response and subsequent improved outcome in intensive care patients. Thus enteral feeding by nasogastric tubes is the preferred route of nutritional support for most surgical intensive care patients. ⋯ These tubes offer a good alternative to more demanding procedures as they are easy to handle and rapidly available. They confer clinical and cost advantages in terms of the early establishment of enteral feeding, no routine X-ray confirmation in the case of the Corflo-Tube® and avoidance of endoscopic guidance for tube placement or parenteral nutrition. In addition they are always justified in the event of a lack of endoscopic positioning.
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The aim of this study was to examine documentation quality in physician staffed emergency medical services (EMS). This study compared simulated on-site care with the associated patient records written by EMS physicians. ⋯ Patient safety can be reduced if relevant preclinical data are not transmitted correctly to the admitting hospital. Therefore there is a need to improve documentation quality in EMS. Electronic documentation, training of EMS staff and quality management programs might offer solutions. Because of the small sample size further studies are needed to evaluate the validity of these results.
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Ultrasound imaging has attained great significance as a tool for diagnostics in emergency and intensive care medicine. The major advantages of this technique are its instantaneous bedside availability and the possibility to perform repeatable examinations. These advantages are based on recent developments, such as portable ultrasound devices offering excellent imaging quality as well as a quick-start-function. ⋯ The goal is to classify the patient's present physical state and to define a targeted therapeutic approach. The characteristics of whole-body sonography are similar to the field of anesthesiology which is an interdisciplinary one. Currently, these characteristics deserve more attention in training in sonography.
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The decrease in airway muscular tone seen during natural sleep and sedation, as well as in the supine position, can lead to anatomic changes in the structures that surround the airway. Some patients need sedation for diagnostic or interventional procedures. ⋯ In addition to different techniques of body positioning, simple airway maneuvers, such as chin lifting can maintain airway patency or open an obstructed upper airway. These maneuvers need an age-related evaluation and application.
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Burn injuries represent a severe form of acute pain. In spite of improvements in wound treatment and pain regimens during recent years, the management of burn pain still remains a common problem and a tremendous challenge for clinical staff. ⋯ A standardized continuous pain assessment and documentation are a cornerstone of burn pain control. In addition to pharmacological methods non-pharmacological procedures can play an important role and should be started early during burn patient therapy.