Der Anaesthesist
-
Acute pancreatitis is a potentially fatal disease with individually differing expression of systemic involvement. For this reason early diagnosis with subsequent risk stratification is essential in the clinical management of this frequent gastroenterological disorder. ⋯ Concerning the administration of antibiotics and the nutritional support of patients with acute pancreatitis a change in paradigms could be observed in recent years. Furthermore, endoscopic, radiological or surgical interventions can be necessary depending on the severity of the disease and potential complications.
-
The overwhelming postsplenectomy infection syndrome (OPSI) is a fulminant sepsis that is mainly caused by Streptococcus pneumoniae and is characterized by a particular high mortality. Patients whose spleen was removed due to a hematological disease are at special risk. Even after the recommended immunization against Streptococcus pneumoniae 20-30 % of these patients do not develop an adequate level of antibody response. Therefore, this particular group of patients must be trained how to behave in case of fever and need to obtain immediate specific sepsis therapy with antibiotic prophylaxis.
-
The Deutsche Interdisziplinäre Vereinigung für Intensivmedizin und Notfallmedizin (DIVI) is divided into sections one of which is the "Sektion Notaufnahmeprotokoll" (emergency department protocol section) founded in 2007. The main task was to create a national data set for the documentation of patients in emergency departments (ED). ⋯ Beside the ability to exchange information the presented data set is the basis for internal and external quality assessment in the ED even if most of the available scoring and benchmarking tools are not validated for the German medical system. Implementing an ED register in Germany which is planned in the future, could close this gap.
-
In the context of the new education program for German paramedics, a discussion has been fueled regarding the emergency care competencies of paramedics. In 1999 a system for training and qualification of paramedics was established in the emergency medical service (EMS) area of Reutlingen (Germany), including an algorithm for analgesia using ketamine and midazolam. Under defined circumstances analgesia may be administered to patients in the absence of a physician. ⋯ After appropriate training and regular control analgesia administered by paramedics in the present system was safely and effectively applied.