Der Anaesthesist
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Randomized Controlled Trial
[Sciatic nerve block "out-of-plane" distal to the bifurcation: effective and safe].
Ultrasound guided distal sciatic nerve block (DSB) at bifurcation level shows fast onset and provides excellent success rates. However, its safe performance might be difficult for the unexperienced physician. Just slightly distal to the bifurcation, the tibial nerve (TN) and common fibular nerve (CFN) can be shown clearly separated from each other. Therefore, we investigated if a block done here would provide similar quality results compared to the DSB proximally to the division, with a potentially lower risk of nerve damage. ⋯ DSB slightly distal to the bifurcation, in an out-of-plane technique between the TN and CFN, can be done fast, effectively and safe.
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A 43-year-old woman became exhausted and fainted on descent at 1127 MAMSL altitude and snowfall. A rescue team diagnosed asystole. With manual cardiopulmonary resuscitation (CPR) she was transported to the next extracorporeal life support (ECLS) center. ⋯ Two days later she was awake, orientated, and with no neurological deficits. With hypothermic cardiac arrest, a favorable outcome depends on early continuous CPR, triage, and ECLS rewarming. It holds true that "nobody is dead until they are warmed and dead" if one cools first and arrests thereafter.
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Pulmonary embolism is a potentially fatal disorder and frequently seen in critical care and emergency medicine. Due to a high mortality rate within the first few hours, the accurate initiation of rational diagnostic pathways in patients with suspected pulmonary embolism and timely consecutive treatment is essential. ⋯ Special focus is put on a structured patient management based on the individual risk of early mortality. In particular risk assessment and new risk-adjusted treatment recommendations are presented and discussed in this article.
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Use of intraosseous access to the vascular system is rare in the pre-hospital setting (<1%). However, as patients for which the use of an intraosseous device is indicated are usually in a critical condition, awareness of possible application errors is vital. A survey was performed to evaluate intramedullary needle placement by means of computed axial tomography. ⋯ Even though clinical criteria may suggest correct placement of an intraosseous device, the results of this survey provide evidence that deviations in positioning are common. Placement of the needle too deep can cause complications within the soft tissues or potentially impede intraosseous infusion.