Der Anaesthesist
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Acute pain is a common reason for calling emergency medical services (EMS) and can require medication depending on the pain intensity. German EMS personnel feel strong pressure to reduce a patient's pain but are restricted by law. Currently, German federal law only allows the administration of opioid-containing drugs by or on the order of a physician, while in other European countries (e.g. Switzerland and The Netherlands) the administration of opioid-based analgesia by trained and certified paramedics is common practice. Consequently, a patient in Germany experiencing acute pain needs the attendance of an emergency physician in EMS missions. According to international standards pain reduction on the numeric rating scale (NRS) score by ≥2 or a NRS score ≤4 at the end of the patient transport is considered to be adequate. ⋯ The administration of analgesia by EMS personnel with teleconsultation of a physician is effective and has a low rate of complications, particularly morphine. Overall, algorithm-based call back-supported as well as telemedically supported analgesia concepts based on regular training improve the management of pain in the prehospital setting. In addition, the resources of the emergency physician remain available for life-threatening emergencies. The training, certification and supervision of EMS personnel is very important in both systems to ensure the best pain management care and patient safety. Adjustments to the federal law on the administration of analgesics would facilitate the realization of algorithm-based concepts by paramedics as pain reduction could be performed with delegation by a medical director without consulting another physician.
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Case Reports
[PGE1-assisted treatment of microcirculation disturbance in complicated falciparum malaria].
This article reports the course of a complicated malaria in a 41-year-old male patient. After spending several months in Mali, the patient decompensated shortly after onset of the first symptoms. Under the signs of a multi-organ failure and with an initial parasitic load of 25%, the patient developed a microcirculation disturbance in the acra. ⋯ The microcirculatory disturbances were no longer evident and the necrosis healed. Furthermore, the clearance course of the plasmodia was delayed under artemisinin-based combination therapy. Prolonged hemolysis required multiple transfusions.