Der Anaesthesist
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We have used the Stewart approach to typical acute and compensated acid-base disorders here. Dedicated software developed by the author is available with this article and will be of help to anyone considering analyzing his or her own patients using the Stewart approach. The Stewart approach shares analytical steps with the more traditional Siggard-Andersen method, and in most cases the two methods arrive at the same therapeutic solutions. The Stewart approach is, however, more than merely a biophysical appendix to the traditional clinical model, since metabolic acid-base disorders in particular are understood within a completely different pathophysiological framework; this results in a fresh and sometimes unexpectedly helpful perspective that highlights the functional relevance of seemingly forgotten components such as the chloride ion or albumin.
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Over the last 30 years the Advanced Trauma Life Support (ATLS) course has become the most successful training program in the world for the early care of severely injured patients. It has shaped trauma care systems in many countries and is now on the verge of being introduced into Germany by the German Society of Trauma Surgery (DGU). However, after publication of the latest edition in 2004 there are rising concerns regarding the lack of multi-disciplinarity, out-dated contents and lack of adaptability to regional needs. This article questions the beneficial effect of ATLS on the advanced German trauma care system and concludes that ATLS is not likely to improve trauma care in Germany.
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Review Meta Analysis
[Combined analgesics for postoperative pain therapy. Review of effectivity and side-effects].
The supplementation of an opioid by a non-opioid analgesic is a widely accepted technique for the treatment of postoperative pain. However, it is still unclear whether a combination of different non-opioids has an advantage in terms of an improved analgesia and/or a reduction of the opioid-related adverse effects. ⋯ A combination of non-opioid analgesics, in particular NSAIDs with paracetamol, cannot be recommended at present due to the lack of data showing improved effectiveness.
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Emergencies on or in water are relatively rare in the rescue service. For this reason, water accident treatment and management does not receive much attention in the training of emergency medicine physicians. ⋯ In Germany the number of non-swimmers is also increasing, so it can be assumed that the number of water-related accidents will continue to rise. Drowning accidents and near drowning are important in this context and will be discussed in detail in this review as well as hypothermia (a frequent problem), accompanying injuries and diving accidents.
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The number of diagnostic and surgical procedures being performed outside the core operating area is growing disproportionately. Due to the higher perioperative risk for such patients, anesthesia should only be provided by a very experienced anesthesiologist, even for supposedly small interventions. At these locations, timely and direct access to the anesthesia machine and/or the patient is often limited and if additional personnel or supplies are required, substantial time delays usually occur and should be allowed for. ⋯ For angiography, maximum monitoring needs to be available to provide hemodynamically unstable patients with adequate anesthesia care; comprehensive radiation protection for patients and staff as well as temperature monitoring for prolonged diagnostic procedures is also necessary. Monitoring oxygen saturation and end-tidal carbon dioxide as well as employing visual and audible alarms is an essential requirement even during conscious sedation. In summary, the number of diagnostic and surgical procedures performed outside the core operating area should be reduced to a minimum and, whenever possible, diagnostic or surgical procedures should be performed within the core operating area.