Der Anaesthesist
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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.
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Editorial Comment
[Which fluids does my patient need and when yes, how much?]