Der Anaesthesist
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Home mechanical ventilation represents a valuable therapeutic option to improve alveolar ventilation in patients with chronic respiratory failure. For this purpose both invasive ventilation via tracheostomy and noninvasive ventilation via facemasks are available. ⋯ However, invasive mechanical ventilation is increasingly being used to continue ventilatory support in polymorbid patients following unsuccessful weaning. Recommendations and guidelines have been published by the German Respiratory Society (DGP).
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Biography Historical Article
[From the legacy of Carl Koller : Notations on his experiments with cocaine].
The history of local anesthesia began with the discovery of the anesthetic properties of cocaine by the physician Carl Koller from Vienna 130 years ago. After he had realized the options for painless surgery using this substance, he analyzed cocaine in detail from this point of view and evaluated the drug's significance in animal experiments, in self-experiments and in colleagues. The findings of his experiments were accurately recorded by Koller and after his death remained in the possession of the family for a long time until his daughter Hortense Becker-Koller handed these documents over to the Library of Congress in Washington. These recordings were recently studied and will now be presented to the public for the first time ever.
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In 2015 the German Society for Diving and Hyperbaric Medicine (GTÜM) and the Swiss Underwater and Hyperbaric Medical Society (SUHMS) published the updated guidelines on diving accidents 2014-2017. These multidisciplinary guidelines were developed within a structured consensus process by members of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), the Sports Divers Association (VDST), the Naval Medical Institute (SchiffMedInst), the Social Accident Insurance Institution for the Building Trade (BG BAU), the Association of Hyperbaric Treatment Centers (VDD) and the Society of Occupational and Environmental Medicine (DGAUM). This consensus-based guidelines project (development grade S2k) with a representative group of developers was conducted by the Association of Scientific Medical Societies in Germany. ⋯ Hyperbaric oxygen (HBO) recompression remains unchanged the established treatment in severe cases with no therapeutic alternatives. The basic treatment scheme recommended for diving accidents is hyperbaric oxygenation at 280 kPa. For quality management purposes there is a need in the future for a nationwide register of hyperbaric therapy.
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To describe the trend of acute self-poisoning in the emergency and intensive care. ⋯ Acute self-poisoning is an increasing medical issue. Psychotropic drugs remain the most common means of suicide attempt. Although alcohol intoxication is very frequent, intake of illicit drugs as the cause of emergency admission is increasing.
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Sudden cardiac death (SCD) in young athletes during physical stress is a rare event with an incidence of 1-3 deaths per 100,000 athletes per year. A coronary anomaly is the second most common cause of death following hypertrophic cardiomyopathy. ⋯ Despite immediate resuscitation attempts and initial return of spontaneous circulation (ROSC), a pulseless electrical activity (PEA) followed and the patient died 1 h after arrival in the resuscitation unit. The autopsy revealed an anomalous left coronary artery (ALCA), which can lead to ischemia of the respective heart muscles under severe stress.