Der Anaesthesist
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Approximately 18 million patients are treated in German hospitals annually. On the basis of internationally published data the number of in-hospital cardiac arrests can be estimated as 54,000 per year. A structured treatment of in-hospital resuscitation according to the current scientific evidence is essential. ⋯ The prevention of cardiac arrest is of special importance. Uniform and low threshold criteria for alarming the medical emergency team have to be defined to be able to identify and treat critically ill patients in time before cardiac arrest occurs.
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For patients with acute kidney injury (AKI) and continuous renal replacement therapy, it is essential that the dosing of antibiotics is adequately adjusted in order to achieve an effective drug level above the minimum inhibition concentration but avoiding toxic side effects. In the selection of substances, preference should be given to antibiotics with a broad therapeutic spectrum, low incidence of side effects and, as far as possible, extrarenal elimination. ⋯ An accurate as possible estimation of residual renal function and calculation of the mechanical clearance allows determination of the necessary maintenance dosage, which is acceptably accurate for clinical needs. Recent studies have shown that under modern continuous renal replacement therapy, the extent of elimination of antibiotics is regularly underestimated so that nowadays, the risk of antibiotic underdosing is higher than toxicity due to overdosing.
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Stress is an integral part of the daily routine among healthcare workers in anesthesiology and emergency medicine. ⋯ Research in aviation and psychology has provided various tools to improve performance during stressful events and should be taken into consideration for routine daily use.
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Emergency sonography encompasses a number of targeted sonographic investigation techniques, which allow a quick response to frequently occurring situations arising in anesthesiology, including intensive care and emergency medicine. Emergency sonography supports point of care diagnostics to clarify the possible causes of hemodynamic and respiratory instability, e.g. to determine the extent of intra-abdominal bleeding in a still compensated patient with multiple trauma and to support interventions, such as pleural fluid drainage. ⋯ In comparison to conventional sonographic examination techniques, these techniques are used with reduced examination times and a focussed assessment of specific clinical problems. By means of a few standardized cross-sectional planes, numerous questions can be quickly addressed and therapeutic consequences can be deduced.
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Metformin-induced lactic acidosis is a rare but severe disease for the individual patients. A case of a 64-year-old patient with diabetes mellitus type 2 suffering from this disease is presented where metformin accumulation was caused by prerenal acute kidney failure. ⋯ Additionally, the current guidelines regarding the perioperative management of metformin administration are summarized. The case described aims to direct attention to the rare but, nevertheless, severe symptoms of metformin-induced lactic acidosis.