Der Anaesthesist
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The development of modern critical care lung ultrasound is based on the classical representation of anatomical structures and the need for the assessment of specific sonography artefacts and phenomena. The air and fluid content of the lungs is interpreted using few typical artefacts and phenomena, with which the most important differential diagnoses can be made. According to a recent international consensus conference these include lung sliding, lung pulse, B-lines, lung point, reverberation artefacts, subpleural consolidations and intrapleural fluid collections. ⋯ Ultrasound-based diagnosis of pneumothorax is superior to supine anterior chest radiography: for ultrasound the sensitivity is 92-100% and the specificity 91-100%. For the diagnosis of pneumothorax a simple algorithm was therefore designed: in the presence of lung sliding, lung pulse or B-lines, pneumothorax can be ruled out, in contrast a positive lung point is a highly specific sign of the presence of pneumothorax. Furthermore, lung ultrasound allows not only diagnosis of pleural effusion with significantly higher sensitivity than chest x-ray but also visual control in ultrasound-guided thoracocentesis.
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Guidelines on opioid therapy for patients with chronic non-tumor pain should support pain relief, prevent iatrogenic suffering, collateral health damage and legal restrictions on the availability of opioid analgesics. A total of six North American and two European committees recently developed guidelines which differ from the previous ones by being based on many more randomized controlled trials. ⋯ Drafting recommendations for a preferably individual efficacy prognosis is a further objective of the guidelines. This article will discuss if previous and current recommendations of opioid guidelines meet these requirements.
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The Central Command for Maritime Emergencies was founded in Germany in 2003 triggered by the fire on board of the cargo ship "Pallas" in 1998. Its mission is to coordinate and direct measures at or above state level in maritime emergency situations in the North Sea and the Baltic Sea. A special task in this case is to provide firefighting and medical care. ⋯ This form of organization provides a concept to counter mass casualty incidents and peril situations at sea. Since the foundation of the Central Command for Maritime Emergencies there have been 5 operations for firefighting units and 4 for medical response teams. Assignments and structure of the Central Command for Maritime Emergencies are unique in Europe.
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Clinically relevant bleeding in the upper gastrointestinal tract due to stress lesions is a rare event; however, the related mortality may be as high as 13% (van Leerdam, Best Pract Res Clin Gastroenterol 2008; 22:209-224). Most often affected are patients in the intensive care unit (ICU) with impaired perfusion as the protective pathways are critically dependent on a near normal blood flow. Minimal mucosal lesions with a tiny hemorrhage can escalate to severe bleeding as the coagulation potential in the presence of an acidic pH is clearly decreased. ⋯ However, the side effects of PPI can cause severe morbidity and therefore H(2)RAs may be the drug of choice for prophylaxis. Endoscopy is recommended as a diagnostic and therapeutic tool for patients with active bleeding. Treatment with PPI in this scenario (before and after endoscopy) may reduce complications by leading to premature hemostasis and reduced recurrence of bleeding.