Der Anaesthesist
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The emergency medical service (EMS) should work according to criteria of evidence-based medicine. In Germany the EMS of each state is under the control of at least one medical supervisor known as emergency medical directors (EMD) and most states have several different EMDs responsible for one or more provinces of the state. The German Medical Association advises these supervisors to specify the pharmacological resources in store for use in physician powered EMSs. This study examines the pharmacological resources in EMSs which is provided by the EMDs in Germany. Furthermore, a comparison of the inventory analysis of stored drugs was carried out with the requirements according to guidelines for selected tracer diagnoses. ⋯ Due to recent treatment recommendations provision with sodium bicarbonate, calcium, magnesium, noradrenaline, adenosine, lorazepam iv, dobutamine and as well with ipratropium bromide and salbutamol (both as liquid preparations for inhalation) should be improved. For the future, a federal uniform minimum standard due to evidence-based principles is desirable.
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Review Meta Analysis
[Endotracheal tubes in pediatric patients. Published formulas to estimate the optimal size].
Estimating the endotracheal tube size with the optimal internal diameter (ID) is of outstanding importance for airway management in pediatric patients. For many years different weight, height, and/or age-based formulas have been published. The aim of the present study was to identify and to compare published formulas to estimate optimal tube size in pediatric patients. ⋯ The identified formulas were comparatively simple to apply but were validated only for pediatric patients older than 1 year. Using tubes with a cuff can minimize the problem of optimal tube size. If a tube without a cuff is intended to be used other sizes should also be available.
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Review Meta Analysis
[Estimation of substitution volume after burn trauma. Systematic review of published formulae].
Fluid resuscitation after severe burns remains a challenging task particularly in the preclinical and early clinical phases. To facilitate volume substitution after burn trauma several formulae have been published and evaluated, nevertheless, the optimal formula has not yet been identified. ⋯ The identified formulae led to sometimes strikingly diverse calculations of resuscitation fluid volumes. Therefore their use should be monitored closely and clinical values included. Urine output is a well established individual parameter. Use of colloid and hypertonic solutions leads to a reduced total fluid volume but is still controversially discussed.
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With increasing demands for blood transfusions, the costs and shortages, clinically relevant risks and doubts on the efficacy, blood conservation is an important issues. Among the available methods cell salvage is of great importance as it has proven effective and safe. The high availability and cost efficacy allows fast processing of at least half of the lost red blood cells. ⋯ Cell salvage provides autologous, washed, unstored red blood cells with unimpaired function and viability, avoiding immunological reactions and storage damage, for optimal hemotherapy. No restrictions in the indication for transfusion are necessary, thus allowing real therapy of anemia. The high quality of salvaged blood should be assured by a quality management including quality controls.
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Oxygen (O(2)) is the most frequently used pharmaceutical in anesthesiology and intensive care medicine: Every patient receives O(2) during surgery or during a stay in the intensive care unit. Hypoxia and hypoxemia of various origins are the most typical indications which are mentioned in the prescribing information of O(2): the goal of the administration of O(2) is either an increase of arterial O(2) partial pressure in order to treat hypoxia, or an increase of arterial O(2) content in order to treat hypoxemia. Most of the indications for O(2) administration were developed in former times and have seldom been questioned from that time on as the short-term side-effects of O(2) are usually considered to be of minor importance. ⋯ However, there is an emerging body of evidence that specific side-effects of O(2) result in a deterioration of the microcirculation. The administration of O(2) induces arteriolar constriction which will initiate a decline of regional O(2) delivery and subsequently a decline of tissue oxygenation. The aim of the manuscript presented is to discuss the significance of O(2) as a pharmaceutical in the clinical setting.