Der Anaesthesist
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Obesity in Germany is becoming more and more prevalent. Significantly overweight patients (>200 kg) pose an increasing and difficult challenge for emergency medical services, emergency doctors and the hospitals responsible for further treatment. The anatomic and physiological characteristics of patients with extreme obesity must be taken into consideration, particularly the airway, breathing, circulation, disability, exposure and environment of the patient. ⋯ Emergency transport in a bed should be avoided. Neighboring rescue services must be alarmed at an early stage if the commune concerned does not have adequate means of its own. Politics should guarantee cost-covering remuneration for hospitals and rescue services.
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Intravenous administration of fluids, electrolytes and glucose are the most common interventions in hospitalized pediatric patients. Parenteral fluid administration can be life-saving, however, if used incorrectly it also carries substantial risks. Perioperatively, adequate hydration, prevention of electrolyte imbalances and maintenance of normoglycemia are the main goals of parenteral fluid therapy. ⋯ Although there is no convincing evidence that colloids are better than crystalloids, there are clinical situations where the use of the more expensive colloids seems justified. It may be reasonable to choose a solution for fluid replacement which has a composition comparable to the composition of the fluid which must be replaced. Although hypertonic saline can reduce an elevated intracranial pressure, this therapy cannot be recommended as a routine procedure because there is currently no evidence that this intervention improves long-term outcome in pediatric patients with traumatic brain injury.
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Case Reports
[Management of cardiac high risk pregnancy. Caesarean section in a primagravida with cyanotic cardiac defect].
A 37-year-old gravida I with cyanotic heart disease presented for caesarean section in the 31st week of gestation. Caesarean section was performed uneventfully with the patient under epidural anaesthesia accompanied by invasive monitoring. ⋯ Every patient with complex comorbidities has to be managed according to individual prerequisites and the experiences and preferences of the team. For such high risk pregnancies regional anaesthesia seems to be a possible option although no clear evidence can be found in the literature.
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The aim of this study was to examine whether it is possible to perform resuscitation according to the present European Resuscitation Council (ERC) guidelines with a modified algorithm in the case of special, e.g. military, circumstances. On international missions of the German Armed Forces a rescue team only consists of an emergency physician and a paramedic. As the German Armed Forces require the same means of medical aid for all soldiers on every type of mission worldwide the algorithm must meet the ERC requirements. ⋯ During military missions of the German Armed Forces there are no other options to perform resuscitation than by performing this procedure with only two rescuers. Using the algorithm in a modified way securing of the airway with an LT, the performance of over-the-head chest compressions and an effective resuscitation with advanced cardiac life support according to the ERC guidelines of 2005 are feasible even with 2 rescuers. Using the LT instead of endotracheal intubation to secure the airway particularly contributed to shortening the hands-off time.
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Physicians and nurses in anesthesia and critical care medicine are thought to be particularly prone to developing burnout. Epidemiologic data, however, are inconclusive especially because not all of the studies presented here are methodologically sound. Nevertheless, the following conclusions appear reasonable: in several European countries burnout is seen as a relevant problem in anesthesia and critical care medicine with a point-prevalence for moderate or severe burnout, as determined with the Maslach Burnout Inventory, at approximately 30% among nurses and approximately 40-50% among physicians. ⋯ Stress management programs appear to be somewhat efficacious although there are no studies to date for the clientele featured in this publication. Multimodal therapy can be recommended for pronounced burnout, including occupation-related treatment modalities. However, a general open mind towards warning signs of chronic stress disorder on the individual level as well as an adequate gratification for the work performance and sufficient control over the work routine on an organizational level appear to be among the important preventive measures.