Der Anaesthesist
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In Germany only 2-9% of rescue missions performed by emergency physicians are pediatric emergencies. Therefore, an emergency physician has to deal with a pediatric emergency on average every 1.1-1.3 months. There are only a few studies in the literature evaluating the frequency of "invasive" techniques and procedures (e.g. vascular access, endotracheal intubation, alternative airway techniques and insertion of chest tube) in pediatric patients in the prehospital setting performed by German emergency physicians. The purpose of this study was to evaluate the frequency of these kinds of procedures in pediatric emergencies in the field of the Helicopter Emergency Medical Service (HEMS). ⋯ Compared to the results of other studies the number of pediatric emergency patients with a NACA score IV-VII in this study is very high. Furthermore, the percentages of non-invasive monitoring procedures applied to the patients as well as invasive therapeutic procedures performed by the HEMS team were also high. Therefore, a special pediatric training course for emergency physicians seems to be necessary.
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Securing the airway is a rarely performed procedure in the out-of-hospital setting. In recent years evidence has been accumulated indicating that out-of-hospital airway management is more challenging as compared to elective situations even for experienced health care providers. Furthermore, several authors have questioned the benefit of out-of-hospital tracheal intubation. This review argues the problems regarding out-of-hospital airway management studies and discusses potential solutions which may improve out-of-hospital health care.
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Postoperative wound infections are the third most common type of nosocomial infection in German emergency hospitals after pneumonia and urinary infections. They are associated with increased morbidity and mortality, prolonged hospital stay and increased costs. The most important risk factors include the microbiological state of the skin surrounding the incision, delayed or premature prophylaxis with antibiotics, duration of surgery, emergency surgery, poorly controlled diabetes mellitus, malignant disease, smoking and advanced age. ⋯ Blood glucose concentrations should be kept in the range of 8.3-10 mmol/l (150-180 mg/dl) as lower values are associated with increased complications. Intraoperative and postoperative hyperoxia with 80% O(2) has not been shown to effectively decrease wound infections. The application of local anesthetics into the surgical wound in clinically relevant doses for postoperative analgesia does not impair wound healing.
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Modern anesthesia is handling an increasing number of patients with neurological diseases who require narcosis. Regional anesthesia techniques offer qualities which might be advantageous for this group particularly for childbirth. The number of pregnant women with neurological diseases has increased significantly in the recent years due to improved diagnostics and therapy. ⋯ Published data concerning regional anesthesia in this patient group are limited and mainly restricted to case reports. In this review general considerations regarding regional anesthesia, techniques, drugs and methods in these patient groups will be discussed. In the second part the practical approach to regional anesthesia for some of the most important neurological diseases is highlighted.