Der Anaesthesist
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The emergency medical service was called to a 60-year-old woman with intensive chest pain, signs of shock, dyspnoea, intermittent paraesthesia of the right leg and disturbance of consciousness. With the diagnosis of an acute rupture of an aneurysm of the thoracic aorta, the patient was stabilised with volume, catecholamines, intubation and mechanical ventilation before being rushed to the preinformed department of cardiovascular surgery. ⋯ This case shows that a ruptured thoracic aortic aneurysm can be survived although the overall mortality of this incident is more than 97%. The essentials of a good outcome are: 1. perfectly coordinated rescue operation which means an emergency medical service which includes the rupture of an aortic aneurysm in the differential diagnosis of acute chest pain, 2. an early verification of the diagnosis by means of transesophageal echocardiography which should also be carried out by anaesthesiologists due to its importance in the differential diagnosis in haemodynamic unstable patients.
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Case Reports
[40 years after the last polio epidemic. Postpolio syndrome as a cause of "weaning failure"].
About 80,000 polio survivors are still living 40 years after the last polio epidemics in Germany. Of these 40-70% have developed the so called post-polio syndrome (PPS) decades after the infection. The main symptoms of PPS are decreasing strength in voluntary muscles, pain and fatigue which occur spontaneously but may also be induced by physical stress and general illness. ⋯ The patient could be discharged from intensive care only after treatment by intermittent positive pressure ventilation via a facial mask. This case report shows that even patients who have a mild handicap after poliomyelitis can develop weaning problems. A PPS can exacerbate with inclusion of respiratory muscles in critically ill patients.
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Laws regulating emergency medical systems in the federal state of Baden-Wuerttemberg call for equipment of physician-staffed ambulances that is based on current knowledge in emergency medicine. The grade of implementation is determined using single issue complexes. ⋯ When comparing equipment of physician-staffed ambulances statewide, striking differences can be found.