Der Anaesthesist
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During the perioperative and postoperative care of pregnant women it is prudent to pay close attention to the changed physiology of these patients. The main principles of care are the preservation of maternal and fetal homeostasis as well as avoidance of any substances with toxic effects on the fetus. In order to provide pregnant patients with good quality care, all relevant disciplines should be involved as early as possible. ⋯ If possible anticonvulsives should not be used as an adjunct in pain management during pregnancy. The use of thoroughly investigated antidepressants seems to be a better alternative. Apart from drug therapy it is important to use all available conservative pain treatment options.
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Due to a huge increase in the implantation of ventricular assist devices (VAD) over the last few years and the enormous technical advances in functional safety, a growing number of patients with VAD are discharged from hospital, who are still considered to be severely ill. This results in an increased probability of these patients interacting with emergency services where personnel are unaware of the presence of a VAD, creating anxiety and uncertainty regarding how to treat these patients. This article presents an overview of the most common problems and pitfalls regarding VADs. It also presents an algorithm for dealing with emergencies involving these patients including the diagnostics, treatment and primary transport.
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An acute obstruction of blood flow in central vessels of the systemic or pulmonary circulation causes the clinical symptoms of shock accompanied by disturbances of consciousness, centralization, oliguria, hypotension and tachycardia. In the case of an acute pulmonary embolism an intravascular occlusion results in an acute increase of the right ventricular afterload. ⋯ The high dynamics of this potentially life-threatening condition is a hallmark of all types of obstructive shock. This requires an expeditious and purposeful diagnosis and a rapid and well-aimed therapy.
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Many missions in the preclinical emergency services seem to be triggered by false indications as defined by the Federal State Rescue Act. These emergency calls are often a result of or associated with social issues. Emergency rescue personnel are confronted with social problems and as a result often feel left alone with the problem. ⋯ Emergency personnel have only limited options for dealing with such problems; however, it is important to be aware of regional structures and non-medical organizations, which might be of help in such situations. These include social services, youth welfare services, crisis interventions teams and social psychiatric services.
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Approximately 18 million patients are treated in German hospitals annually. On the basis of internationally published data the number of in-hospital cardiac arrests can be estimated as 54,000 per year. A structured treatment of in-hospital resuscitation according to the current scientific evidence is essential. ⋯ The prevention of cardiac arrest is of special importance. Uniform and low threshold criteria for alarming the medical emergency team have to be defined to be able to identify and treat critically ill patients in time before cardiac arrest occurs.