Der Anaesthesist
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Tragic accidents, e.g. involving celebrity patients or severe incidents in hospital occur suddenly without any advance warning, often produce substantial interest by the media and quickly overburden management personnel involved in both hospitals and emergency medical services. While doctors, hospitals and emergency medical services desire objective media reports, the media promote emotionalized and dramatized reports to ensure maximum attention and circulation. When briefing the media, the scales may quickly tilt from professional, well-deliberated information to unfortunate, often unintended disinformation. ⋯ Each hospital or emergency medical service should have a professional department for public relations, an exact knowledge of the regional and national media and strategies how to handle an incident that is of interest for the media. The media should be provided with information not only when a negative incident has happened but should be provided with regular positive messages as well. An interview must be carefully prepared to achieve a good image.
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Review Meta Analysis
[Current concepts of augmented spontaneous breathing : New modes of effort-adapted weaning.]
The use of augmented spontaneous breathing is an important component in a bundle concept of weaning from mechanical ventilation as it was demonstrated that controlled ventilation with diaphragmatic underuse induces rapid muscle atrophy and impairs successful weaning. On the other hand spontaneous breathing is often associated with disturbed patient-ventilator interaction resulting in asynchrony (e.g. ineffective triggering, early termination of inspiration and overflow or underflow). ⋯ It was shown in some smaller clinical investigations that these newer modes are able to improve patient-ventilator interaction, to reduce the burden on respiratory muscles and to increase ventilation comfort. Although large randomized controlled studies are lacking, effort-adapted modes of augmented breathing will become a routine part in the management of weaning from mechanical ventilation.
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The results of preclinical and clinical studies indicate that the perioperative period is a vulnerable period for cancer progression and metastasis. The risk of cancer cell dissemination is enhanced by the combination of surgical manipulation and perioperative immunosuppression. Whether the oncological outcome of cancer patients can be influenced by the choice of anesthetic techniques is still a matter of debate. This review summarizes the molecular characteristics of cancer and interaction of anesthetic and analgesic drugs with cancer cells.
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Postpartum hemorrhage (PPH) is one of the main causes of maternal deaths even in industrialized countries. It represents an emergency situation which necessitates a rapid decision and in particular an exact diagnosis and root cause analysis in order to initiate the correct therapeutic measures in an interdisciplinary cooperation. In addition to established guidelines, the benefits of standardized therapy algorithms have been demonstrated. ⋯ The rarity of occurrence for individual patients and the life-threatening situation necessitate a structured approach according to predetermined treatment algorithms. This can then be carried out according to the established algorithm. Furthermore, this algorithm presents the opportunity to train for emergency situations in an interdisciplinary team.
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In Germany 100,000-160,000 people suffer from out-of-hospital cardiac arrest (OHCA) annually. The incidence of cardiopulmonary resuscitation (CPR) after OHCA varies between emergency ambulance services but is in the range of 30-90 CPR attempts per 100,000 inhabitants per year. Basic life support (BLS) involving chest compressions and ventilation is the key measure of resuscitation. ⋯ This might be true in cases of resuscitation due to hypothermia, intoxication and pulmonary embolism as well as for patients requiring transport or coronary intervention when cardiac arrest persists. Three prospective randomized studies and the resulting meta-analysis are available for active compression-decompression resuscitation (ACD-CPR) in combination with an impedance threshold device (ITD). These studies compared ACD-ITD-CPR to standard CPR and clearly demonstrated that ACD-ITD-CPR is superior to standard CPR concerning short and long-term survival with good neurological recovery after OHCA.