Zentralblatt für Chirurgie
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The emergency room functions as a junction between preclinical and early clinical treatment of patients with multiple trauma and should have defined technical and room possibilities. The personal staff should continue resuscitation measures and perform clinical and technical diagnostic procedures according to trained algorithms. The recognition of life-threatening injuries, the set up of correct priorities and application of respective surgical procedures characterize a good emergency room management.
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The patient-controlled analgesia (PCA) or "ondemand analgesia" is a pain-relieving therapy, which is regulated and monitored by the patient himself. Postoperative pain therapy is the main approach for PCA, which facilitates a long-term, individually controlled pain relief. ⋯ This kind of therapy needs the acceptance and understanding of the patient as a main condition for the success. Beside an increase of patients' comfort and patients' independence of analgetic demand from the medical staff a reduction in postoperative complications can be expected, the time of hospitalisation might be decreased.
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A prospective documentation of patients data on an internal and a surgical intensive care unit (ICU) has been transacted. The physician and nursing staff used an online electronic documentation program, which has been developed in Frankfurt. Main emphasis has been placed on the epidemiological data, clinical diagnoses as well as diagnostically and therapy costs. ⋯ Patients underwent 2.2 +/- 0.12 chest x-rays and 1.4 +/- 0.1 ultrasound investigations. The study shows that an online data processing is practicable and can be integrated in the daily work flow. Furthermore, it can be seen that the collected data play an important role to secure the increasing administrative requisition to the modern medicine in view of costs and quality management.
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We describe our method of transcranial Doppler (TCD) monitoring during carotid endarterectomy (CE) procedures. During a period of 35 months we performed 257 CE with TCD monitoring. ⋯ Further advantages of the TCD monitoring are: detection of microemboli, control of the potential collateralisation of the external carotid artery and the control of efficacy and accurate positioning of the intraluminal shunt. We comment our results of cerebral monitoring and consider it as a useful tool for optimizing the postoperative results of carotid surgery.
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Diagnosis of diaphragmatic rupture is often missed after blunt thoracic and abdominal injuries because diaphragmatic injury does not play an important role beside severe injuries of intrabdominal and/or thoracic organs. Between 1976 and 1993, 141 patients were treated for traumatic injury of the diaphragm. In 42 patients with penetrating injuries following stab or shot wounds diaphragmatic lesions were diagnosed by the emergent surgical therapy. 99 had diaphragmatic tears from blunt thoracic or abdominal trauma by accidents. 14 of 99 patients sustained isolated diaphragmatic rupture, in 85 the rupture was combined with other injuries, 24 had fractures of the pelvic ring. ⋯ Therapy of diaphragmatic injury was performed in 83 patients within 4 days, in 9 within 4 months and in 7 later than one year. For diaphragmatic repair 87 patients underwent laparotomy and 12 thoracotomy. Local complications were found in 13 patients (13.1%). 19 patients (19.2%) died postoperatively due to accompanying injuries.