Praktische Anästhesie, Wiederbelebung und Intensivtherapie
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The physical principles of electricity and types of electrical injuries are reviewed. The extent of such injuries depends on the strength of the current: ventricular fibrillations can be induced by a current of 10mA, and even of 10 muA if the current passes directly through the heart. ⋯ Risks attendant on the use of even the "safest" electrical apparatus are discussed, with special reference to the risks arising from interaction between, e.g., high frequency diathermy and monitoring equipment or domestic appliances (beside lamp, razor) and monitoring or electrical therapeutic equipment. A number of safety measures to minimize the risk of electrical injuries are discussed.
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Two cases of malignant hyperthermia with different clinical courses are reported. The patients showed the classical signs of malignant hyperthermia consisting of tachycardia, tachypnoea, ocasional peripheral cyanosis, high body temperature as well as characteristic rise in serum enzymes. In one of the patients the symptoms were recognized early during the operation. ⋯ On the basis of the observed variable course, the various symptom complexes reported in the literature to data are reviewed. A detailed discussion of the "carrier problem" and the available treatment possibilities is also made. Realising that malignant hyperthermia is an inheritable disease, prophylactic measures such as, f.i. the issue of medical certificates to the patient and his relatives are suggested.
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Corresponding to the fact that flammable anaesthetics are still very seldron in use the possibility of fires an explosions has diminished; the frequency of accidents caused by flammable colonic gases and by desinficients is about unchanged whilst a new kind can and dose occur: Fires and (occassional) explosions with "nonflammable" anaesthetic technics. A survey about 16 cases (including oxygen-fires) should be of interest for surgeons and intensive-care-people as well as for anaesthetists.
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With the Engström Respirator the waste gases can be removed by using the rebreathing position and by replacing the reservoir-bag with a long widebore tubing.