Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · Feb 2013
Review[Chest pains in emergency admission. Diagnostics and treatment].
Thoracic pain is a common symptom in the emergency medicine setting and represents a diagnostic and therapeutic challenge. A multitude of differential diagnoses must be considered many of which are associated with a high mortality. ⋯ Also for some underlying pathologies the physical examination can have an inconspicuous or"false negative" result and atypical presentations can give rise to false interpretations. The clinical and technical diagnostic methods, the implementation and interpretation including possible sources of error and limitations will be described in detail.
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Med Klin Intensivmed Notfmed · Feb 2013
Case Reports[Arteriovenous extracorporeal membrane oxygenation (ECMO). A therapeutic option for fulminant pulmonary embolism].
According to the guidelines of the European (2008) and German Societies of Cardiology (2009) thrombolysis is recommended for patients with pulmonary embolisms presenting with cardiogenic shock (recommendation level I, evidence level A). If there are contraindications or thrombolysis is not successful surgical embolectomy should be considered (recommendation level I, evidence level C). Additional options are catheter-based therapies in the proximal pulmonary artery (recommendation level IIb, evidence level C). ⋯ Acute heart failure and hypoxemia of all organs are the main symptoms of massive pulmonary embolisms. The use of arteriovenous ECMO represents a therapeutic option for life-threatening pulmonary embolism. A decisive factor for success is immediate diagnosis and rapid implementation of the system.
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Med Klin Intensivmed Notfmed · Feb 2013
[Influence of personnel staffing on patient care and nursing in German intensive care units. Descriptive study on aspects of patient safety and stress indicators of nursing].
In this article selected results of a descriptive study on personnel staffing and patient care in German intensive care units are presented and discussed. The main focus is on comparing features of personnel staffing with indicators of the job situation and patient care. The study is based on a standardized survey of nursing managers from 535 intensive care units carried out in 2011. The results show that a low nurse-patient ratio in intensive care units has a tendency to cause higher risks in patient care and also in other stress indicator situations, such as absenteeism.
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Hyponatremia is the most common electrolyte disorder in the hospital setting and is defined as a serum sodium concentration less than 135 mmol/l. Most patients have mild hyponatremia (plasma sodium concentration 130-134 mmol/l) and few if any symptoms. Serum sodium concentrations between 120 and 129 mmol/l can be associated with lack of concentration, nausea, forgetfulness, apathy and loss of balance. ⋯ Recently a new class of pharmacological agents has become available, the vaptans, orally taken vasopressin antagonists. Clinical trials showed them to provide effective, specific and safe therapy of hyponatremia. In Europe tolvaptan, the only such agent on the market is now approved for the treatment of euvolemic hyponatremia.