Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Mechanical ventilation (MV) is one of the most essential cornerstones of intensive care therapy. Although of pivotal importance for many patients suffering from respiratory insufficiency MV itself may further induce pathophysiological processes due to the mechanical stress exerted on the lungs. ⋯ Although MV is necessary for the treatment of severe hypoxemia it causes damage not only in the lungs but also in other organs due to a secondary inflammatory process in the lungs. To reduce these reactions an evidence-based concept of lung protective ventilation is essential.
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Med Klin Intensivmed Notfmed · Oct 2013
Review[Atrial fibrillation in the ICU. Distinct entity--special treatment?].
Atrial fibrillation (AF) is the single most frequent arrhythmia in the intensive care unit, occurring among 44-61 % of all patients with arrhythmias in the intensive care unit. The success rate of electrical cardioversion (DC-CV) early after surgery is as low as 10-35 % in postoperative AF but 6 weeks after discharge 90 % are in sinus rhythm (SR). ⋯ DC-CV is recommended in unstable and heart failure patients. The term resistant AF is suggested for that distinct situation of AF not amenable to cardioversion solely in the acute phase of critical illness.
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This overview describes antidotes, and their clinical pharmacology, that have an established significance in the currently practiced clinical toxicology because of their proven effectiveness in the treatment of serious poisonings. For the proper, efficient, and targeted use of an antidote, pharmacological knowledge is required, which is a central subject of this article. Current data from the literature are used as reference along with the accumulated experiences about possible adverse effects in order to include them in therapeutic considerations. The dosage of antidotes is the subject of several other review articles and is therefore not included in this synopsis.
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Drug use has changed dramatically in recent years. Classic drugs such as marijuana, heroin, and cocaine are being pushed progressively into the background. Consumer behavior has also changed and so-called designer drugs dominate the market. ⋯ A ban often follows a latency period. Estimating the risk is difficult, and the problem of intoxication increases. This overview presents the activity profiles and risks of classic and new drugs.
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Med Klin Intensivmed Notfmed · Sep 2013
Review[Dermal and inhalation poisoning. Rare guests in our intensive care units?].
Patients with dermal and inhalation poisoning are uncommon in intensive care treatment. We describe the diagnostics and specific toxicological treatment of patients with hydrofluoric acid burns. For inhalation poisoning, we focus on smoke inhalation, especially the management of cyanide and carbon monoxide poisoning. Special attention is given to the use of hyperbaric oxygenation for the treatment of carbon monoxide poisoning.