Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · Apr 2015
Review[Choice of crystalloids in interventions and surgery].
Fluid therapy is daily routine in the perioperative setting; however, high quality guidelines are lacking. The S3-guideline Intravasal Fluid Therapy in the Adult Patient gives evidence- and consensus-based recommendations for the use of fluids in perioperative and critically ill patients. In addition to identifying hypovolemia and guiding volume replacement, the type of fluid that should be used is addressed. ⋯ In this review the recommendations and their rationale in the perioperative setting are presented. Crystalloids are the basis of fluid therapy. Instead of isotonic saline, buffered solutions are recommended. Regarding the type of buffer (lactate, acetate, malate), no preferences based on outcome data can be made.
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Med Klin Intensivmed Notfmed · Apr 2015
Review[Dos and don'ts for crystalloids in intensive care medicine. Can too much water be bad?].
Notwithstanding the use of colloids, crystalloids have a firm position in today's intensive care: In addition to the substitution as a basic requirement of the human organism or drug carriers, they are primarily used for volume replacement. A common complication is the development of interstitial edema, which is due to the composition of these solutions and the permeability of the glycocalyx. ⋯ The use of 0.9% saline solution is regarded as obsolete. With low cost and a good safety profile, a few relevant aspects, e.g., the risk of hypervolemia and electrolyte imbalance, must be taken into account in the use of crystalloids.
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Med Klin Intensivmed Notfmed · Apr 2015
[Ten years of early defibrillation: "Bochum against sudden cardiac death". Acceptance and critical analysis of using automated external defibrillators].
There is a comprehensive early defibrillation program in Bochum (Germany); since 2003 a total of 175 automated external defibrillators (AEDs) have been installed in urban areas by the city of Bochum and private companies. These were preferably installed in places with high foot traffic, e.g., public buildings, companies, and event/shopping centers. Approximately 15,000 laypeople who work in the vicinity of the AED locations were trained in the use of defibrillators and in basic resuscitation. In addition, rescue workers on fire trucks and medically trained personnel in physicians' medical practices were equipped as "first responders" with AEDs. ⋯ Compared to the number of existing units and an estimated number of 37-100 SCD/100,000, the use of the AEDs only 17 times appears relatively small. To improve the effectiveness of the AED program in Bochum, an analysis of the emergency service responses, which were necessary because of sudden circulatory collapse, is currently being performed. This will allow areas with an increased incidence of SCD to be identified and a plan for the strategic placement of AED and emergency services can be made.
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The primary aim of cardiopulmonary resuscitation after cardiac arrest is to achieve the return of spontaneous circulation (ROSC). However, following ROSC the clinical and neurologic outcome is mainly influenced by adequate treatment in the postresuscitation period. There are several novel recommendations in the current 2010 guidelines of the European Resuscitation Council (ERC) concerning advanced life support (ALS). ⋯ Major aspects concerning the therapy of the postcardiac arrest syndrome include temperature management with therapeutic hypothermia, mechanical ventilation and the extent of oxygenation and blood glucose control. Thus, the initial cardiopulmonary resuscitation and the following postresuscitation treatment have to be considered as merging therapy concepts. Only a standardized therapeutic approach in these different phases of treatment will result in successful resuscitation with high rates of survival and good neurologic outcome.
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Due to the geographical conditions, large-scale accidents amounting to mass casualty incidents (MCI) in Alpine terrain regularly present rescue teams with huge challenges. Using an example incident, specific conditions and typical problems associated with such a situation are presented. ⋯ Rescue operations in Alpine terrain have to be performed according to the particular conditions and require rescue teams to have specific knowledge and expertise. The possibility of a large-scale accident should be considered when planning events. With respect to optimization of rescue measures, regular training and exercises are rational, as is the analysis of previous large-scale Alpine accidents.