Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · Feb 2015
Review[Sepsis - Knowledge of non-physician personnel in Africa. A cross-sectional study in Malawian district hospitals].
Malawi has one of the worst human resource situations in the world and each clinically working doctor has to serve around 50,000 patients. There are almost no Malawian specialists physicians so that in the district hospitals it is usually non-medical staff (e.g. anesthesia clinical officer) who have the responsibility for severely sick patients with sepsis. At the Queen Elizabeth Central Hospital we have organized different courses over the years to support these colleagues. ⋯ Healthcare workers in Malawi are not aware of key recommendations of the Surviving Sepsis Campaign. Guidelines have to be adapted to the specific healthcare structures in underdeveloped countries. We realized the wish and the desire of the participants for more training and more courses in Malawi. In order to be able to support these needs we would like to invite cooperation from interested institutions and colleagues for a special sepsis course on the occasion of the annual World Sepsis Days.
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Med Klin Intensivmed Notfmed · Nov 2014
Review[Neurological and psychological long-term effects of sepsis].
In addition to the limitations to the health-related quality of life that have been compiled with validated test instruments, a number of former sepsis patients suffer from functional impairments, which are categorized under the terms critical illness polyneuropathy (CIP) or critical illness myopathy (CIM), which have been in existence for over 20 years now. ⋯ The degree of functional deficits resulting from sepsis and the actual quality of life of those affected may, however, be influenced by taking appropriate rehabilitation measures. However, neither therapeutic rehabilitation standards nor any rehabilitation facilities tailored to the needs of these patients currently exist.
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Med Klin Intensivmed Notfmed · Nov 2014
Randomized Controlled Trial Comparative Study[Saving lives with dispatcher-assisted resuscitation: importance of effective telephone instruction].
Survival rates after sudden cardiac arrest could be increased if bystanders could be encouraged to perform CPR until emergency services arrive. This should be initiated by the dispatcher at the emergency control facility who receives the call. For the first time the ERC guidelines of 2010 included instructions to be given to untrained rescuers by the dispatcher. Rapid recognition of cardiac arrest and initiation of emergency measures is assured by means of specific training for the dispatchers. ⋯ There were no significant differences between the groups regarding the target variables. The results show that already extremely short instructions or advice by the dispatcher to start CPR is sufficient to encourage bystanders to give assistance in an emergency. Continuous support over the phone does not appear to be necessary.
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The Surviving Sepsis Campaign strongly recommends that intravenous antibiotic therapy should be started as early as possible, ideally within the first hour of recognition of severe sepsis or septic shock. There is ample evidence that failure to initiate early antimicrobial treatment correlates with increased morbidity and mortality. ⋯ The administration of antibiotics based on the local epidemiology should be initiated quickly in critically ill patients with severe sepsis and septic shock. In patients who are not in septic shock, treatment can be withheld, while awaiting further studies or clinical assessment to confirm the suspicion of infection.