Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · Mar 2014
Review[Delirium on the ICU: clinical impact, diagnostic workup, and therapy].
Delirium is an acute, potentially life-threatening organ dysfunction with an incidence reported to range between 10 and 92 %. Delirium is potentially preventable and has a great impact on patients' outcomes, even beyond their stay in the hospital. It was found to be associated with persisting cognitive deficits, increased physical dependence, institutionalization, and increased mortality. ⋯ Prevention and treatment options include behavioral, cognitive training programs and possibly anti-inflammatory and antipsychotic drugs. Delirium requires search for underlying illness, intoxication or drug side effects. This review summarizes recent work from the last two years, giving a brief overview and background information with regard to risk factors, impact on outcome parameters, mechanisms of pathophysiology, non-pharmacological and pharmacological prevention and treatment strategies of delirium in critically ill patients.
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Med Klin Intensivmed Notfmed · Mar 2014
Review[Noninvasive ventilation in out-of-hospital emergency medicine].
Noninvasive ventilation is mechanical respiratory support without the use of an artificial airway. There is no need for a tube or analgosedation. There are some advantages in comparison to invasive forms of ventilation. ⋯ In order to offer noninvasive ventilation to all patients, it also has to be available in the prehospital setting. Modern mechanical ventilators, which are used in emergency medical service, are eligible to provide noninvasive ventilation.
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Med Klin Intensivmed Notfmed · Mar 2014
Randomized Controlled Trial Multicenter Study[Temperature management after cardiac arrest].
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Helicopter emergency medical service (HEMS) have become a main part of prehospital emergency medical services over the last 40 years. Recently, an ongoing discussion about financial shortage and personal shortcomings question the role of cost-intensive air rescue. Thus, the value of HEMS must be examined and discussed appropriately. ⋯ Medical competence is key in order to balance guideline compliant or maximal care versus optimal care characterized as a mission-specific, individualized emergency care concept. Although, medical decision making and treatment is typically based on the best scientific evidence, personal skills, competence, and the mission scenario will determine the scope of interventions suitable to improve outcome. Thus, the profile of requirements for the HEMS medical crew is high.