Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · May 2012
[Quality management in intensive care medicine. Indispensable for daily routine].
In areas requiring maximum safety like intensive care units or operating room departments, modern quality management and risk management are essential. Treatment of critically ill patients is associated with high risk and, therefore, demands risk management and quality management. ⋯ In addition, regional networks of intensive care physicians result in improved local networking. In intensive care medicine, this innovative modular system of quality management and risk management is pursued more consequently than in any other specialty.
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Communication plays a crucial role in the intensive care unit. Posttraumatic stress syndromes develop in a significant number of patients and their relatives after being in an intensive care unit. The syndromes may persist for several years. ⋯ Rounds of discussions among the work groups are the basis for a healthy team structure. Inadequate communication, e.g., during emergencies or shift change, endangers the safety of patients and in the worst case, results in treatment mistakes. Measures for improved communication in the intensive care unit should always be implemented.
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Med Klin Intensivmed Notfmed · Apr 2012
Review[Emergency trauma room management in severely and most severely injured patients. A multidisciplinary task].
The treatment of most severely injured patients represents a great challenge for the trauma room team. Besides the time factor, which is a crucial cornerstone of the treatment in general and of the appropriate treatment of life-threatening injuries in particular, minor injuries and non-life-threatening injuries must also be taken into account. ⋯ These concepts allocate the highest treatment priority to injuries that may be immediately fatal for the patient. Besides those life-threatening injuries that are commonly summarised under the term "deathly six", other minor traumas should also be assessed and treated in a structured manner as they may often considerably affect the quality of life after trauma.
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Med Klin Intensivmed Notfmed · Apr 2012
Review[Drug-induced long QT syndrome. Relevancy in intensive care medicine].
QT-prolonging drugs delay ventricular repolarization and, thus, favor the occurrence of Torsade de pointes (TdP). Intensive care patients are particularly endangered to suffer from this clinical picture as they often simultaneously exhibit multiple risk factors. In the following article, the most important risk factors for drug-induced long QT syndrome are described. ⋯ Potential explanations why prolongation of the QT interval is not the main or only factor for the proarrhythmic potential of QT-prolonging drugs are discussed. Furthermore, a summary of QT-prolonging drugs relevant in intensive care units is given and prevention of drug-induced long QT syndrome with consecutive TdP is discussed. Finally, recommendations for treatment of drug-induced TdP are reviewed.
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Non-invasive mechanical ventilation is the preferred method for the treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD). Primary contraindications and stopping criteria must be regarded to avoid delaying endotracheal intubation. The primary interface is usually a nasal-oral mask. ⋯ COPD patients can also benefit from preventive non-invasive ventilation in order to avoid re-intubation after a planned extubation. Domiciliary nocturnal non-invasive ventilation is an option for some patients with COPD in chronic hypercapnic respiratory failure. This treatment should be established in a specialised unit.