Medizinische Klinik, Intensivmedizin und Notfallmedizin
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In order to reduce mortality in severely injured patients, a rapid radiologic diagnosis is essential. Sonography plays a role only as a focused assessment with sonography for trauma (FAST) to clarify free intraperitoneal fluid immediately on admittance. ⋯ Based on the results of the CT scan, patients can be referred for laparotomy or safely classified for "wait and see" treatment. Although the reduction in injury-related mortality would outweigh the risk of radiation dose, the indiscriminate use of CT for patients with minor injuries is not justified and must be avoided.
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Med Klin Intensivmed Notfmed · Sep 2011
Review[Medical geriatric aspects in intensive care therapy of elderly patients].
For elderly patients specific medical problems, such as the consequences of aging organs, comorbidities or geriatric syndromes must be considered in the intensive care treatment of acute diseases. Under these circumstances special instruments for geriatric assessment are particularly useful. Up to now geriatrics and intensive care medicine have made complementary contributions in the treatment of severely ill elderly patients. A closer interdisciplinary cooperation of the two disciplines could be of substantial beneficial value in the care of the sick and elderly to overcome the many open questions and pressing problems.
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Med Klin Intensivmed Notfmed · Sep 2011
Review[Volume replacement therapy options for critically ill patients].
For critically ill patients with hypovolemia, volume replacement therapy is important to maintain sufficient tissue perfusion and oxygenation. Nearly all patients receive crystalloids and often additionally colloids. The advantages of the former are low costs, immediate availability, the ability to fill both the intravascular and extravascular fluid spaces and a non-allergenic potential. ⋯ Colloids are more efficient volume expanders and tissue edema can be avoided. The disadvantages compared to crystalloids are the higher costs and the risk of rare but potentially severe anaphylactic reactions. Artificial colloids (hydroxyethyl starch) are cheaper than the natural colloid albumin but the safety profile is less favorable.