Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · Sep 2019
Review[Use of lung and pleural ultrasonography in emergency and intensive care medicine].
Bedside lung ultrasound (LUS) in emergency rooms and intensive care units can serve as a tool to diagnose common lung pathologies, monitor their course and guide clinical management. LUS requires only a few minutes and is a useful extension of the physical examination. Fractures of the ribs as well as the sternum are seen well on ultrasound. ⋯ LUS should replace chest X‑ray in the diagnosis of ambulant acquired pneumonia. In ventilator-associated pneumonia and atelectasis, LUS measures the presence of lung consolidation as well as dynamic changes und reventilation. A heart-lung-vessel integrated triple ultrasonography according to clinical findings can help with the diagnosis of pulmonary embolism and should be a necessary weapon for the physicians, especially in emergency departments.
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Med Klin Intensivmed Notfmed · Sep 2019
[Skill retention using extraglottic airways in out-of-hospital emergencies: efficacy and long-term results of simulator-based medical education : A prospective follow-up study].
For emergency medicine personnel (EMP), there is little evidence concerning the adequate timing for refresher courses to maintain routine in the application of extraglottic airways. The aim of this study was to evaluate the efficacy and long-term results of a simulator-based education concept teaching the basic airway management skills with extraglottic airways for EMP and also to draw conclusions concerning the adequate time interval for refresher courses. ⋯ The results of this simulator study indicate that a standardized introduction lecture is appropriate to ensure long-lasting procedural skills up to 12 months, so that subsequent refresher courses in basic airway management with the LMA‑S once a year may be adequate. A simulator-based education in basic airway management skills with extraglottic airways is recommended for facilitation of further clinical education according to the current guidelines.
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Med Klin Intensivmed Notfmed · Jun 2019
Review[Modern coagulation management in bleeding trauma patients : Point-of-care guided administration of coagulation factor concentrates and hemostatic agents].
Uncontrolled bleeding with trauma-induced coagulopathy (TIC) is still the leading cause of preventable death following severe multiple injury. Rapid diagnosis and treatment are associated with improved outcome. Early individualized goal-directed therapy and the use of point-of-care technology may be superior to empiric and ratio-based therapies with conventional blood products. ⋯ Individualized therapeutic concepts based upon viscoelastic point-of-care (ROTEM®) assays present an alternative to empiric and ratio-based therapies with conventional blood products in bleeding trauma patients and may be associated with reduced need for allogenic blood products and morbidity.
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Med Klin Intensivmed Notfmed · Jun 2019
Review[Diagnosis and treatment of status epilepticus in the intensive care unit].
Both convulsive and nonconvulsive status epilepticus are associated with a high risk of morbidity and mortality. To limit brain damage, emergency investigation of etiology and treatment must be done synchronously. This review presents the general rules for treatment. The steps of pharmacologic escalation with benzodiazepines, antiepileptics, and anesthetics are discussed together with their advantages and disadvantages.
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Med Klin Intensivmed Notfmed · May 2019
Review[Decision-making support in Intensive Care to facilitate organ donation : Position paper of the Ethics Section and the Organ Donation and Transplantation Section of the German Interdisciplinary Association of Critical Care and Emergency Medicine (DIVI) in collaboration with the Ethics Section of the German Society of Medical Intensive Care Medicine and Emergency Medicine (DGIIN)].
Injuries, especially traumatic brain injury, or specific illnesses and their respective sequelae can result in the demise of the patients afflicted despite all efforts of modern intensive care medicine. If in principle organ donation is an option after a patient's death, intensive therapeutic measures are regularly required in order to maintain the homeostasis of the organs. These measures, however, cannot benefit the patient afflicted anymore-which in turn might lead to an ethical conflict between dignified palliative care for him/her and expanded intensive treatment to facilitate organ donation for others, especially if the patient has opted for the limitation of life-sustaining therapies in an advance directive. ⋯ The aid described can help mitigate ethical conflicts as to the extent of intensive care treatment for moribund patients, when organ donation is a medically sound option. NOTE: Gerald Neitzke und Annette Rogge contributed equally to this paper and should be considered co-first authors.