Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Triage decisions are concerned with the distribution of limited resources in times of crises, which is why the term is normally used in war and catastrophe scenarios. Under the leadership of the Academy for Ethics in Medicine (AEM) and the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), intensive care physicians from nine specialist societies together with representatives from medical ethics and jurisprudence elaborated clinical and ethical recommendations on "necision on the allocation of intensive medical care resources in the context of the COVID-19 pandemic". ⋯ After a critical consideration of the comments a second version was published on 16 April 2020. In the currently occurring second wave of the COVID-19 pandemic, the question of triage now threatens to become acute.
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In Germany, the scarcity of donor organs has persisted over decades and reached an historical low point in the year 2017. A thorough analysis of the causes revealed structural deficits in the identification and registration of possible donors as one of the central reasons for the low donation rate. This prompted the political authorities to act and resulted in two new laws, which led to a modification of the German Transplantation Act. ⋯ In order to enable a reliable and transparent documentation an organ donor registry will be established. The practical implementation of the various measures of both Acts is supported by a multi-institutional collaborative initiative plan for organ donation. The legal regulations and their practical implementation are depicted in detail.
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Resuscitative endovascular balloon occlusion of the aorta (REBOA) describes an endovascular procedure in which a blocking balloon is introduced into the aorta to reduce bleeding situated distal to the balloon and simultaneously to improve cardiac and cerebral oxygenation. ⋯ A balloon block of the aorta is well established in the treatment of ruptured aortic aneurysms. There is growing evidence that REBOA is a minimally invasive alternative to open surgical cross-clamping of the aorta by thoracotomy for the treatment of patients with polytrauma and hemorrhagic shock due to abdominal or visceral bleeding. Due to the development of new balloon catheters, which can be placed without stiff guidewires and require smaller sheath diameters, REBOA is also discussed for treatment of postoperative abdominal or gynecological bleeding or as a possible adjunct to cardiopulmonary resuscitation for nontraumatic cardiac arrest.
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Periprosthetic fractures of the knee joint are complex injuries and frequently represent a challenge for the surgeon. ⋯ Periprosthetic fractures of the knee joint are complex injuries, requiring a thorough preoperative planning and an interdisciplinary treatment with trauma and endoprosthetic expertise.
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Periprosthetic fractures (PPFx) are becoming an increasingly important topic in orthopedics and trauma surgery due to the rising number of endoprosthetic joint replacements. The recently published unified classification system (UCS) has replaced numerous historical classification systems and can be applied to all PPFx regardless of the bone or joint involved. ⋯ In contrast, the choice between operative treatment and deciding between osteosynthesis or revision arthroplasty is particularly based on the assessment of the implant stability. In order to achieve fracture consolidation and also a good functional outcome, knowledge of the basic biomechanical principles of operative (osteosynthesis or endoprosthesis) treatment of periprosthetic fractures is necessary.