Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2013
Review Practice Guideline[Management of extended blood loss and massive transfusion].
In patients suffering from massive bleeding, transfusion of allogenic blood products (red blood cells, fresh frozen plasma and platelets) and the application of other hemostatic therapy in form of coagulation factor concentrates represent therapeutic approaches to optimize hemostasis and to restore and assure tissue oxygenation. In accordance to the "Helsinki declaration on patient safety" of the European Society of Anaesthesiology, this review article describes a clinical practice guideline for the treatment of patients requiring massive transfusion that was implemented at the University hospital Frankfurt in 2013. Our guideline may be used as a template for other institutions.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2013
Comparative Study[Introduction into "Point-of-Care" testing: indications and limitations].
The advancement of well known techniques in Point-of-Care coagulation diagnostics (e.g. thromboelastography/-metry) has lead to further distribution in perioperative coagulation management. By increasing user friendliness these devices have helped to expand the spectrum of coagulation diagnostics in daily clinical routine. But can they really be considered as the ne plus ultra in diagnosis of coagulopathy? In this article the authors would like to mark up indications as wells as limitations in Point-of-Care coagulation diagnostics.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2013
[Point-of-care-testing and haemostaseological treatment algorithms].
In patients suffering from acute haemorrhages, a prompt, targeted and restrained coagulation management is required. This should be based on a contemporary and sophisticated analysis of the coagulation system. ⋯ Bedside tools of haemostaseological point-of-care-testing (POCT, e.g. viscoelastic and aggregometric POCT) were shown to be superior in this setting. Especially the implementation of POCT-based treatment algorithms for patients suffering from acute haemorrhages was able to improve patient' outcome and resulted in reduced haemotherapy-associated costs.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2013
[Perioperative point-of-care coagulation testing--recently published studies].
Point-of-care (POC) devices are increasingly being used at the bedside in perioperative patient management of hemostatic function. Aggregometric methods can be utilized in preoperative screening of thrombocytopathia and are qualified to describe the efficacy of antiplatelet therapy. Published data about the value of point-of-care diagnostic gives partially conflicting results. Current prospective randomized studies indicate that implementation of hemostatic treatment algorithms based on viscoelastic and aggregometric POC-analysis may reduce transfusion rate of allogenic blood products, improve clinical outcome and reduce cost of hemostatic treatment.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2013
[Interhospital transfer--clinical approach: equipment, risks and complications].
Interhospital transfers are an integral part of German health care system and a prerequisite to provide specialist investigation, management and best possible outcome for all patients irrespective of regional differences in medical care. In order to reduce transport associated risks to a minimum, adequate specialized transport teams and modern equipped transport vehicles are needed better and better adapted to regional and demographic changes.