Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2016
Review[Quality improvement in acute pain management in Germany].
In Germany, different quality management approaches in postoperative pain management have been established. In this context, quality is distinguished into structure quality (e.g. personnel and equipment resources), process quality (e. g. standardized treatment schemes) and outcome quality (e.g. pain intensity, side effects, satisfaction). ⋯ By use of feedback and benchmarking tools, they can be used for outcome-oriented quality improvement. Certification projects assess compliance with or achievement of defined quality criteria on the basis of predefined structure, process, and outcome parameter.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2016
Review[The patient with intra-abdominal hypertension].
An intra-abdominal hypertension (IAH) defined as a pathological increase in intra-abdominal pressure (IAP) is commonly found on ICU admission or during the ICU stay. Several studies confirmed that an IAH is an independent predictor for mortality of critically ill patients. The abdominal compartment syndrome (ACS) which is defined as a sustained IAP>20 mmHg (with or without an abdominal perfusion pressure [APP]<60mmHg) that is associated with new organ dysfunction or failure has a mortality of up to 60%. ⋯ Thus, by an increase of the respective compartment pressure, e.g. intracranial pressure, a poly-compartment syndrome may result. Adequate prevention, a forward-looking strategy, and objective techniques for measurement of IAP are required to avoid or early detect an IAH or ACS. Finally, an immediate and consequent interdisciplinary management using conservative, interventional and operative options are necessary to solve an IAH or ACS.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2016
Case Reports[Emergency medicine at the limit: shock-, analgesic therapy and airway management in difficult terrain].
Rescue operations in mountain and remote areas pose special challenges for the rescue team and often differ substantially from rescue missions in the urban environment. Given the growing sports and leisure activities in mountains, incidence of alpine emergencies is expected to rise further. The following article describes the treatment of haemorrhagic shock, analgesic therapy and airway management in mountain rescue.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2016
Case Reports[Case report: resuscitation of a hypothermic patient - "Nothing's like it seems!"].
We report about a prolonged resuscitation of a hypothermic patient (26.2°C) in stadium HT III of the Swiss Staging System (SSS). A mechanical chest compression with the Lund University Cardiac Assist System (LUCAS) and the rewarming with a haemodialysis device were implemented. ⋯ After the defibrillation a return of spontaneous circulation (ROSC) was established. The patient achieved a very good cognitive-mnestic result after the resuscitation but he suffered a neurological deficit in the meaning of paraplegia.