Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2012
[Prehospital treatment of polytrauma patients by emergency physicians].
Even in the 21st century major trauma still contributes to a svere loss of life in our society. Severly injured victims benefit from prehospital care that both considers tactical and medical aims. Knowledge of major trauma care has grown over the past years. ⋯ By putting up the new structure of german traumacenters involving certified trauma hospitals it is easier for ambulance doctors to find the best hospital for their patient. Thought has been given to nearly al organ systems and body-areas in the guidelines making them a very usefull orientation guide for prehospital care. Emergency anesthesie including intubation is a mayor issue of the new guidelines.
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Among clinical benefits like reduction in blood loss, faster postoperative recovery of gastrointestinal and lung function, lower rate of perioperative complications and less postoperative pain level, cost reduction by shortening of hospital stay plays a pivotal role for high incidence of laparoscopic surgery. Elevated intraabdominal pressure due to creation of pneumoperitoneum induces various pathophysiologic changes. Most of these changes are clinical inapparent in case of appropriate anesthesiologic management. This paper aims to sensibilize the anaesthesiologist for pathophysiologic changes, particularly with regard to hemodynamic and pulmonary complications, differential diagnosis and therapies.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2012
Review[If the extracorporeal lung assist comes to its limit: use and management of extracorporeal membrane oxygenation in severe acute respiratory distress syndrome].
In patients with the most severe forms of acute respiratory distress syndrome (ARDS) refractory to conventional mechanical ventilation and adjunctive or rescue therapies like kinetic therapy, inhaled vasodilators or extracorporeal CO2-elimination (extracorporeal lung assist), the use of the extracorporeal membrane oxygenation (ECMO) can secure gas exchange. Due to technical improvements and miniaturization, the new ECMO system is safer and simpler. ⋯ Recent data suggests, that outcome of patients with severe ARDS treated with ECMO may improve. This review describes the function and the management of ECMO-therapy in ARDS-patients.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2012
[Percutaneous tracheostomy in intensive care medicine - Update 2012].
Percutaneous tracheostomy has become an established procedure in airway management of critically ill patients. It offers advantages over prolonged tracheal intubation. To date, there is no evidence of the optimal timing of the procedure. ⋯ Provided that specific contraindications are observed (e.g. difficult tracheal intubation, inability to identify anatomic landmarks, severe coagulopathy etc.), all techniques have low complication rates. The use of ultrasound may further enhance perioperative safety. Finally it must be noted that percutaneous tracheostomy is an elective procedure that requires informed consent from the patient or an attorney of law.