Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2024
Review[Thoracoabdominal Trauma Caused by Blast and Gunshot Injuries].
In Germany, blast and gunshot injuries are uncommon but complex injury entities. Due to the global political situation, terrorist attacks, accidents, or acts of violence, these injuries are potentially part of the reality of care for every anaesthetist, surgeon, and emergency physician. In principle, this type of injury should be treated in a trauma centre with appropriate expertise, but the knowledge of basic treatment principles is necessary for all practitioners. ⋯ Moreover, if chest injuries are ruled out, the resuscitative endovascular balloon occlusion of the aorta (REBOA) can be considered as a bridge to surgery. Whether projectiles, fragments, or shrapnels require removal depends on the location and the potential complications of tissue dissection. Penetrating injuries due to blasts and gunshots are always contaminated.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2024
Review[Reconciling Sustainability and Hygiene in the Healthcare Sector].
In the course of climate change, doctors will not only be confronted with heat-related consequences, but also with the emergence of infectious diseases caused by previously tropical pathogens in temperate climate zones. Fortunately, the topics of sustainability and climate change are also becoming increasingly important in discussions in the healthcare sector, which accounts for 4.4% of global greenhouse gas emissions. The topic of hygienically safe sustainability in healthcare facilities is highly complex due to the large number of possible adjustments, but also offers a great deal of potential. ⋯ It is not always the large investments that make their contribution to reducing CO2-emissions - many smaller measures can also be implemented without high costs, but with great sustainability potential. Similar to hand hygiene compliance, behavior modification by each individual plays a decisive role in the implementation of such projects. There is great practical savings potential, for example, in the indication-based use of disposable medical gloves, the hygienically safe handling of medication or the decision between reusable and disposable medical products, just to name a few items discussed in the article.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2024
Review[Gunshot and Blast Injuries from a Trauma Surgery Perspective].
The severity and extent of gunshot and blast injuries are often misjudged due to a lack of specialist knowledge. The aim of this article is to outline the characteristics of gunshot and blast injuries, including emergency diagnostics and initial surgical treatment. Due to multiple high-energy penetrating injuries, barotrauma, or blunt trauma, affected patients are usually polytraumatized, with multiple organ damage and an average Injury Severity Score (ISS) of > 36. ⋯ The procedure should be based on a standardized, internal hospital emergency medical and emergency surgical algorithm. Damage control surgery can then be used to treat acutely life-threatening complications of gunshot and blast injuries in order to prevent the fatal triad and the occurrence of further early complications. Examples of interventions include debridement and decontamination, fracture stabilization (external fixators and splints), surgical decompression (skull, thorax, compartment syndromes) and surgical hemostasis.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2024
Review[Transgender People in Emergency And Rescue Services].
The treatment of transgender individuals presents a multifaceted challenge for those involved in emergency and rescue services, encompassing not only medical but also social aspects. Despite the increasing importance of healthcare for transgender individuals in Germany over recent years, there remains significant uncertainty among healthcare professionals in addressing the needs of this population. This uncertainty can result in transgender individuals delaying access to the healthcare system due to previous negative experiences, thereby increasing the risk of receiving suboptimal medical care. ⋯ Additionally, there is a notable lack of specific guidelines for the treatment of transgender individuals within both emergency services and emergency rooms. Establishing specific treatment guidelines can enhance the safety of healthcare workers and consequently improve the medical care provided to transgender individuals. The objective of this CME article is to outline the key aspects of emergency medical care for transgender individuals, aiming to reduce uncertainties among emergency service personnel and enhance the quality of medical care for this group.
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Although evacuations of hospitals are considered rare events, they might be more frequent than often thought. Recent research revealed 158 evacuations of hospitals in the USA within 17 years (mean 9.3/year). Leading causes for evacuations might be natural disasters, technical issues or man-made threats like bomb or active shooter events. ⋯ Management of these situations requires efficient leadership and coordination between hospital employees and rescue organizations such as fire departments or emergency medical services. Therefore, a robust concept for evacuation of hospitals is needed. Our publication describes hospital evacuations and appropriate concepts in Germany.