Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2005
Clinical Trial[Extravasal position of central venous catheters despite unsuspicious ECG-guidance].
Does the electrocardiographic method for central venous catheter positioning distinguish between a correct intravasal and a malpositioned extravasal position? ⋯ The electrocardiographic method can not differentiate between intra- and extravasal position of a central venous catheter, and thus, presumably fails to identify malpositioning as a result of vascular perforation.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2005
Guideline[Guidelines for preventing health-care-associated pneumonia].
Because of the high morbidity and mortality associated with health-care-associated pneumonia, it is important to implement evidence-based prevention measures. Recently by CDC published Guidelines for Preventing Health-Care-Associated Pneumonia describe prevention measures based on evaluated studies, randomized controlled trials or meta-analyses. In this paper the most important prevention measures are given, as well as the evidence classification. "Among the changes in the recommendations to prevent bacterial pneumonia, especially ventilator-associated pneumonia, are the preferential use of or tracheal rather than naso-tracheal tubes in patients who receive mechanically assisted ventilation, the use of noninvasive ventilation to reduce the need for and duration of endotracheal intubation, changing the breathing circuits of ventilators when they malfunction or are visibly contaminated, and (when feasible) the use of an endotracheal tube with a dorsal lumen to allow drainage of respiratory secretions."
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2005
Review["Highlights" in emergency medicine -- severe head trauma, polytrauma and cardiac arrest].
According to scientific publications focusing on emergency medicine and published in international journals in the past few months, new and clinically important results can be identified. In patients with severe head trauma (SHT), application of hypertonic solutions is possible; long term outcome, however, is not improved by this measure. Prehospital capnometry is important, because otherwise up to 40 % of all mechanically ventilated patients are hypoventilated. ⋯ In a very clear advisory statement, the "International Liaison Committee on Resuscitation" (ILCOR) has recommended mild therapeutic hypothermia (i. e., cooling of cardiac arrest victims to 32 - 34 degrees C central body temperature for 12 - 24 h following cardiac arrest of cardiac etiology) not only for unconciuous patients with ventricular fibrillation as initial prehospital rhythm, but also for all other adult patients (other rhythms, intrahospital CPR) following cardiac arrest. In randomised controlled clinical trials, this therapy has markedly improved survival rate and neurological outcome. Such therapeutic cooling can be initiated nearly everywhere and with simple methods - like the infusion of ice-cold cristalloid solutions.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2005
Case Reports[Spontaneous breathing and stable hemodynamics during severe accidental hypothermia (22 degrees C)].
We present a case of severe accidental hypothermia (core temperature 22 degrees C) after a suicide attempt. The initial symptoms and the pre-hospital and hospital treatment are discussed. Additionally, different rewarming strategies for patients with severe accidental hypothermia are compared.