Der Anaesthesist
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Severe clinical incidents occur in up to 10% of all non-intensive care unit (ICU) patients, which have an estimated mortality of 5-8%. As in the prehospital setting, early clinical warning signs can be identified in the majority of cases. ⋯ According to this concept, METs would evaluate and treat non-ICU patients at risk at an early stage before a potentially fatal deterioration of cardiorespiratory parameters occurs. This article reviews available data on preventive in-hospital intensive care medicine and reflects on the circumstances for an implementation of METs in Germany, Austria and Switzerland.
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Electrical impedance tomography (EIT) is a non-invasive, radiation-free functional imaging technique, which offers the possibility of continuous bedside measurement of regional lung ventilation. The principle of EIT is based on the input of alternating current and voltage measurement via surface electrodes placed around the thorax, which measure changes of electrical impedance parallel to changes in aeration within the lungs. ⋯ For more than 20 years EIT has been intensively used for research purposes, but has not yet been used for the monitoring of regional lung function in the routine clinical setting. This review describes the status of EIT in the clinical routine, its possibilities and limitations.
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Case Reports
[Unclear altered mental state and respiratory insufficiency following multiple injuries: fat embolism syndrome].
Fat embolism syndrome is associated with respiratory failure, hypoxia, petechial rash, pyrexia and altered mental state. Signs and symptoms usually begin within 12-72 h after trauma. The pathophysiology, differential diagnosis and therapeutic options of fat embolism syndrome are described and the case of a 29-year-old motorcyclist with fractures of the lower extremities, coma and respiratory failure 24-36 h after an accident is reported. Based on the clinical signs and course, fat embolism syndrome was suspected which was substantiated by ophthalmic fundoscopy and magnetic resonance imaging of the head.
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Case Reports
[Symptomatic epidural haematoma under therapeutic dose heparin: occurrence after removal of a peridural catheter].
A 55-year-old patient with severe arterial occlusive disease underwent a femoral artery bypass operation under combined spinal-epidural anaesthesia. Platelet count and coagulation tests were normal after phenprocoumon had been discontinued. The epidural catheter was removed on day 1 while the patient was under therapeutic dose heparin. ⋯ Computed tomography and magnetic resonance imaging showed a lumbar epidural haematoma, which together with a previously existing protrusion of the fourth lumbar disc, compressed the cauda equina. A neurosurgical consultation recommended a conservative approach. The symptoms resolved spontaneously and the patient was discharged in good condition 12 days after the operation.
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Case Reports
[Patient with heparin-induced thrombocytopenia type II and implanted left ventricular assist device].
The administration of heparin can lead to life-threatening heparin-induced thrombocytopenia (HIT) type II, which is caused by antibodies against heparin-platelet factor 4-complexes. The multimorbid patient presented here suffered from HIT II. ⋯ During therapy with argatroban, discrepancies in the partial thromboplastin time (PTT) and the international normalized ratio (INR) appeared sporadically. The clinical causes for these differences remain unclear.