Der Anaesthesist
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The healthcare market is facing a serious shortage of qualified personnel in 2020. Aging of staff members is one important driver of this human resource deficit but current planning periods of 1-2 years cannot compensate the demographic effects on staff portfolio early enough. Therefore, prospective human resource planning is important to avoid loss of competence. ⋯ Prospective human resource planning for the OR and intensive care units can help to detect shortage of staff and loss of competence early enough to apply effective personnel development measures. A growing number of companies have started to plan ahead of the current demand of human resources. Hospitals should follow this example because the competition for qualified staff members is increasing rapidly.
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Approximately 5-8 million people in Germany suffer from chronic pain and some patients can profit from specific interventional techniques. In detail these are regional anesthetic techniques close to the spinal cord, neuromodulation, blocks of the sympathetic chain and peripheral nerve blocks. ⋯ Regional anesthetic techniques close to the spinal cord are of high importance for the treatment of chronic low back pain although the efficiency is highly disputed due to the lack of evidence. Neuromodulation includes amongst others intrathecal pharmacotherapy and spinal cord stimulation, which are used for highly selected patients and can lead to very good results for these patients.
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A case of successful resuscitation of a patient with severe amitriptyline intoxication is reported. The measured amitriptyline serum levels far exceeded those assumed to be lethal according to the literature. Resuscitation was successful with the administration of intravenous fat emulsion and the patient recovered without any neurological sequelae.
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Despite improved strategies in the treatment of polytraumatized patients the mortality rate of severely injured patients remains high. Thus, worldwide 5 million patients die due to trauma or trauma-related complications each year. As the majority of early trauma-related deaths are attributed to or caused by exsanguination the prevention and treatment of coagulopathy is of paramount significance. ⋯ Under consideration of new clinical studies, an updated version of the original publication from 2007 has recently been published. Based on a systematic review of published literature the recommendations were formed according to "Grading of Recommendations Assessment, Development and Evaluation" (GRADE). This publication summarizes the main recommendations with a special emphasis on revisions and new aspects.
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The prognosis of polytraumatized patients is basically dependent on the quality of emergency room (ER) management and a smooth transition from prehospital emergency therapy to ER therapy is essential. The accurate prediction of the prehospital injury severity by emergency physicians influences prehospital therapy and level of care of the destination hospital. Furthermore it helps to provide medical resources on time. Overestimation of injury severity wastes resources, underestimation puts patients at risk. Prehospital misjudgement of injury severity is common. The aim of this study was to evaluate reliability of the injury severity estimated by emergency physicians. ⋯ The prediction of prehospital injury severity is difficult and less reliable. Relevant underestimation of injury severity was observed in visceral cavities. In order to evaluate injury severity the use of anatomical trauma scores alone might be not sufficient. In addition, the mechanism of injury and the deduced consequences, such as prehospital therapy, the choice of destination hospital and the need of ER treatment should be taken into account.