Der Anaesthesist
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Adequate prehospital and inhospital primary care is a decisive factor in the successful treatment of multiple trauma patients. For optimization of treatment algorithms the implementation of a medical quality management is of utmost importance. The aim of this study was to extend quality management by including data on process quality. ⋯ Including process data of prehospital mission data recording facilitates an extended medical quality management.
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Psychiatric emergency situations (PES) are common in the physician-based emergency medical system (EMS) in Germany. However, many emergency physicians (EP) feel insecure in assessing the necessity for treatment of these patients. The aim of this investigation was to evaluate whether a short, newly developed questionnaire (Indicator for Psychiatric Pharmacotherapy, IPP) is able to help EPs in deciding for or against pharmacological treatment. ⋯ The IPP can be a valuable tool to assess the necessity of pharmacological treatment for patients in PESs. The assessment of the symptom categories "anxiety", "agitation/aggression", "mood" and "physical symptoms/disorders" seems to be sufficient to estimate a need for treatment.
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Case Reports
[Naloxone-induced pulmonary edema. Case report with review of the literature and critical evaluation].
A case of pulmonary edema after the administration of naloxone for laparoscopic splenectomy is reported. Previous reports of naloxone-induced pulmonary edema are listed and reviewed. The clinical course is compared to other forms of non-cardiogenic pulmonary edema. Uncertainty remains about the underlying pathophysiological process and the true impact of naloxone on the development of pulmonary edema.
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Case Reports
[Legal liability problems in outpatient operations. View from an anesthesiological perspective].
The rapid technical and medical progress in endoscopic and laparoscopic interventions and the increasing acceptance by patients, lead to an expansion of outpatient operations. The endoscopic laparoscopic operation technique, the operative implementation and the inclusion of an accompanying and a surveillance person in the postoperative phase conceal, however, specific dangers which the physician must recognize and remove. It is absolutely necessary that anesthetists pay attention to some basic principles concerning protection and safety of patients, considerations on the comfort of patients, quality measures and the resulting practical consequences. Particularly prone to liability problems are the postoperative phase and discharge of patients which will be demonstrated in some exemplary cases.