Der Anaesthesist
-
In the case of a mass casualty incident an advanced medical post (AMP) plays a central role in the medical care by ambulance service and civil protection units. Besides the traditional organization with one triage category per medical services tent, it can also be structured in a mixed form (i.e. a defined number of patients with different triage categories are assigned to each medical services tent). To date it remains unclear which organization format is better in order to rapidly evacuate those patients with the highest priority. ⋯ Depending on the mission requirements the mixed form of AMP organization can provide several advantages. In addition to rapid operational readiness and high flexibility the patient distribution by triage category could be processed better and the evacuation time of critical patients could be shortened.
-
Ketamine and midazolam form the endpoint of a series of articles about intravenous induction of anesthesia. Both substances can be used as single induction hypnotic drugs; however, in practice, this is unusual. Both substances, with the exception of a few very specific indications and clinical situations, are more frequently used in combination or with one of the more common alternatives propofol, barbiturates and etomidate. ⋯ The use in certain clinical constellations and in special patient populations is evaluated individually for each substance. It is highlighted which drug appears most appropriate in which situation. As methohexital is nowadays only administered in very few clinical situations, this substance is not included in the comparative assessment.
-
Sepsis is associated with a high mortality, which can be reduced by starting screening, diagnostics and treatment as early as possible. Due to multiple educational programs and increased awareness, a decreased sepsis mortality on intensive care units has been achieved. Many patients with sepsis are admitted by the prehospital emergency service to hospital emergency departments. Thus, prehospital emergency services and emergency departments provide an opportunity to start screening, diagnosis and treatment earlier. ⋯ Although emergency personnel rated an early initiation of sepsis treatment as important, sepsis knowledge was limited. While the majority of emergency doctors and many nurses had attended educational programs on sepsis within the last year, an alarmingly high percentage of paramedics and emergency dispatchers had never received sepsis education. Emergency personnel are mostly unfamiliar with the qSOFA score and did not associate an altered mental status with sepsis. In light of the high sepsis morbidity and mortality, further achievements might be made by initiating sepsis screening and diagnostics in the prehospital setting. Analogous to advancements in intensive care units, increased educational programs for emergency personnel might lead to an earlier detection and improved prognosis of sepsis.