Der Anaesthesist
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Tunnelled hemodialysis catheters are well accepted and widely used devices to provide vascular access for dialysis in patients when an arteriovenous shunt is not feasible or dysfunctional. In the literature complications after implantation are well documented but fatal or near-fatal events during implantation are seldom reported. In this article 3 such cases from a single tertiary center over a period of more than 10 years are presented and discussed. ⋯ Performing the procedure with the patient under conscious sedation has benefits compared to general anesthesia. If the patient indicates atypical pain, the procedure should be stopped immediately and re-evaluated for any cause. If a perforation with relevant vascular damage is suspected, we recommend leaving the dilator/introducer/catheter in place to reduce major hemorrhage until the vascular or cardiothoracic surgeon can fix the problem.
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With the coronavirus disease 2019 (COVID-19) outbreak hospitals prepared for increasing numbers of patients without knowing how patient populations were evolving and what resources would be required. The present study aimed to analyze the impact of the local COVID-19 pandemic on emergency resources of all hospitals in a major urban center (Mönchengladbach) in Germany. ⋯ The regional COVID-19 outbreak led to significantly reduced ED contacts in a German major urban region after the first COVID-19 cases appeared. Both hospital admissions and the number of ED to ICU admissions decreased, whereas the ratio of emergency outpatients vs. inpatients remained stable. Therefore, it can be assumed that patients with severe medical problems did not seek emergency care. These secondary effects of the pandemic on healthcare and the socioeconomic impact should be analyzed further.
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In Germany, postmortem organ donation requires a diagnosis of irreversible brain death (BD) in strict compliance with the guidelines of the German Medical Association. ⋯ According to the recently amended German Transplantation Act, a centrally organized consultation service for BD diagnostics must be implemented as soon as 2021. Recommendations can be derived from the present survey and from the experience of the regionally established consultation service. In addition to neurological and neurosurgical expertise, qualified pediatricians and mobile ancillary instrumental diagnostics should also be provided. Expert advice from neurointensive care physicians should be available at an early stage in order to identify potentially affected patients. The highly variable participation of hospitals in organ donation, despite the availability of an expert diagnostic service free of charge, points to an important role of additional factors, some of which may be nonmedical in nature.
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Immune thrombozytopenia (ITP) is a rare acquired thrombocytopenia occurring in 2 to 4 persons per 100,000 per year. ITP is defined as a platelet count less than 100 G/l in patients in whom other causes of thrombocytopenia have been ruled out. ⋯ Emergency splenectomy has to be considered in otherwise untreatable bleeding. We present the case of a 65-year-old patient with chronic refractory ITP and finally fatal bleeding.
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Mechanical circulatory support using extracorporeal life support systems (ECLS) has significantly increased in recent years. These critically ill patients pose special challenges to the multiprofessional treatment team and require comprehensive, interdisciplinary and interprofessional concepts. For this reason, to ensure the best possible patient care a standardized ECLS training module has been created at national specialist society level, taking emergency and intensive care management into account.