Zentralblatt für Chirurgie
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Review
[Acute abdominal pain in the emergency department - a clinical algorithm for adult patients].
Acute abdominal pain represents the cardinal symptom behind a vast number of possible under-lying causes including several ones that re-quire surgical treatment. It is the most common sur-gical emergency, the most common cause for a surgical consultation in the emergency department and the most common cause for non-trauma related hospital admissions. The golden mis-sion statement is to rapidly identify whether the underlying cause requires an urgent or even immediate surgical intervention. ⋯ Our intention is to devel-op such an algorithm to approach acute abdominal pain from the surgeon's point of view. Based on daily practice and with reference to available literature, it is the aim of this study to define a work flow that simply summarises all steps in-volved and defines the required decision process in order to form the intellectual basis for an evidence-based clinical algorithm. The result is illustrated as a first draft of such an evidence-based algorithm to allow emergency evaluation of adult patients with acute abdominal pain.
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During the last years we have always found an increase of antibiotic resistance. This increase is combined with high antibiotic consumption. The reasons for the problems are mis-takes in the prescription of antibiotics and the -in-crease of risk-patients because of demographic aging and the development and progress of surgery and medicine. ⋯ In order to positively influence the development of bacterial resistance, strict guidelines, especially for intensive stations, must be consequently applied and controlled. In spite of knowledge of these problems for a number of years many reserves are still available for the care of critical patients.
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Knowledge on potentially pathogenic microbes including characteristics of their antibiotic resistance in septic patients as well as on the ward- and department-specific microbial spectrum can be considered essential for an efficient initiation of an adequate antimicrobial treatment, which turns out to become pivotal for patient outcome. Permanent changes in microbial patterns and antibiotic resistance can only be identified by a continuous investigation of various microbiological specimens. ⋯ ICU relocation from the pavillon-based system to a new complex clinic building was not associated with any significant alteration of the microbial spectrum on the surgical ICU. Increasing incidences of resistant Enterococcus and Gram-negative problematic microbes may indicate a general spread of multi-resistant microbes under the steady selecting pressure of a not always adequately initiated antibiotic / antimicrobial therapeutic regimen and underline the required but specific and selected microbiological screening.
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Review Case Reports
[Ethical conflicts in the surgical intensive care setting - impact of ethics consultations].
In surgical intensive care medicine an increase in ethical conflicts regarding treatment plans has been observed due to marked changes in medical possibilities and social epidemiology resulting in intensive care treatment of old and oldest patients following surgery, trauma or transplantation. Without ethical support, physicians, nurses, and families are not able to come to a decision about medical treatment when value conflicts are involved. ⋯ The incidence of ethical conflicts increases even in surgical intensive care units and ethics consultations may help in the integration of ethics principles in clinical practice.