Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

Some skin conditions may require intensive care treatment. Early diagnosis can be challenging but is crucial to adequate patient management and decision making, since appropriate treatment influences prognosis. The following skin conditions will be reviewed: severe cutaneous drug reactions (drug reaction with eosinophilia and systemic symptoms [DRESS], Stevens-Johnson syndrome/toxic epidermal necrolysis [SJS/TEN]), acute cutaneous graft versus host disease (aGvHD) following allogeneic stem cell transplantation, infectious diseases (staphylococcal scalded skin syndrome [SSSS], toxic shock-syndrome [TSS], necrotizing fasciitis) and vascular disease (acute infectious purpura fulminans). We focus on the course of the diseases, describing clinical presentation and differential diagnosis as well as diagnostic and therapeutic strategies.

Background: Sustainability in emergency medicine constitutes a nascent area of inquiry that has thus far attracted limited scholarly attention; however, it is experiencing burgeoning interest. To date, there are no empirical studies examining how emergency medical personnel evaluate the concept of sustainability or what specific aspects and propositions they may have regarding the topic.

Objectives: The primary objective of this study was to investigate the perspectives of emergency medical employees concerning the concept of sustainability in prehospital emergency medicine.

Materials and methods: An online survey comprising 23 questions was administered. Participation was voluntary and conducted anonymously.

Results: A total of 462 participants participated in the survey, predominantly consisting of paramedics (74% male, 26% female), aged between 25 and 44. Approximately 70% of respondents expressed that they had contemplated the potential for enhancing sustainability within emergency medicine. Participants deemed the separation of packaging as a practical measure, particularly concerning syringes, cannulas and infusion systems. The estimated incidence of contamination for these materials is less than 50%. Nevertheless, factors such as insufficient time, space or motivation are cited as barriers to effective waste separation. Packaging, especially for patient blankets, cervical collars and infection protection gowns, is identified as potentially superfluous. Participants indicated that the majority of waste is attributed to plastic packaging and disposable gloves.

Conclusion: The findings of this study indicate that emergency medicine employees are aware of sustainability issues. Participants identified pragmatic avenues for waste separation and reduction in prehospital patient care, while also acknowledging potential challenges. Further research is needed to elucidate sustainability opportunities within prehospital emergency medicine.

Background: The number of long-term ventilated patients in out-of-hospital intensive care (OIC) in Germany has risen sharply in recent years. Due to financial disincentives, structural care deficits and resource bottlenecks, there is an increasing risk of inadequate care. In 2020, the Intensive Care and Rehabilitation Strengthening Act (IPReG) was therefore passed by legislators with the aim of improving OIC. This study examines the opportunities and challenges of the IPReG with regard to the care of long-term ventilated patients in OIC from the perspective of payers and healthcare policy.

Materials and methods: A qualitative interview study was conducted as part of the process evaluation of the multicenter study PRiVENT (Prevention of invasive Ventilation). Using semi-structured, guideline-based individual interviews, health policy actors and representatives of statutory health insurers were asked about the IPReG.

Results: In all, 11 health policymakers and 12 representatives of statutory health insurance companies took part in the interviews. Both interview groups showed a positive attitude towards the IPReG and expressed the expectation of added value for the outpatient care of long-term ventilated patients. The current remuneration regulations for weaning and the assessment of weaning potential in the OIC were criticized, among other things.

Conclusion: The IPReG provides a legal basis for improving OIC, but there is still room for improvement in its current version. The evaluation planned by legislators should be used to identify potential weaknesses and make appropriate adjustments.

Critically ill patients with liver cirrhosis exhibit complex alterations in coagulation that should be considered in clinical acute management. As routine laboratory tests (e.g., INR, aPTT, platelet count) cannot always adequately reflect the coagulation status of critically ill patients with liver cirrhosis, functional hemostatic tests, such as viscoelastic tests, should also be used to assess coagulation disorders in these patients. If invasive procedures are planned, hemostatic interventions to prevent bleeding and measures to stabilize coagulation disorders should be considered depending on the risk of procedure-associated bleeding, while a prophylactic routine correction of abnormal laboratory coagulation parameters should be avoided. If an acute bleeding complication manifests in critically ill patients with liver cirrhosis, an individualized correction of hemostatic changes is indicated in addition to prompt identification of the source of bleeding. This review article describes the pathophysiological changes underlying the altered hemostatic system in critically ill patients with liver cirrhosis and provides an overview of diagnostic and therapeutic options for hemostatic complications.

Over 1391 patients presented to the emergency department (ED) of a German university hospital with primary diagnosis of syncope from 2019-2022. This monocentric, retrospective study aims to characterize this cohort regarding secondary diagnoses and blood laboratory parameters. Principal focus lay on the differentiation between inpatients (n = 190; 13.7%) and outpatients (n = 1201; 86.3%). Most common secondary diagnoses comprised head injury (n = 188; 13.5%), infection (n = 126; 9.1%), body injury (n = 124; 8.9%), neurological disease (n = 85; 6.1%), arrhythmogenic heart failure (n = 76; 5.5%), cardiovascular risk factors (n = 75; 5.4%), metabolic/nephrological disease (n = 69; 5.0%), and structural heart disease (n = 68; 4.9%). Surgical interventions were performed using catheter (n = 16; 1.2%), percutaneous coronary interventions (n = 15; 1.1%), and pacemaker/defibrillator/event recorders (n = 12; 0.9%). Inpatients had significantly more secondary diagnoses (3.5 vs. 0.3) and higher incidences of abnormal laboratory parameters compared to outpatients. Secondary diagnoses more common in inpatients included cardiovascular risk factors (37.9 vs. 0.2%), arrhythmogenic heart failure (35.3 vs. 0.7%), infection (57.9 vs. 1.3%), and lung disease (6.3 vs. 0.2%). Abnormal blood laboratory values more frequent in inpatients included elevated levels of highly sensitive (hs) troponin T (58.8 vs. 25.7%), creatinine (36.2 vs. 14.8%), leukocytes (43.4 vs. 36.3%), besides decreased hemoglobin (33.3 vs. 16.0%), potassium (5.3 vs. 1.2%), and sodium (2.1 vs. 0.6%).