Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

Dealing with dying and death is an integral part of working in an intensive care unit, yet time pressure and workload often leave little room for emotional processing. A shared moment of silence offers intensive care staff the opportunity to pause after a patient's death, to uphold dignity, and to foster team reflection. This article explores the origin and significance of the ritual, summarizes the current evidence, and provides practical recommendations for its implementation-including appropriate language, involvement of relatives, framework conditions, and evaluation. The moment of silence does not replace structural support measures (e.g., supervision or ethical consultations) but can serve as a meaningful complement to them.

Potassium disorders are common in patients treated in emergency departments or intensive care units and are associated with increased mortality. Severe hyperkalemia but also severe hypokalemia can lead to fatal arrhythmias and therefore necessitate emergency treatment. This article gives guidance on the diagnostic and therapeutic approach in patients with acute dyskalemia. Correct diagnosis requires not only a reliable measurement of serum potassium concentration but also knowledge of changes to the electrocardiogram caused by dyskalemia. This article outlines key steps in the treatment of hyperkalemia, including cardioprotection, shifting potassium into cells, and removing potassium from the body. Important pitfalls of potassium replacement in hypokalemia and the further approach after completion of initial emergency treatment are also reviewed.

Background and objective: Violence against healthcare workers in emergency departments and intensive care units has increased significantly in recent years, posing a substantial threat to staff safety. In German emergency departments, 97% of staff report verbal violence and 76% report physical violence. The German Society for Medical Intensive Care and Emergency Medicine (DGIIN) presents the first comprehensive position paper on violence prevention and protective measures.

Methods: The position paper was developed by an interprofessional author group of the DGIIN based on current research data, international literature, and clinical practice experience. It analyzes forms, frequency, causes, and consequences of violence in the hospital setting and develops concrete recommendations for action.

Results: Violence manifests as verbal, physical, sexual, and racist assaults, with patient-related violence (type II) being most common. Main causes are intoxication (45%), long waiting times, staff shortages, and existential fears. Consequences include work disability to posttraumatic stress disorder (PTSD, 15.8%). The position paper defines eight action areas: standard operating procedures (SOPs), leadership responsibility, systematic incident reporting, mandatory training and de-escalation programs with emphasis on verbal and nonverbal communication techniques (active listening, body language), structured psychosocial support (acute care and peer support), staffing, security measures (services, structural modifications, alarm systems, video surveillance), legal protection.

Conclusion: Violence prevention and staff protection are essential to patient safety. Professional communication competencies are central de-escalation instruments. The DGIIN demands systematic implementation of all measures in hospitals and their integration into financing. A zero-tolerance culture toward violence, combined with preventive, intervening, and follow-up structures, secures workforce capacity and qualified personnel retention.