Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

Mpox (previously known as monkeypox) is receiving attention worldwide due to outbreaks in various countries since May 2022. On August 14, 2024, based on the increase Mpox infections, the World Health Organization (WHO) declared a public health emergency. The zoonotic disease is caused by the Mpox virus, an Orthopoxvirus related to other Poxviridae. The virus is transmitted via direct contact with infected bodily fluids, respiratory droplets, or contaminated objects and has an incubation time of 5-21 days. Symptoms include fever, headache, muscle pain, and a characteristic skin rash which progresses from macules, to papules, to vesicles, and to pustules before scabbing over. There are two main genetic clades of Mpox: clade I (Central Africa) and clade II (West Africa), whereby clade IIb was responsible for the 2022 outbreak. Diagnosis is based on PCR testing of skin lesions. Although Mpox may mimic other diseases such as chickenpox or syphilis, lymphadenopathy is a distinguishing feature. Treatment is primarily supportive, although antiviral agents such as tecovirimat and cidofovir have shown a certain efficacy. Vaccination is an important protective measure; MVA-BN and ACAM2000 are among the available vaccines. Prognosis depends on the clade, the access to medical care, and the underlying health status. Immunocompromised persons and children are at a higher risk of a severe course.

Background: Structured procedures have been established internationally for the initial clinical care of patients with traumatic injuries. Comparable concepts have not yet been applied to the initial clinical care of life-threatening nontraumatic emergencies. In 2022, a working group of the German Society for Acute and Emergency Medicine (DGINA) presented the Advanced Critical Illness Life Support (ACiLS) concept for the care of nontraumatic emergencies and offers corresponding training courses.

Objective: To present systematic clinical first aid for patients with the leading symptom of shock according to the ACiLS concept.

Result: The (PR_E-)AUD²IT basic algorithm used in the ACiLS concept divides the initial care of a critically ill patient into the elements of preparation, resources, initial care, medical history, examination, differential diagnosis, diagnostics, interpretation and to do, interrupted by three team time-out elements for structured communication. The use of this concept is demonstrated here using the example of shock.

Conclusion: The ACiLS concept has the potential to improve the quality of initial care of nontraumatic emergencies in emergency department shock rooms and intensive care units. Further evaluations in practice and training capacities are essential.

Background: The treatment of acute life-threatening conditions in intensive care and emergency medicine requires in-depth training and education, with initial training playing a key role.

Research question: What is the structure and quality of the initial training of physicians and nurses in intensive care units and emergency departments in Germany?

Methods: With the help of survey software, an online questionnaire comprising 40 questions in German on the aforementioned topic was designed. It was distributed via the website of the German Society for Internal Intensive Care and Emergency Medicine (DGIIN) and via pertinent social media channels.

Results: In total, 103 nurses and 125 physicians participated in the survey. The average work experience of the participating nurses and physicians was 8.5 ± 5.1 and 3.0 ± 3.1 years, respectively. The majority of participants worked primarily in intensive care units (59%) or in emergency departments (22%). On average, the initial training lasted 45 ± 27 and 13 ± 13 days for nurses and physicians, respectively. Only 20% of the initial training comprised seminars or hands-on workshops taught outside of routine clinical care. In all, 47% of the participants stated that they were not able to complete the entire initial training period. Only 49% had been officially certified for usage of the technical equipment in their department. A total of 35% reported feeling confident or somewhat confident in handling predictable tasks after initial training, but only 15% in handling acute emergencies.

Discussion: The present study revealed that initial training in intensive care and emergency medicine is frequently incomplete, unstructured, as well as inadequate and bears both safety and liability risks. New concepts are needed to improve the initial training across clinics.

Tracheotomy has long been performed outside of intensive care medicine. In modern medicine, it has a firm place in the management of critically ill and emergency care patients as well as in cancer surgery of the head and neck, the care of long-term ventilated patients, patients with swallowing disorders, and neurological diseases. The indication, technique, and timing of tracheotomy are very different for the various diseases. This article provides an overview of the different indications, surgical techniques, and timing of tracheotomy in modern intensive care medicine.

Background: Critically ill patients in the intensive care unit require intensified monitoring to control the treatment with volume and/or vasoactive substances.

Research question: What role does functional hemodynamic monitoring play in controlling treatment and what techniques are used to manage this?

Material and methods: Review of the current literature.

Results and discussion: Precise knowledge of the physiology of the cardiovascular system as well as the pathophysiology of individual clinical pictures and the possibilities of invasive and noninvasive monitoring are the prerequisites for the indications, implementation and interpretation of functional hemodynamic monitoring. An understanding of the heart-lung interaction and the influence of invasive ventilation on the volumetric target parameters, such as stroke volume variation, systolic pressure variation and pulse pressure variation as well as sonography of the inferior vena cava are indispensable prerequisites for the question of volume responsiveness. Other maneuvers, such as the passive leg raising test, can be very helpful when deciding on volume administration in everyday clinical practice. Static parameters such as central venous pressure generally play no role and if any only a subordinate one.