Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

In Germany, a substantial reform of emergency care is strictly recommended. Regulation of patient flows into the ambulatory and stationary sectors remains a major issue.In the OPTINOFA project funded by Innovationsfunds, a new triage system was developed for a structured primary evaluation of both urgency and care level of emergency cases. OPTINOFA was evaluated in a cluster-randomized, controlled multicenter trial using a stepped-wedge design in eight emergency departments (ED) from 1 July 2019 to 31 May 2021. Additionally, data from one ED were used for comparison of temporal changes without intervention. The primary study endpoint represented the increase of patient transfers to the ambulatory sector; secondary endpoints included the outcome, process and quality indicators as well as mean emergency care costs.In the study, 46,558 emergency cases were included in the control period and 37,485 emergency cases in the intervention period. Concerning the primary endpoint, a significant increase of transfers to the ambulatory sector were detected in the per-protocol EDs (p < 0.001, odds ratio = 10.59). Waiting times were significantly reduced by an average 20 min in the intervention phase. Furthermore, a stable admission rate was found within 3 days after initial ED presentation. Cost analysis revealed no increase of treatment expenses within 28 days after ED admission.In this project a valid assistant service for structured primary evaluation of urgency and care level was successfully developed for emergency cases and served as a digital triage instrument with interoperable format. Clinical trial results revealed great potential for the OPTINOFA triage system to control patient flows in emergency and acute medicine.

Novel immunotherapies such as chimeric antigen receptor T‑cell therapy (CAR T‑cell therapy) and bispecific T‑cell engagers (BiTEs) have transformed the treatment of hematologic malignancies in recent years. Despite their high efficacy, they pose considerable risks, particularly for cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Both typically occur within the first 2 weeks after therapy and may require admission to an intensive care unit (ICU). Other relevant side effects include persistent cytopenias, hypogammaglobulinemia, and increased susceptibility to infections. These long-term complications are gaining importance and require structured follow-up strategies. Up to 35% of patients undergoing CAR T‑cell therapy require intensive care, mostly due to CRS or ICANS. Nevertheless, the rates of organ support and ICU mortality remain comparatively low, indicating that these toxicities are, in principle, manageable. The severe toxicities of these novel therapies increasingly pose ethical challenges in intensive care. Decision-making frameworks such as the "ICU trial" model can provide valuable guidance. This article offers a comprehensive overview of acute and delayed side effects of immune-based therapies, their intensive care management, and current strategies for optimizing patient care.

Video laryngoscopy (VL) and direct laryngoscopy (DL) are both intubation methods used on the intensive care unit although it is unclear if the routine use of VL is meaningful in this setting. A systematic literature search was carried out up to April 2024 in the data banks MEDLINE, CENTRAL and LIVIVO. Included were studies in which a comparison between VL and DL in adult patients on the intensive care unit was carried out. The primary endpoint was determined as the rate of the first attempt success (FAS). The secondary endpoints were visualization of the glottis according to Cormack-Lehane, the time to intubation and complications. A total of 13 studies with 4232 intubations were included. The FAS was significantly higher for VL compared to DL (odds ratio, OR = 1.97, 95% confidence interval, CI 1.47-2.64, p < 0.001). The use of VL led to an improved visualization of the glottis according to Cormack-Lehane and was associated with a lower rate of esophageal intubation failure and hypoxemia. This resulted in tendencies for action for the future utilization of VL on the intensive care unit. Further studies should evaluate the experience of the user with intubation, various VL designs and the use of bougies and stylets to be able to make a better assessment of the routine use of VL on the intensive care unit.

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.

Acute abdomen can represent a serious clinical condition with a variety of different and potentially life-threatening underlying causes. Rapid identification of the underlying etiology through a structured approach and the prompt initiation of adequate diagnostic and treatment measures is highly relevant in order to reduce the patient's mortality risk. This article provides an overview of important differential diagnoses of an acute abdomen and describes recommended diagnostic and therapeutic measures that are relevant in acute and emergency clinical care.

Background and objectives: Sustainability in prehospital emergency medicine has received little attention, unlike in the hospital sector, where climate change and resource conservation are increasingly addressed. Ecological sustainability holds ethical significance within the Georgetown Mantra, as individual health must be viewed within the broader context of public health. The World Health Organization considers climate change the greatest threat to human health in the 21st century.

Methods: An online survey of 23 questions was conducted among emergency medical personnel. This study focuses on three specific questions related to ethical considerations of sustainable practices in emergency medicine. Subgroup analyses were performed.

Results: A total of 387 respondents (73% men, 27% women, aged 18-65 years, 17% physicians) participated. Most acknowledged climate change as a major health threat, but the 18-24 age group considered waste management less important in emergencies and prioritized individual health over public health. This age group also showed the lowest concern for climate change.

Conclusion: The low concern about climate change among 18- to 24-year-old emergency medical staff, along with their lower prioritization of waste separation, highlights the need for targeted education. This study is the first to show age- and profession-specific differences in the prioritization of individual versus public health, sustainable behavior, and the perceived relevance of climate change. Sustainable practices in emergency medicine could contribute to global public health and promote intergenerational justice. Ethical considerations play a critical role in balancing acute care with long-term sustainability.

Background: Emergency departments and intensive care units are of great importance for patient care and require qualified and competent medical staff.

Objective: To present the range of tasks and career paths in emergency and intensive care medicine that make further training and long-term employment in these areas attractive.

Methods and results: Emergency and intensive care medicine are characterized by a wide range of clinical tasks, but also by stresses resulting from, for example, shift work. As an alternative to full-time employment, part-time work can also be combined with other tasks, such as training, continuing education, teaching, research, or management.

Conclusion: Emergency and intensive care medicine offers a variety of exciting and promising fields of activity, but also specific stresses that must be taken into account in work models.

Emergency medicine places high demands on all specialized healthcare professionals. A structured onboarding process is essential for high-quality care and effective interprofessional collaboration. Current onboarding concepts in emergency departments are heterogeneous and often insufficient. Organizational measures, such as reliable rotation schedules, evaluation meetings and the integration of interprofessional perspectives create the foundation for effective onboarding. Investing in induction concepts promotes employee loyalty, team dynamics and efficiency of patient care in the long term.A wide range of methods can be utilized for knowledge transfer, including the use of digital media and low-threshold learning units in everyday working life. Simulation plays a particularly important role, enabling realistic, interprofessional and interdisciplinary training of emergency situations. Internal standards should be actively included and communicated during induction. Mentoring programs for new professionals provide orientation and enable regular, personalized feedback. An open error culture that views mistakes as an opportunity for improvement should be communicated from the outset and practiced within the team. In addition, biopsychosocial stresses such as shift work, moral distress and emotional exhaustion must be addressed. Digital learning platforms and artificial intelligence (AI)-supported tools will increasingly enable new, personalized learning pathways. The development of uniform (inter)national standards could improve onboarding on a broad scale and promote the exchange between emergency departments.

The medical onboarding process for physicians in internal medicine intensive care units in Germany reveals significant deficiencies, as highlighted by a 2023 survey from YDGIIN. Many physicians report feeling insecure and inadequately prepared after their onboarding phase. The study identifies core issues such as heterogeneous levels of training, unstructured onboarding processes, and a lack of support and competency checks in daily clinical practice. To address these challenges, the study proposes solutions including individualized onboarding, mentoring and feedback systems, and a structured onboarding and training plan. The goal is to make the onboarding process more effective, thereby improving the quality of patient care and increasing physician satisfaction.