Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie最新文献

Transfusion of platelet concentrates (PC) can be a life-saving measure in case of severe thrombocytopenia or thrombocytopathy, particularly in bleeding patients. Although acaryote, platelets are involved in several important functions including immunomodulation, but their most important function is in primary and secondary haemostasis. In this German review, apheresis and whole blood derived PC are compared and indications as well as transfusion triggers and dosage of PC are discussed. Apart from emergencies, transfusion of PC can only occur after informed consent. Therefore, the treating physician should be aware of the potential adverse events and their prophylaxis in order to best advise the patient. Eight of the most prevalent and/or clinically severe adverse events following PC transfusion and their handling and prevention are discussed. In addition, practical aspects of PC transfusion are depicted as well as the treating physician's choice of the appropriate PC including a flowchart for refractory patients.

In Germany, blast and gunshot injuries are uncommon but complex injury entities. Due to the global political situation, terrorist attacks, accidents, or acts of violence, these injuries are potentially part of the reality of care for every anaesthetist, surgeon, and emergency physician. In principle, this type of injury should be treated in a trauma centre with appropriate expertise, but the knowledge of basic treatment principles is necessary for all practitioners. First, emergency training and surgical simulation courses should be carried out regularly to remain confident in emergency surgery techniques and treatment strategies. In addition, minimally invasive methods are predominantly used in elective surgery, meaning that the routine of primarily open surgery is missing. Therefore, it is important that surgeons learn surgical steps to be better prepared for emergency open surgery.The critical principle of damage control surgery is stopping the bleeding and the contamination and preventing a delay in intensive care therapy. For penetrating thoracic trauma, a chest tube must be inserted. If the patient is hemodynamically unstable, an anterolateral thoracotomy should be performed to achieve bleeding control, e.g., by cross-clamping the aorta or pulmonary hilum. For stable patients, a video-assisted thoracoscopy might be an option.The standard abdominal approach is the median laparotomy. Bleeding control can be achieved by hiatal aortic cross-clamping and packing of the abdomen, followed by a systematic exploration. If necessary, a laparostomy must be established. Moreover, if chest injuries are ruled out, the resuscitative endovascular balloon occlusion of the aorta (REBOA) can be considered as a bridge to surgery.Whether projectiles, fragments, or shrapnels require removal depends on the location and the potential complications of tissue dissection. Penetrating injuries due to blasts and gunshots are always contaminated.

Hardly any other speciality is as fraught with tension as emergency medicine. In addition to the need to have a broad spectrum of knowledge about illnesses and injuries, the time factor is particularly important. Emergency physicians have to quickly gain an overview of their patients' condition. Mostly without having all the information about the patient's medical history, long-term medication or previous findings. Decisions have to be made under time pressure. In addition to experience and knowledge, the targeted use of the available diagnostic options is essential for quick treatment decisions. A detective-like approach is sometimes required here, particularly in order to confirm suspected diagnoses and rule out differential diagnoses by using focussed diagnostics. Clinical experience, training and the odd "trick" lay the foundation for skillfully using the diagnostic options at the right time for the right patient - i.e. point-of-care - and finding the right diagnosis. Aha!

The severity and extent of gunshot and blast injuries are often misjudged due to a lack of specialist knowledge. The aim of this article is to outline the characteristics of gunshot and blast injuries, including emergency diagnostics and initial surgical treatment.Due to multiple high-energy penetrating injuries, barotrauma, or blunt trauma, affected patients are usually polytraumatized, with multiple organ damage and an average Injury Severity Score (ISS) of > 36. In addition to the complexity of the wounds, they are characteristically severely contaminated. After pre-hospital treatment, life-threatening injuries and conditions should be identified and initially treated in the trauma room phase. The procedure should be based on a standardized, internal hospital emergency medical and emergency surgical algorithm. Damage control surgery can then be used to treat acutely life-threatening complications of gunshot and blast injuries in order to prevent the fatal triad and the occurrence of further early complications. Examples of interventions include debridement and decontamination, fracture stabilization (external fixators and splints), surgical decompression (skull, thorax, compartment syndromes) and surgical hemostasis.

Gunshot and blast injuries are extremely rare in the emergency services. However, in the context of the increasing threat of terrorist attacks, the possibility of these traumas is also coming into focus. This article provides an overview of the various entities and the corresponding treatment principles for penetrating injuries.

In the course of climate change, doctors will not only be confronted with heat-related consequences, but also with the emergence of infectious diseases caused by previously tropical pathogens in temperate climate zones.Fortunately, the topics of sustainability and climate change are also becoming increasingly important in discussions in the healthcare sector, which accounts for 4.4% of global greenhouse gas emissions. The topic of hygienically safe sustainability in healthcare facilities is highly complex due to the large number of possible adjustments, but also offers a great deal of potential.Numerous measures can be implemented without any restrictions in terms of hygiene requirements or occupational safety.It is not always the large investments that make their contribution to reducing CO₂-emissions - many smaller measures can also be implemented without high costs, but with great sustainability potential. Similar to hand hygiene compliance, behavior modification by each individual plays a decisive role in the implementation of such projects. There is great practical savings potential, for example, in the indication-based use of disposable medical gloves, the hygienically safe handling of medication or the decision between reusable and disposable medical products, just to name a few items discussed in the article.

With the end of the pandemic in April 2023 the whole learning environment had run through some major changes. The act of normal teaching was not that easy anymore during the pandemic. The size of a class had to be cut down to a size that fits the hygienic guidelines. Therefore, methods like blended learning and virtual classrooms came to life stronger than before. The methods were not new but never before needed in such a strong matter. Due to the experience with these methods of education, teaching and learning stayed different. Topics like virtual reality and even augmented reality stayed and are to some point part of the educational system nowadays. Due to the pandemic, it may seem that these new kinds of methods are worse compared to the ones we are used to but several studies can prove the opposite.The University Hospital Würzburg (UKW) has adapted to these kinds of changes. Every specialist training was formed to fit the necessary changes during the pandemic. It was not easy to keep up good practical education with the correct distance measurement, open windows for fresh air every 45 minutes or an FFP2 mask for protection. The rest of the close to 190 trainings held in the rooms of the academy of the UKW had to be cancelled or cut down to a group size allowed. Most of the known digital teaching and learning system that were installed at that time remained and are in use.

There are numerous reports from patients concerning perceptions during deep unconsciousness, be it general anaesthesia, cardiopulmonary resuscitation or intensive care and coma treatment. These experiences can cause considerable traumatisation. The most stressful experience is apparently not feeling pain, but the lack of communication, i.e. being recognised and being able to express oneself. Although there are already indications of positive effects of positive communication during general anaesthesia, these findings have not yet markedly changed the way we deal with the unconscious.