Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

{"title":"[Children and adolescents in German emergency departments : The most common reasons for presentation throughout the day-current insights from the AKTIN emergency department registry].","authors":"Johanna Bergmann, Alina Balandin, Susanne Drynda, Gunnar Elke, Marcus Klein, Ronny Otto, Domagoj Schunk","doi":"10.1007/s00063-025-01254-z","DOIUrl":"https://doi.org/10.1007/s00063-025-01254-z","url":null,"abstract":"<p><strong>Background: </strong>The planned hospital and emergency care reform in Germany aims, among other things, to restructure emergency services towards integrated emergency centers (INZ) and integrated emergency centers for children and adolescents (KINZ). There is a gap in current data on the reasons for presentation and the use of emergency departments by patients under 18 years of age. This study provides a multicenter analysis of the most common reasons for presentation among children and adolescents in German emergency departments.</p><p><strong>Methods: </strong>In a retrospective, descriptive cross-sectional analysis, data were collected from 251,570 emergency patients under 18 years of age from January 1, 2019, to June 30, 2022, across 22 emergency departments (including three pediatric emergency departments). Reasons for presentation were categorized according to the Canadian Emergency Department Information System-Presenting Complaint List (CEDIS-PCL) and analyzed by age group, gender, and mode of arrival.</p><p><strong>Results: </strong>Over 64.1% of children and adolescents presented with one of the ten most common reasons. In pediatric emergency departments, nontrauma-related reasons, such as respiratory infections and abdominal pain, were predominant, while trauma-related reasons were more frequent in general emergency departments. The gender distribution showed a majority of male patients for trauma-related reasons, whereas some nontrauma-related reasons, like abdominal and headache complaints, were more common among females. Most patients (85.5%) arrived at the emergency department independently; only for seizures did ambulance transport prevail. During the day, 67% of patients presented between 06:00 and 18:00, with 33% presenting in the evening and nighttime hours.</p><p><strong>Conclusions: </strong>The results show that more than half of children and adolescents present to emergency departments with one of the ten most common chief complaints. Notably, nontraumatological presentations in emergency departments (EDs) highlight that pediatric care also takes place in facilities primarily serving adults. In the future, staff and infrastructure should be appropriately equipped to efficiently ensure the quality of pediatric emergency care on a broad scale. An important approach in this regard is health education and the optimization of access to outpatient care structures.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Diagnosis and treatment of acute pulmonary embolism].","authors":"M Hecker, M Bayer, G A Krombach, N Sommer","doi":"10.1007/s00063-025-01249-w","DOIUrl":"https://doi.org/10.1007/s00063-025-01249-w","url":null,"abstract":"<p><p>Acute pulmonary embolism is a common and potentially fatal condition in intensive care and emergency medicine. The mortality rate within the first few hours of its occurrence is particularly high; thus, even in the event of clinical suspicion, immediate initiation of diagnostics and treatment is crucial. The current European and national guidelines on acute pulmonary embolism provide valuable and practical support on this topic and form the basis of this review. A particular focus lies in the presentation of a risk-adapted and algorithm-based diagnostic and therapeutic approach. In particular, there are new recommendations regarding risk stratification and differentiated therapy, which are discussed in this article.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Ten key statements on the guideline \"Peripheral administration of vasopressors\"].","authors":"Silke Fortenbacher, Stefan John","doi":"10.1007/s00063-024-01201-4","DOIUrl":"10.1007/s00063-024-01201-4","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"135-137"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitteilungen der DGIIN.","authors":"","doi":"10.1007/s00063-025-01257-w","DOIUrl":"https://doi.org/10.1007/s00063-025-01257-w","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":"120 2","pages":"183"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Acute ischemic stroke treatment].","authors":"Muadh Hussain, Jan Purrucker, Peter Ringleb, Silvia Schönenberger","doi":"10.1007/s00063-024-01233-w","DOIUrl":"10.1007/s00063-024-01233-w","url":null,"abstract":"<p><p>Intravenous thrombolysis (IVT) and endovascular therapy (EVT) are the cornerstones of acute ischemic stroke treatment. While IVT has been an integral part of acute therapy since the mid-1990s, EVT has evolved as one of the most effective treatments in medicine over the past decade. Traditionally, systemic thrombolysis has been performed with alteplase (rtPA). More recently, tenecteplase (TNK) has been shown to be non-inferior to rtPA. TNK has some pharmacological advantages over rtPA and may lead to earlier recanalization, particularly in large vessel occlusions. All recanalization therapies are highly time dependent. To ensure rapid treatment, standard operating procedures (SOPs) should be established and followed in clinical practice. The optimal time window for IVT is 4.5 h after symptom onset and can be extended up to 9 h using specialized imaging techniques. For EVT, studies suggest a time window up to 24 h after symptom onset. In some cases, EVT has been successfully performed beyond this time window. To select patients for EVT, advanced imaging identifying salvageable brain tissue might be necessary. Even in large ischemic stroke, EVT can still improve outcome. Compared to EVT, IVT requires fewer technical and human resources, so more stroke patients can potentially be treated. In contrast, EVT requires highly trained personnel with sophisticated equipment and can, therefore, only be performed in specialized centers. Both procedures should be combined within the 4.5 h time window for patients without contraindications.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"120-128"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Skill-grade mix and shared governance in the intensive care unit: development of a management triangle and the advancement of nursing roles].","authors":"Christian Siegling, Esther Mertins, Franziska Wefer, Christina Bolte, Lars Krüger","doi":"10.1007/s00063-024-01175-3","DOIUrl":"10.1007/s00063-024-01175-3","url":null,"abstract":"<p><strong>Background: </strong>In the Federal Republic of Germany, it has been possible for some years to study (intensive) nursing care alongside further training in intensive care and anaesthesia. This results in a nursing skill-grade mix in the intensive care unit (ICU), which nursing management must consider.</p><p><strong>Objectives: </strong>The aim is to show the development and implementation of a new nursing management structure in the ICU and also provide an overview of the parallel role development with preliminary results at a university hospital.</p><p><strong>Materials and methods: </strong>Within a working group of nursing management, a narrative analysis of the current situation was carried out with close involvement of the ICU ward managers and the staff units for nursing development, further education and nursing education. The content was organized into subject areas and a new management model was subsequently developed. The evaluation took place narratively within the context of employee interviews.</p><p><strong>Results: </strong>The management model in the ICU was divided into the areas of nursing management, nursing education, and nursing science as a management triangle. Nursing management is staffed by at least two people as ward managers and deputies, while the nursing education and science team leaders have equal decision-making powers in terms of shared governance. The respective specialist departments work together within the hospital in networks with other ICUs. Other specialist roles such as primary nurses, advanced practice nurses, heart failure nurses or practical instructors are given specific contact persons in the management team to match their tasks, which was viewed positively.</p><p><strong>Conclusions: </strong>The development of nursing practice can be promoted through close co-operation within the management team.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"153-161"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Overlooked threat: Sepsis with an uncommon source of infection].","authors":"Tanja Knoll, Christian Hohmann, Oliver Kemper, Rolf Dembinski","doi":"10.1007/s00063-024-01205-0","DOIUrl":"10.1007/s00063-024-01205-0","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"166-169"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Management of acute community-acquired bacterial meningitis : Leading symptoms of impaired consciousness and fever with/without headache].","authors":"Susanne Dyckhoff-Shen, Matthias Klein","doi":"10.1007/s00063-024-01210-3","DOIUrl":"10.1007/s00063-024-01210-3","url":null,"abstract":"<p><strong>Background: </strong>Simultaneous symptoms of impaired consciousness and fever are suspicious for acute bacterial meningitis. This is a medical emergency and prompt action is essential.</p><p><strong>Objectives: </strong>The clinical workup for suspected bacterial meningitis as well as treatment recommendations and differential diagnosis for the main symptoms of decreased vigilance and fever are described.</p><p><strong>Methods: </strong>Evaluation of selective literature using PubMed (U.S. National Library of Medicine®, Bethesda, MD, USA), especially taking into account the AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften) guideline of community-acquired bacterial meningoencephalitis in adults.</p><p><strong>Results: </strong>Bacterial meningoencephalitis presents with the main symptoms of impaired consciousness, nuchal rigidity, headache and fever, which may, however, be absent in some cases. The diagnosis is confirmed by investigation of the cerebrospinal fluid. Further diagnostics include emergency laboratory tests, blood cultures, microbiological examinations, and cranial computed tomography (CCT). Empirical treatment should be administered promptly.</p><p><strong>Conclusion: </strong>Acute bacterial meningitis must be considered in cases of loss of vigilance and fever, requiring a rapid, structured approach in the emergency department.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"97-102"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Spotlight on neurological acute and emergency medicine].","authors":"Hagen B Huttner, Matthias Klein","doi":"10.1007/s00063-025-01248-x","DOIUrl":"https://doi.org/10.1007/s00063-025-01248-x","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":"120 2","pages":"95-96"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Leading symptom: motor manifestations with impaired consciousnes : Management of epileptic seizures and status epilepticus].","authors":"Leona Möller, Clara Jünemann, Christian Claudi, Patrick Schramm","doi":"10.1007/s00063-024-01223-y","DOIUrl":"10.1007/s00063-024-01223-y","url":null,"abstract":"<p><p>Epileptic seizures, which are often accompanied by a reduction in vigilance, are a common emergency. Every first-time epileptic seizure should be investigated further. Particular attention should be paid to whether it is an acute symptomatic seizure, which is an acute event characterized by a metabolic disorder or acute cerebral damage within a certain period of time, or possibly epilepsy. In terms of differential diagnosis, psychogenic nonepileptic seizures also pose a challenge, as they are often not easy to distinguish from epileptic seizures, but require a different therapeutic approach. Persistent epileptic seizures in the sense of status epilepticus (duration: > 5 min) are also common in the (pre)clinical emergency situation and require immediate initiation of adequate therapy, which consists of rapid and sufficient administration of benzodiazepines. Nasal administration is a quick and simple option here, particularly in the prehospital setting. Furthermore, persistent reductions in vigilance are a not infrequently occurring phenomenon in the (pre)clinical setting, which is, however, based on numerous differential diagnoses. Here, nonconvulsive status epilepticus should be considered as a possible cause and rapid diagnosis using EEG should be sought in order to begin early treatment, which improves patient outcomes.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"103-109"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}