Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

{"title":"[Sustainability in preclinical emergency medicine : What is the influence of ethical considerations on sustainable and resource-saving practices in prehospital emergency medicine?]","authors":"Julia Johanna Grannemann, Martin Deicke, Eugen Latka, Bernd Strickmann, Gerrit Jansen","doi":"10.1007/s00063-025-01322-4","DOIUrl":"10.1007/s00063-025-01322-4","url":null,"abstract":"<p><strong>Background and objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"484-492"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975725","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 management of bleeding complications and coagulation disorders in critically ill patients with liver cirrhosis].","authors":"Philipp Kasper, Frank Tacke, Matthias Kochanek, Guido Michels","doi":"10.1007/s00063-024-01242-9","DOIUrl":"10.1007/s00063-024-01242-9","url":null,"abstract":"<p><p>Critically ill patients with liver cirrhosis exhibit complex alterations in coagulation that should be considered in clinical acute management. As routine laboratory tests (e.g., INR, aPTT, platelet count) cannot always adequately reflect the coagulation status of critically ill patients with liver cirrhosis, functional hemostatic tests, such as viscoelastic tests, should also be used to assess coagulation disorders in these patients. If invasive procedures are planned, hemostatic interventions to prevent bleeding and measures to stabilize coagulation disorders should be considered depending on the risk of procedure-associated bleeding, while a prophylactic routine correction of abnormal laboratory coagulation parameters should be avoided. If an acute bleeding complication manifests in critically ill patients with liver cirrhosis, an individualized correction of hemostatic changes is indicated in addition to prompt identification of the source of bleeding. This review article describes the pathophysiological changes underlying the altered hemostatic system in critically ill patients with liver cirrhosis and provides an overview of diagnostic and therapeutic options for hemostatic complications.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"445-453"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383688","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":"[High-flow oxygen in acute hypoxemic respiratory failure: no improved survival but clinically relevant? : Commentary on the SOHO trial].","authors":"Sebastian Mang, Jens Gottlieb, Hendrik Bracht, Philipp M Lepper","doi":"10.1007/s00063-026-01456-z","DOIUrl":"10.1007/s00063-026-01456-z","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"506-508"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934847","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":"[Refractory ventricular fibrillation in an 18 -year-old patient].","authors":"Marie Kuschnereit, Dorothea Sauer","doi":"10.1007/s00063-026-01448-z","DOIUrl":"10.1007/s00063-026-01448-z","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"509-511"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786707","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":"[German Medical Assembly 2026: implications for internal medicine intensive care and emergency medicine : Policy Statement of the German Society of Internal Medicine Intensive Care and Emergency Medicine (DGIIN)].","authors":"Michael Buerke, C Karagiannidis, U Janssen, H-J Busch, M Kochanek","doi":"10.1007/s00063-026-01466-x","DOIUrl":"10.1007/s00063-026-01466-x","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"496-498"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220600","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":"[Heat-related illnesses in emergency and intensive care medicine : Consensus paper of the German Society for Internal Intensive Care and Emergency Medicine (DGIIN) and the German Association for Emergency Medicine (DGINA)].","authors":"Pia Lebiedz, Janika Briegel, Christian Karagiannidis, Rosa van de Loo, Uwe Janssens, Michael Buerke, Stefan Kluge, Matthias Kochanek, Dirk Weismann, Martin Pin, Christoph Hüser, Guido Michels, Hans-Jörg Busch","doi":"10.1007/s00063-026-01497-4","DOIUrl":"https://doi.org/10.1007/s00063-026-01497-4","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148800473","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":"Erratum zu: Diagnostik und Therapie der akuten Lungenembolie.","authors":"M Hecker, M Bayer, G A Krombach, N Sommer","doi":"10.1007/s00063-026-01483-w","DOIUrl":"10.1007/s00063-026-01483-w","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725615","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":"[DGIIN action algorithm: management of heat-related illnesses in clinical acute care and emergency medicine].","authors":"Guido Michels, Hans-Jörg Busch, Janika Briegel, Michael Buerke, Pia Lebiedz","doi":"10.1007/s00063-026-01486-7","DOIUrl":"https://doi.org/10.1007/s00063-026-01486-7","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148594075","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":"[Cost and revenue analysis of inpatient and outpatient cases in emergency departments: potential for optimization and control?]","authors":"Anja Kummer, Helmar Wauer, Martin Möckel","doi":"10.1007/s00063-026-01477-8","DOIUrl":"https://doi.org/10.1007/s00063-026-01477-8","url":null,"abstract":"<p><strong>Background: </strong>A precise economic representation of the central emergency department (ZNA) is a challenge for most hospitals. Due to the complex interrelationship of revenues from various systems, internal service billing, costs associated with the German Association of Statutory Health Insurance Physicians (KV), and process indicators, there are currently no analytical models that provide full transparency regarding the economic reality of the ZNA, and, thus, there is no solid basis for differentiated management.</p><p><strong>Methods: </strong>In a retrospective, quantitative study based on routine data (n = 150 cases) from 2024 from the Charité - Universitätsmedizin Berlin emergency department, which was selected based on specific criteria, a cost and revenue analysis was performed. In addition, resource intensive formal \"hybrid cases\" that were billed formally as outpatients but with inpatient characteristics were defined and included in the analysis, which until now have not been adequately reflected in any renumeration system. The term \"hybrid\" describes formal outpatient but resource intensive processes with inpatient characteristics. Personnel costs were not analyzed based on each case due to lack of a reliable method to assign these to the individual cases.</p><p><strong>Results: </strong>Remuneration was inadequate in nearly all outpatient cases (-242 to -346 €/case depending on the Charité site). Hybrid cases form an especially critical group (-205 to -290 € per case depending on the site) due to the longer hospital stay and higher costs in the internal cost allocation (ILV). In some cases, inpatient cases had more favorable remuneration ratios and thus appear to be more cost-effective due to internal splitting logic. However, because only about 22 % of cases are hospitalized, while 78 % remain outpatients, the inpatient minority can not compensate for the structural deficits of the outpatient majority. The economic outcome is also negatively affected by the about 10 % costs associated with the KV.</p><p><strong>Discussion and conclusion: </strong>The systematic integration of cost, revenue, and process data is feasible and generates new information for management, but it remains incomplete due to limitations in the routine data. The results show that the economic difficulties of the ZNA are not primary due to the inefficient provision of services, but are due to structural causes of renumeration logic in the German healthcare system. The internal establishment of specific management tools, especially the linking of ILV, hospital stay duration and case type (\"hybrid flag\"), can contribute to improvements, but can not overcome the structural deficit. This structural underfinancing of emergency preparedness exacerbates the already strained financial situation of hospitals and requires future reform that explicitly takes into consideration aspects of standby capacity components and the actual provision of services.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551044","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":"[Measures to improve bystander resuscitation : Kids Save Lives and public-access defibrillation].","authors":"Andreas Atzeni, Dennis Lindemann, Janika Briegel","doi":"10.1007/s00063-026-01482-x","DOIUrl":"https://doi.org/10.1007/s00063-026-01482-x","url":null,"abstract":"<p><p>Bystander cardiopulmonary resuscitation (CPR) and early use of automated external defibrillators (AEDs) are key measures to improve neurologically intact survival after out-of-hospital cardiac arrest (OHCA). In Germany, however, heterogeneous emergency medical service structures, insufficient legal frameworks for public-access defibrillation, and only partially implemented CPR training in schools limit the full realization of this potential. This review summarizes the available evidence on school-based CPR training, national and international programs (including \"Kids Save Lives\"), and innovative mobile AED strategies. As an example, a regional project in the city and district of Osnabrück is presented, in which a non-profit organization has been implementing CPR training in schools since 2020, training both teachers and students. Building on this, regional initiatives have been launched to systematically record and improve the availability of AED locations. Based on these findings, key fields of action for policymakers, emergency medical service providers, and civil society stakeholders are identified. Nationwide, legally mandated CPR training in schools, a structured public-access defibrillation concept including AED registries, and the consistent involvement of local non-profit organizations appear crucial to strengthening the early links in the chain of survival and to sustainably improving outcomes after OHCA.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551060","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}