Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

{"title":"[Combination of Manchester Triage System and chief complaint: development and internal validation of a new algorithm for patient flow management in integrated emergency centres].","authors":"Domagoj Schunk, Milda Aleknonyte-Resch, Arvid Lepsien, Alina Balandin, Hans Jörg Busch, Florian Ketels, Sascha Thielke, Sebastian Wolfrum","doi":"10.1007/s00063-026-01475-w","DOIUrl":"https://doi.org/10.1007/s00063-026-01475-w","url":null,"abstract":"<p><strong>Background: </strong>A central element of the emergency care reform in Germany is the establishment of integrated emergency centres (INZ) with a central point of assessment (ZE). This simulation study presents a new tool (L-MTS) combining the Manchester Triage System (MTS) with the Canadian Emergency Department Information System (CEDIS) chief complaint to identify patients with low urgency early, thereby decreasing the workload in the central emergency department (ZNA) while ensuring patient safety in the urgent care centre (AA).</p><p><strong>Methods: </strong>Retrospective analysis of 38,639 adult self-presenting emergency patients (fNP) at two university hospitals (2024). Following randomization (70% training, n = 27,048/30% test, n = 11,591), chief-complaint-based outpatient rates were calculated as pretest probabilities. Using ROC analysis and the maximum Youden index, a 74% cutoff was defined for the allocation algorithm. This was refined into an optimized version (L-MTS opt.) by routing high-risk complaints directly to the ZNA. Internal validation within the test dataset was performed using decision curve analysis (DCA), calibration curves (Brier score), and bootstrapping (min. 5000 iterations).</p><p><strong>Results: </strong>Outpatient rates varied substantially depending on the chief complaint. Using L-MTS opt., the ZNA workload could be reduced by up to 44.3% of all fNP within the test dataset. This includes 12.9% of patients requiring secondary transfer from the AA to the ZNA. The proportion of AA patients requiring monitoring or who died was 0.20% and 0.14%, respectively.</p><p><strong>Conclusion: </strong>L-MTS opt. substantially reduces emergency department overcrowding while maintaining high patient safety. The broad availability of the variables used and the high adaptability of the allocation algorithms allow for wide application of the system. The findings support the need for close spatial and organizational integration of ZNA and AA to optimize patient flow.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148457597","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":"[Prehospital point-of-care ultrasound (pPOCUS): \"See, decide, act\" : Evidence, training concepts, and the role of pPOCUS in the acute assessment of traumatic and nontraumatic emergencies].","authors":"Sarah Funk, Doreen Sternheim","doi":"10.1007/s00063-026-01478-7","DOIUrl":"https://doi.org/10.1007/s00063-026-01478-7","url":null,"abstract":"<p><strong>Background: </strong>Prehospital point-of-care ultrasound (pPOCUS) enables focused sonography for immediate management-relevant clinical questions.</p><p><strong>Objective: </strong>To summarize the role of pPOCUS in traumatic and nontraumatic emergencies with regard to evidence, indications, training, and limitations.</p><p><strong>Results: </strong>pPOCUS may provide clinically relevant adjunctive information in trauma, acute dyspnea, chest pain, undifferentiated shock, resuscitation, and selected procedural settings. Current evidence supports its feasibility and frequent impact on management decisions, whereas robust data on patient-centered outcomes remain limited.</p><p><strong>Conclusion: </strong>The clinical benefit of pPOCUS depends on appropriate indications, integration into team workflows, structured training, documentation, and quality assurance. pPOCUS should be regarded as focused decision support rather than as an exclusionary diagnostic modality.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148457586","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":"[Treatment algorithm: decannulation management in the context of discontinuous weaning from mechanical ventilation in critically ill patients with tracheal cannula].","authors":"Tilo Zimmermann, Lars Krüger, Franziska Wefer, Peter Nydahl, Marius Ostermöller, Lisa Peper, Daniel Plaß, André Ramos Y Soto, Richard Schalk, Valery Maurice Kitz, Thomas Mannebach, Tobias Alzen, Pia Kirchhoff, Sarah Köster, Sarah Lohmeier, Anne Oldag, Thomas Kirschning, Oliver Rothaug","doi":"10.1007/s00063-026-01474-x","DOIUrl":"https://doi.org/10.1007/s00063-026-01474-x","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438777","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":"[Tele-emergency physicians-a cost-benefit analysis].","authors":"Pia Lebiedz, Ronja Craayvanger, Andreas Atzeni","doi":"10.1007/s00063-026-01471-0","DOIUrl":"https://doi.org/10.1007/s00063-026-01471-0","url":null,"abstract":"<p><p>Telemedical applications are increasing-ranging from patients contacting a general practitioner to tele-emergency medicine and tele-intensive care for medical professionals. Telemedical applications range from callback systems as simple telephone counseling up to telemedical transfer of diagnostic results such as ECG and modern systems aiming for real-time audiovideo consultation. With the establishment of the new profession called Notfallsanitäter (specialized emergency paramedic), which is one of the highest trained nonphysician medical professions, the prehospital use of artificial intelligence, and the rapidly rising health care costs in Germany, a critical review of the telephysician system in a cost-benefit analysis is required. Furthermore, regarding the lack of highly trained consultants in ambulatory as well as hospital settings, employing those specialized physicians in the tele-emergency center instead of bedside raises concerns about the use of limited resources.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425662","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":"[Chemical attacks and accidents : Prehospital management].","authors":"Christoph Hüser, Philipp Gotthardt, David Steindl","doi":"10.1007/s00063-026-01479-6","DOIUrl":"https://doi.org/10.1007/s00063-026-01479-6","url":null,"abstract":"<p><p>Chemical attacks and accidents involving so-called C (chemical)-agents are rare but represent a significant challenge for emergency medical services. More often than classical warfare agents, \"dual-use\" substances used in industry and everyday settings are involved. Early recognition of a possible exposure is crucial, for example, through clustering of cases or unexplained symptom patterns consistent with a toxidrome. Simple interventions such as undressing and dry decontamination can substantially reduce contamination and help with patient and personnel safety. Initial medical management follows ABCDE (airway, breathing, circulation, disability, and exposure) principles and may be supplemented by targeted antidote therapy. Knowledge of the clinical features, key problems, and management of common substance groups such as organophosphates or cyanides enables a structured and effective approach and is discussed in this article.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413483","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":"[Efficacy of a psychosocial workplace within the Berlin Fire Department's dispatch center: a randomized controlled trial].","authors":"Lisa Wollenhaupt, Jan Moll, Michael Mihasi, Daniela Krüger, Antje Fischer-Rosinský, Julian Friebel, Charlotte Rust, Joanna Geib, Dörte Huscher, Andrea Figura, Twyla Michnevich, Paul Brettschneider, Eiko Spielmann, Anna Slagman","doi":"10.1007/s00063-026-01470-1","DOIUrl":"https://doi.org/10.1007/s00063-026-01470-1","url":null,"abstract":"<p><strong>Background: </strong>The emergency medical services in Berlin are facing an increasing number of missions, partly because people with low-priority psychosocial problems are calling the emergency number 112 for help. Although international evidence shows that telephone counseling can resolve some cases, there is currently no alternative to dispatching ambulances for these calls in Germany.</p><p><strong>Objectives: </strong>The study examines the efficacy of a psychosocial telephone service in the emergency control center (PSAPL) in reducing the number of ambulance dispatches.</p><p><strong>Materials and methods: </strong>This is a randomized, controlled study conducted in the emergency dispatch center. Participants were selected according to standardized emergency call query codes. On intervention days, callers with low-priority psychosocial requests for help were advised by the PSAPL and, if necessary, referred to other support structures. On control days, an ambulance was routinely dispatched. Individuals who gave their consent were contacted again after 14 days to collect self-reported outcomes (e.g., satisfaction).</p><p><strong>Results: </strong>There were 72 PSAPL conversations during the 2‑month study period. Callers were mostly the affected persons themselves or people close to them. The median call duration was 14 min. In 48 cases, an ambulance dispatch was avoided and alternative assistance was usually provided. In 24 cases, it was not possible to conclude the case by telephone consultation and an ambulance was dispatched. Those seeking help were predominantly satisfied with the PSAPL intervention.</p><p><strong>Conclusion: </strong>For the first time, case-resolving telephone counselling at the control center actively prevented ambulance missions and transports to emergency rooms in the psychosocial spectrum. The PSAPL, therefore, offers a way to close an existing gap in acute psychosocial care and to refer these requests for help in a targeted manner. This could save direct ambulance costs as well as costs of follow-up care.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413473","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":"[Modern therapy of pulmonary embolism with PERT and EKOS: an advantage also for in-hospital time?]","authors":"Matthias Mezger, Julia Schulten-Baumer, Christian Frerker, Tobias Schmidt, Karolin Schmoll, Patrick Parschke, Ingo Eitel, Tobias Graf","doi":"10.1007/s00063-026-01473-y","DOIUrl":"10.1007/s00063-026-01473-y","url":null,"abstract":"<p><strong>Background and objectives: </strong>Today, patients with intermediate high-risk pulmonary embolism are usually treated by a pulmonary embolism response team (PERT) and often EKOS lysis. We investigated whether this approach leads to a reduction in the hospital stay duration.</p><p><strong>Materials and methods: </strong>A retrospective analysis of patients with intermediate high-risk pulmonary embolism clinically assessed by PERT and treated with EKOS lysis in a medical intensive care unit (ICU) between 01 October 2021 and 21 August 2024 was undertaken. The control group comprised patients suffering from intermediate high-risk pulmonary embolism, treated with medication alone (without assessment by PERT) in the ICU between 01 January 2010 and 31 December 2021. The economic/process-associated endpoint of the study was duration of hospital stay (days in hospital).</p><p><strong>Results: </strong>A total of 45 patients were treated in the EKOS and PERT group and 31 in the control group. No differences regarding sex, vital signs, and laboratory parameters were observed. Despite the higher age of patients in the group treated by PERT and EKOS (64.7 years [53.4-71.6] vs. 54.0 years [38.6-63.1], *p = 0.03), the duration of hospital stay was significantly shorter (7.8 days [5.2-13.2] vs. 12.9 days [7.1-22.1], *p = 0.003). Time in the ICU was also significantly shorter (0.9 days for PERT and EKOS [0.5-1.5] vs. 2.0 days [0.9-6.2], *p = 0.01).</p><p><strong>Conclusion: </strong>In addition to being advantageous in situations where there is a shortage of acute care beds, a reduction of hospital stay may also potentially reduce treatment costs. This is especially important in ageing societies like Germany suffering from constantly increasing healthcare costs.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370408","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":"[Invasive mechanical ventilation: indications and alternatives : Systematic evaluation of the evidence and recommendations for clinical practice from the S3 guidelines \"invasive mechanical ventilation and the use of extracorporeal procedures in acute respiratory failure\"].","authors":"Margarethe Grupp, Patrick Schramm, Nora Bruns, Martin Olivieri, Helmut Frohnhofen, Sandra Delis, Thomas Schaible, Rolf Dembinski, Stefan Kluge, Falk Fichtner","doi":"10.1007/s00063-026-01468-9","DOIUrl":"https://doi.org/10.1007/s00063-026-01468-9","url":null,"abstract":"<p><strong>Background: </strong>Selecting the appropriate mode of respiratory support in cases of acute respiratory failure is clinically challenging and has relevant implications for patient outcomes. Despite the widespread use of noninvasive techniques, uncertainties remain regarding optimal indications, timing of escalation and patient-centered aspects.</p><p><strong>Aim of this study: </strong>This paper summarizes the chapter on interpretation of indications and alternatives to invasive mechanical ventilation from the German S3 clinical guidelines \"invasive ventilation and extracorporeal life support in acute respiratory failure\".</p><p><strong>Methods: </strong>For the guideline revision a systematic literature search and critical appraisal were conducted, including national and international guidelines. Recommendations were developed using the evidence to decision framework and a consensus was reached in several conferences.</p><p><strong>Results: </strong>Noninvasive respiratory support, including noninvasive ventilation (NIV) and high-flow nasal oxygen (HFNO), is effective in patients with moderate impairment of oxygenation (PaO₂/FiO₂ 100-300 mm Hg) and can avoid endotracheal intubation but requires close clinical monitoring. In patients with severe respiratory failure (PaO₂/FiO₂ < 100 mm Hg) or treatment failure under noninvasive respiratory support, invasive ventilation is required. Further recommendations concern specific patient groups.</p><p><strong>Discussion: </strong>The available evidence supports an individualized approach to the choice of respiratory support that incorporates patients' preferences. Key elements include a regular reassessment, avoidance of delayed intubation, adequate personnel and expert resources and transparent communication within the interdisciplinary treatment team.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310169","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":"[Videolaryngoscopic endotracheal intubation during out-of-hospital cardiac arrest from the perspective of paramedics : Training requirements and subjective procedural confidence-results of an anonymous cross-sectional survey].","authors":"Julia J Grannemann, Berrin Winkler, Bernd Strickmann, Gerrit Jansen","doi":"10.1007/s00063-026-01469-8","DOIUrl":"https://doi.org/10.1007/s00063-026-01469-8","url":null,"abstract":"<p><strong>Background: </strong>Videolaryngoscopic endotracheal intubation (VL_ETI) was implemented as a structured training module for paramedics as part of an annual continuing education program in a German EMS system. The aim was not to evaluate intubation success rates, but rather to assess perceived training needs and subjective confidence in the application of the technique.</p><p><strong>Methods: </strong>An anonymous online cross-sectional survey was conducted among participants of the 2025 training program. Only datasets from paramedics were included in the analysis. Subjective confidence in five airway management techniques was ranked using a Borda score (rank 1 = 5 points, rank 5 = 1 point).</p><p><strong>Results: </strong>Seventy-nine paramedics participated (62.7%). The iGel® achieved 336 of a maximum of 395 points. Macintosh-like VL_ETI with stylet and with bougie each reached 256 points. Hyperangulated techniques scored considerably lower (171 and 166 points). About half of the participants reported a need for more frequent training.</p><p><strong>Conclusions: </strong>Although VL_ETI was generally well accepted, its perceived safety remained lower than that of supraglottic airway devices. These findings support structured, repeated, and quality-assured training approaches rather than an uncontrolled expansion of invasive airway techniques.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273619","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":"[An unusual arterial pressure curve : When an aneurysm doubles the pulse-pulsus bisferiens as a rare manifestation of an abdominal aortic aneurysm].","authors":"Ileana M Minerva, Urs Pietsch","doi":"10.1007/s00063-026-01453-2","DOIUrl":"https://doi.org/10.1007/s00063-026-01453-2","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266621","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}