Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

{"title":"[Nutrition (therapy) in gastrointestinal failure].","authors":"Georg Braun","doi":"10.1007/s00063-023-01082-z","DOIUrl":"10.1007/s00063-023-01082-z","url":null,"abstract":"<p><strong>Background: </strong>The presence of gastrointestinal dysfunction is an outcome-relevant complication in critically ill ICU patients.</p><p><strong>Aims, materials and methods: </strong>The following review aims to show the importance of gastrointestinal dysfunction. Multimodal therapy for gastroparesis and paralytic ileus is discussed.</p><p><strong>Conclusion: </strong>Erythromycin and metoclopramide are options for gastroparesis, while neostigmine is commonly used for paralytic ileus.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138177597","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":"[Ultrasound diagnostics in prehospital emergency care-do we need a standardized educational approach?]","authors":"Christine Eimer, Ulf Lorenzen, Florian Reifferscheid, Nils Passau, Katharina Helzel, Alexander Schmuck, Stephan Seewald, Andrea Köser, Norbert Weiler, Holger Gässler, Björn Hossfeld, Matthias Gruenewald, Maximilian Feth","doi":"10.1007/s00063-023-01045-4","DOIUrl":"10.1007/s00063-023-01045-4","url":null,"abstract":"<p><strong>Background: </strong>Limited diagnostic capabilities represent an ongoing obstacle in out-of-hospital emergency settings. Prehospital deployment of ultrasound might reduce this particular diagnostic gap. So far, little is known about the availability and usage of ultrasound in emergency medical services (EMS) or about the level of education of EMS physicians regarding prehospital ultrasound (point-of-care ultrasound, POCUS).</p><p><strong>Methods: </strong>A nationwide survey was conducted among emergency physicians in Germany focusing on POCUS education and experience.</p><p><strong>Results: </strong>Between 02/2022 and 05/2022, 1079 responses were registered, of which 853 complete responses were analyzed. Of the emergency physicians, 71.9% consider POCUS beneficial for out-of-hospital diagnostics and 43.8% had participated in a certified POCUS training prior to the survey. The self-evaluation of POCUS skills among emergency physicians depended significantly on their participation in a certified training (p < 0.001) and frequent ultrasound routine (p < 0.001).</p><p><strong>Conclusion: </strong>The majority of participating emergency physicians in Germany consider POCUS to improve out-of-hospital diagnostic capabilities. Participation in a certified POCUS training and frequent use of ultrasound facilitated higher self-confidence in POCUS skills.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11058608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10129641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Extracorporeal cardiopulmonary resuscitation-An orientation].","authors":"Axel Rand, Peter M Spieth","doi":"10.1007/s00063-024-01135-x","DOIUrl":"10.1007/s00063-024-01135-x","url":null,"abstract":"<p><p>Both in-hospital and out-of-hospital cardiac arrests are associated with a high mortality. In the past survival advantages for patients could be achieved by optimizing the chain of rescue and postresuscitation treatment; however, for patients with refractory cardiac arrest, there have so far been few promising treatment options. For selected patients with refractory cardiac arrest who do not achieve return of spontaneous circulation with conventional cardiopulmonary resuscitation (CPR), extracorporeal (e)CPR using venoarterial extracorporeal membrane oxygenation is an option to improve the probability of survival. This article describes the technical features, important aspects of treatment, and the current data situation on eCPR in patients with in-hospital or out-of-hospital cardiac arrest.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140295791","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/s00063-024-01139-7","DOIUrl":"https://doi.org/10.1007/s00063-024-01139-7","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140852920","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":"[Time-limited trials (TLT) in the intensive care unit : Recommendations from the ethics section of the DIVI and the ethics section of the DGIIN].","authors":"Susanne Jöbges, Anna-Henrikje Seidlein, Kathrin Knochel, Andrej Michalsen, Gunnar Duttge, Alexander Supady, Jochen Dutzmann, Stefan Meier, Iris Barndt, Gerald Neitzke, Friedemann Nauck, Annette Rogge, Uwe Janssens","doi":"10.1007/s00063-024-01112-4","DOIUrl":"10.1007/s00063-024-01112-4","url":null,"abstract":"<p><p>The rise in intensive care treatment procedures is accompanied by an increase in the complexity of decisions regarding the selection, administration and duration of treatment measures. Whether a treatment goal is desirable in an individual case and the treatment plan required to achieve it is acceptable for the patient depends on the patient's preferences, values and life plans. There is often uncertainty as to whether a patient-centered treatment goal can be achieved. The use of a time-limited treatment trial (TLT) as a binding agreement between the intensive care unit (ICU) team and the patient or their legal representative on a treatment concept over a defined period of time in the ICU can be helpful to reduce uncertainties and to ensure the continuation of intensive care measures in the patients' best interest.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11059002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Internal and external interfaces in the intensive care unit].","authors":"Stefanie Lemme, Uwe Janssens","doi":"10.1007/s00063-024-01132-0","DOIUrl":"https://doi.org/10.1007/s00063-024-01132-0","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866829","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":"[Handoffs in the intensive care unit].","authors":"Eyleen Reifarth, Jan-Hendrik Naendrup, Jorge Garcia Borrega, Lisa Altenrath, Alexander Shimabukuro-Vornhagen, Dennis Alexander Eichenauer, Matthias Kochanek, Boris Böll","doi":"10.1007/s00063-024-01127-x","DOIUrl":"10.1007/s00063-024-01127-x","url":null,"abstract":"<p><strong>Background: </strong>Effective handoffs in the intensive care unit (ICU) are key to patient safety.</p><p><strong>Purpose: </strong>This article aims to raise awareness of the significance of structured and thorough handoffs and highlights possible challenges as well as means for improvement.</p><p><strong>Materials and methods: </strong>Based on the available literature, the evidence regarding handoffs in ICUs is summarized and suggestions for practical implementation are derived.</p><p><strong>Results: </strong>The quality of handoffs has an impact on patient safety. At the same time, communication in the intensive care setting is particularly challenging due to the complexity of cases, a disruptive work environment, and a multitude of inter- and intraprofessional interactions. Hierarchical team structures, deficiencies in feedback and error-management culture, (technical) language barriers in communication, as well as substantial physical and psychological stress may negatively influence the effectiveness of handoffs. Sets of interventions such as the implementation of checklists, mnemonics, and communication workshops contribute to a more structured and thorough handoff process and have the potential to significantly improve patient safety.</p><p><strong>Conclusion: </strong>Effective handoffs are the cornerstone of high-quality and safe patient care but face particular challenges in ICUs. Interventional measures such as structuring handoff concepts and periodic communication trainings can help to improve handoffs and thus increase patient safety.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140159317","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":"[The center for intensive care medicine: a model for interdisciplinary and interprofessional collaboration].","authors":"Reimer Riessen, Matthias Kochanek, Birte Specketer, Tobias Wengenmayer, Stefan Kluge","doi":"10.1007/s00063-024-01128-w","DOIUrl":"10.1007/s00063-024-01128-w","url":null,"abstract":"<p><strong>Background: </strong>The Federal Joint Committee has established requirements for centers for intensive care medicine which, in cooperation with other clinics, are to take on special tasks for intensive care medicine in a region. High demands are placed on these centers, which it may not be possible to meet without restructuring the existing intensive care structures.</p><p><strong>Objective: </strong>In this study, an organizational model for a center for intensive care medicine based on broad interdisciplinary and interprofessional cooperation is presented for discussion.</p><p><strong>Methods and results: </strong>The organizational model contains proposals for integration of the centers for intensive care medicine into the clinic structure, the management team, the staff composition, the areas of clinical activity, and the further tasks of research, teaching, and education and training.</p><p><strong>Conclusion: </strong>Establishment of the centers for intensive care medicine provides new and forward-looking impetus for the further development of intensive care medicine in Germany. However, for the new organizational model to be implemented effectively, the necessary restructuring measures must be adequately refinanced and supported by hospital management and medical faculties. In addition, a sustained willingness for interdisciplinary and interprofessional cooperation is required on the part of all those involved, and employees in this model must be offered attractive long-term positions in intensive care medicine.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140133061","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":"[Clinical acute and emergency medicine curriculum-focus on internal medicine : Recommendations for advanced training in internal medicine in the emergency department].","authors":"Hans-Jörg Busch, Sebastian Wolfrum, Guido Michels, Matthias Baumgärtel, Klaus-Friedrich Bodmann, Michael Buerke, Volker Burst, Philipp Enghard, Georg Ertl, Wolf Andreas Fach, Frank Hanses, Hans Jürgen Heppner, Carsten Hermes, Uwe Janssens, Stefan John, Christian Jung, Christian Karagiannidis, Michael Kiehl, Stefan Kluge, Alexander Koch, Matthias Kochanek, Peter Korsten, Philipp M Lepper, Martin Merkel, Ursula Müller-Werdan, Martin Neukirchen, Alexander Pfeil, Reimer Riessen, Wolfgang Rottbauer, Sebastian Schellong, Alexandra Scherg, Daniel Sedding, Katrin Singler, Marcus Thieme, Christian Trautwein, Carsten Willam, Karl Werdan","doi":"10.1007/s00063-024-01113-3","DOIUrl":"10.1007/s00063-024-01113-3","url":null,"abstract":"<p><p>In Germany, physicians qualify for emergency medicine by combining a specialty medical training-e.g. internal medicine-with advanced training in emergency medicine according to the statutes of the State Chambers of Physicians largely based upon the Guideline Regulations on Specialty Training of the German Medical Association. Internal medicine and their associated subspecialities represent an important column of emergency medicine. For the internal medicine aspects of emergency medicine, this curriculum presents an overview of knowledge, skills (competence levels I-III) as well as behaviours and attitudes allowing for the best treatment of patients. These include general aspects (structure and process quality, primary diagnostics and therapy as well as indication for subsequent treatment; resuscitation room management; diagnostics and monitoring; general therapeutic measures; hygiene measures; and pharmacotherapy) and also specific aspects concerning angiology, endocrinology, diabetology and metabolism, gastroenterology, geriatric medicine, hematology and oncology, infectiology, cardiology, nephrology, palliative care, pneumology, rheumatology and toxicology. Publications focussing on contents of advanced training are quoted in order to support this concept. The curriculum has primarily been written for internists for their advanced emergency training, but it may generally show practising emergency physicians the broad spectrum of internal medicine diseases or comorbidities presented by patients attending the emergency department.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11098871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Post-resuscitation talk in the intensive care unit : Living interprofessionalism-a must have!]","authors":"Christina Bolte, Franziska Wefer, Sonja Stulgies, Jutta Tewesmeier, Sarah Lohmeier, Christopher Hachmeister, Simeon Günther, Jana Schumacher, Kawa Mohemed, Volker Rudolph, Lars Krüger","doi":"10.1007/s00063-024-01129-9","DOIUrl":"10.1007/s00063-024-01129-9","url":null,"abstract":"<p><strong>Background: </strong>In the context of medical care, healthcare professionals are confronted with cardiopulmonary resuscitation, which can have long-term effects on the participants.</p><p><strong>Objective: </strong>The aim was to develop, implement, and evaluate a protocol-supported post-resuscitation talk for practice in the intensive care unit of a university hospital.</p><p><strong>Materials and methods: </strong>Within the evidence-based nursing working group, university-qualified nurses performed a systematic literature search in CareLit (hpsmedia, Hungen, Germany), the Cochrane Library (Cochrane, London, England), LIVIVO (Deutsche Zentralbibliothek für Medizin, Cologne, Germany), and PubMed/MEDLINE (U.S. National Library of Medicine, Bethesda, MD, USA) as well as using the snowball principle. Based on the results, the post-resuscitation talk and a debriefing protocol were developed and consented in a multiprofessional team. Additionally, a questionnaire to analyze the current situation (t₀) and evaluate the implementation (t₁) was developed.</p><p><strong>Results: </strong>Implementation of the post-resuscitation talk was conducted from August 2021. The t₀ survey took place from June to July 2021 and for t₁ from February to March 2022. In t₀, fewer interprofessional reflections were carried out after resuscitations in the category always or frequently (17.5%, n = 7) than in t₁ (50.0%, n = 13). The rate of initiated improvement interventions was increased (t₀: 24.3%, n = 9 vs. t₁: 59.1%, n = 13). The results show promotion of multiprofessional collaboration in t₀ and t₁, and potential for optimization in the debriefing protocol in t₁.</p><p><strong>Conclusion: </strong>Implementation of a post-resuscitation talk in hospitals is a useful tool for the structured interprofessional follow-up of resuscitation events. The results demonstrated initial positive effects and potential for optimization.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337362","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}