Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

{"title":"[Diagnostic tools for stroke detection-from prehospital to diagnosis].","authors":"Christian Claudi, André Worm, Patrick Schramm, Hagen B Huttner","doi":"10.1007/s00063-024-01220-1","DOIUrl":"10.1007/s00063-024-01220-1","url":null,"abstract":"<p><strong>Background: </strong>Strokes are common neurological emergencies that require rapid diagnosis to minimize long-term damage. Prehospital detection and triage play a critical role in patient outcomes.</p><p><strong>Objective: </strong>How effective are different prehospital diagnostic tools for stroke detection, and which triage strategies optimize patient care?</p><p><strong>Methods: </strong>The article compares prehospital diagnostic tools for stroke detection and evaluates different transport strategies. Case studies illustrate their practical application.</p><p><strong>Results: </strong>Traditional stroke diagnosis methods have limitations, particularly in identifying strokes in the posterior circulation. Newer diagnostic tools that incorporate additional symptoms, such as dizziness and vision problems, show higher sensitivity. The choice of triage strategy depends on the severity of symptoms and regional factors. Direct transport to specialized centers is beneficial for severe strokes, while initial stabilization at nearby units is more efficient in rural areas.</p><p><strong>Conclusion: </strong>Modern diagnostic tools offer better sensitivity for prehospital stroke detection. Regional cooperation and the selection of appropriate triage strategies are key to improving stroke care.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"110-119"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957406","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 delay and risk of toxicity of intraosseous anaesthesia use for awake intraosseous access in children.","authors":"Daniel Pfeiffer, Martin Olivieri, Victoria Lieftüchter, Florian Hey, Florian Hoffmann","doi":"10.1007/s00063-025-01253-0","DOIUrl":"https://doi.org/10.1007/s00063-025-01253-0","url":null,"abstract":"<p><strong>Introduction: </strong>Intraosseous access (IO) is a crucial, life-saving alternative vascular access in paediatric emergency medicine. In awake paediatric patients, the pain of drilling and flushing the marrow cavity are barriers to the use of the IO method or prompt the use of an intraosseous anaesthetic agent, which introduces the risk of dosing errors and drug toxicity. This study aims to identify the frequency of use of anaesthetic agents and analyse the time delay caused by their use.</p><p><strong>Methods: </strong>Prospective surveillance study analysing all patients, aged > 28 days to 18 years, who received one or more IO attempt(s) in and out of the hospital setting in Germany from 1 July 2017 to 30 June 2019 via the reporting mechanism of the German Paediatric Surveillance Unit (GPSU).</p><p><strong>Results: </strong>Our analysis identified 74 patients who received an IO attempt while awake. All patients were younger than 6 years old. Almost every third child (31.6%) was awake during IO use. In 18.9% of all awake patients, an intraosseous anaesthetic was used before the IO was drilled or the marrow cavity was flushed, introducing a significant time delay of approximately 3 min (p = 0.001) compared to IO attempts without intraosseous anaesthesia.</p><p><strong>Conclusions: </strong>Intraosseous anaesthesia prolongs the establishment of working vascular access in an emergency and introduces the risk of drug toxicity. To prevent adverse events, particular emphasis must be placed on placement without intraosseous anaesthesia, and alternative pain management (intranasal) must be considered if necessary. Training courses and guidelines should reflect the advised current practice.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517165","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":"[ECG interpretation in rescue and emergency medical services in Germany: results of a cross-sectional study].","authors":"Angela Gerhard, Yvonne Treusch, Luis Möckel, Karin Kohlstedt, Thomas Hofmann","doi":"10.1007/s00063-025-01252-1","DOIUrl":"https://doi.org/10.1007/s00063-025-01252-1","url":null,"abstract":"<p><strong>Background: </strong>The recording of an electrocardiogram (ECG) is an essential part of basic diagnostics in the emergency medical services (EMS). To provide initial care and make a preliminary diagnosis, paramedics and emergency physicians (EP) need knowledge about the ECG interpretation. Nevertheless, a few studies show that knowledge of ECG interpretation of paramedics and emergency physicians must improve.</p><p><strong>Objectives: </strong>The aim of this study was to analyze the ECG interpretation skills among EMS staff and EP in Germany.</p><p><strong>Materials and methods: </strong>An online survey was conducted to assess these skills from 22 February to 22 March 2023. The survey collected details about gender, age, professional training, years of professional experience, time since the last ECG training, and self-rated ECG interpretation ability. Subsequently, 9 different ECG had to be interpreted in the form of single-choice questions.</p><p><strong>Results: </strong>In all, 908 participants (EMS: 803; EP: 105) were evaluated. The survey identified a knowledge deficit in the interpretation of ECG. On average, 63.3% (EMS: 61.4%; EP: 76.5%) of the ECG were interpreted correctly. The ECG with ST-elevation myocardial infarction (STEMI) of the posterior wall was identified correctly by 79.1% (EMS: 78.1%; EP: 86.7%) of the participants. Specific weak points in interpreting ECG were AV-blocks, tachycardias, atrial fibrillation, bundle branch blocks, pacemaker ECG and determining the ventricular axis. The participants' self-assessment of their ECG skills correlated significantly with the results actually achieved (p ≤ 0.001; p_bonf = 0.016; ρ = 0.378).</p><p><strong>Conclusion: </strong>Based on the lack of diagnostic skills in the interpretation of a 12 lead ECG, continuous education programs should be revised to improve the quality of patient care in prehospital emergency medicine.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494414","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":"[Sustainability in practices and thought processes in prehospital emergency medicine : A survey of emergency service personnel].","authors":"Julia Johanna Grannemann, Martin Deicke, André Kobiella, Eugen Latka, Bernd Strickmann, Gerrit Jansen","doi":"10.1007/s00063-024-01246-5","DOIUrl":"https://doi.org/10.1007/s00063-024-01246-5","url":null,"abstract":"<p><strong>Background: </strong>Sustainability in emergency medicine constitutes a nascent area of inquiry that has thus far attracted limited scholarly attention; however, it is experiencing burgeoning interest. To date, there are no empirical studies examining how emergency medical personnel evaluate the concept of sustainability or what specific aspects and propositions they may have regarding the topic.</p><p><strong>Objectives: </strong>The primary objective of this study was to investigate the perspectives of emergency medical employees concerning the concept of sustainability in prehospital emergency medicine.</p><p><strong>Materials and methods: </strong>An online survey comprising 23 questions was administered. Participation was voluntary and conducted anonymously.</p><p><strong>Results: </strong>A total of 462 participants participated in the survey, predominantly consisting of paramedics (74% male, 26% female), aged between 25 and 44. Approximately 70% of respondents expressed that they had contemplated the potential for enhancing sustainability within emergency medicine. Participants deemed the separation of packaging as a practical measure, particularly concerning syringes, cannulas and infusion systems. The estimated incidence of contamination for these materials is less than 50%. Nevertheless, factors such as insufficient time, space or motivation are cited as barriers to effective waste separation. Packaging, especially for patient blankets, cervical collars and infection protection gowns, is identified as potentially superfluous. Participants indicated that the majority of waste is attributed to plastic packaging and disposable gloves.</p><p><strong>Conclusion: </strong>The findings of this study indicate that emergency medicine employees are aware of sustainability issues. Participants identified pragmatic avenues for waste separation and reduction in prehospital patient care, while also acknowledging potential challenges. Further research is needed to elucidate sustainability opportunities within prehospital emergency medicine.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400425","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":"[Opportunities and barriers of IPReG for out-of-hospital intensive care : Explorative interview study with payers and health policy stakeholders as part of the PRiVENT study].","authors":"Elena Biehler, Thomas Fleischhauer, Gerhard E Fuchs, Johanna Forstner, Aline Weis, Selina von Schumann, Julia D Michels-Zetsche, Franziska C Trudzinski, Felix J F Herth, Joachim Szecsenyi, Michel Wensing","doi":"10.1007/s00063-025-01247-y","DOIUrl":"https://doi.org/10.1007/s00063-025-01247-y","url":null,"abstract":"<p><strong>Background: </strong>The number of long-term ventilated patients in out-of-hospital intensive care (OIC) in Germany has risen sharply in recent years. Due to financial disincentives, structural care deficits and resource bottlenecks, there is an increasing risk of inadequate care. In 2020, the Intensive Care and Rehabilitation Strengthening Act (IPReG) was therefore passed by legislators with the aim of improving OIC. This study examines the opportunities and challenges of the IPReG with regard to the care of long-term ventilated patients in OIC from the perspective of payers and healthcare policy.</p><p><strong>Materials and methods: </strong>A qualitative interview study was conducted as part of the process evaluation of the multicenter study PRiVENT (Prevention of invasive Ventilation). Using semi-structured, guideline-based individual interviews, health policy actors and representatives of statutory health insurers were asked about the IPReG.</p><p><strong>Results: </strong>In all, 11 health policymakers and 12 representatives of statutory health insurance companies took part in the interviews. Both interview groups showed a positive attitude towards the IPReG and expressed the expectation of added value for the outpatient care of long-term ventilated patients. The current remuneration regulations for weaning and the assessment of weaning potential in the OIC were criticized, among other things.</p><p><strong>Conclusion: </strong>The IPReG provides a legal basis for improving OIC, but there is still room for improvement in its current version. The evaluation planned by legislators should be used to identify potential weaknesses and make appropriate adjustments.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383641","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":"https://doi.org/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":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-10","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":"[Characterization of patients with syncope in the emergency department-secondary diagnoses and laboratory parameters of inpatients versus outpatients].","authors":"Aaron Becker von Rose, Adrian Patenge, Bernhard Haller, Niel Mehraein, Lisa Schmid, Dominik Pförringer, Michael Dommasch","doi":"10.1007/s00063-024-01241-w","DOIUrl":"https://doi.org/10.1007/s00063-024-01241-w","url":null,"abstract":"<p><p>Over 1391 patients presented to the emergency department (ED) of a German university hospital with primary diagnosis of syncope from 2019-2022. This monocentric, retrospective study aims to characterize this cohort regarding secondary diagnoses and blood laboratory parameters. Principal focus lay on the differentiation between inpatients (n = 190; 13.7%) and outpatients (n = 1201; 86.3%). Most common secondary diagnoses comprised head injury (n = 188; 13.5%), infection (n = 126; 9.1%), body injury (n = 124; 8.9%), neurological disease (n = 85; 6.1%), arrhythmogenic heart failure (n = 76; 5.5%), cardiovascular risk factors (n = 75; 5.4%), metabolic/nephrological disease (n = 69; 5.0%), and structural heart disease (n = 68; 4.9%). Surgical interventions were performed using catheter (n = 16; 1.2%), percutaneous coronary interventions (n = 15; 1.1%), and pacemaker/defibrillator/event recorders (n = 12; 0.9%). Inpatients had significantly more secondary diagnoses (3.5 vs. 0.3) and higher incidences of abnormal laboratory parameters compared to outpatients. Secondary diagnoses more common in inpatients included cardiovascular risk factors (37.9 vs. 0.2%), arrhythmogenic heart failure (35.3 vs. 0.7%), infection (57.9 vs. 1.3%), and lung disease (6.3 vs. 0.2%). Abnormal blood laboratory values more frequent in inpatients included elevated levels of highly sensitive (hs) troponin T (58.8 vs. 25.7%), creatinine (36.2 vs. 14.8%), leukocytes (43.4 vs. 36.3%), besides decreased hemoglobin (33.3 vs. 16.0%), potassium (5.3 vs. 1.2%), and sodium (2.1 vs. 0.6%).</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371355","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: Psychische Belastung des intensivmedizinischen Personals in Deutschland im Verlauf der COVID-19-Pandemie. Evidenz aus der VOICE-Studie.","authors":"Alexander Niecke, Michaela Henning, Martin Hellmich, Yesim Erim, Eva Morawa, Petra Beschoner, Lucia Jerg-Bretzke, Franziska Geiser, Andreas M Baranowski, Kerstin Weidner, Sabine Mogwitz, Christian Albus","doi":"10.1007/s00063-025-01255-y","DOIUrl":"10.1007/s00063-025-01255-y","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366324","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":"[Intensive care medicine and sustainability : Contradiction or self-evident?]","authors":"Valery Kitz, Dominik Stark, Victoria König, Nadine Weeverink, Sverrir Möller, David Mager, Carsten Hermes","doi":"10.1007/s00063-024-01204-1","DOIUrl":"10.1007/s00063-024-01204-1","url":null,"abstract":"<p><strong>Background: </strong>Intensive care medicine is one of the most resource-intensive areas of the hospital. As a result, nurses have a crucial role to play in adapting processes to promote sustainability in the intensive care unit. This represents a significant contribution to creating a more climate-friendly hospital. This paper aims to provide an overview of the opportunities for nurses in the multiprofessional team to exert influence in their daily practice in order to promote sustainability on their ward.</p><p><strong>Methods: </strong>The authors summarize further results of the online survey of the DGIIN (Deutschen Gesellschaft für Internistische Intensiv- und Notfallmedizin) sustainability working group. In addition, a systematic literature search was carried out in the PubMed (U.S. National Library of Medicine, Bethesda, MD, USA) database and in the internet.</p><p><strong>Results: </strong>Nurses are able to identify an influence on the consumption of materials and the possibility of using them according to indication. The willingness to develop strategies and involvement in process changes are essential.</p><p><strong>Conclusion: </strong>The lack of structures that deal exclusively with sustainability and the lack of knowledge on this topic lead to a general lack of knowledge and uncertainty. This situation can be improved by targeted measures of education and training, e.g., by Green Teams.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"30-36"},"PeriodicalIF":1.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606847","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":"[Action algorithm: management of acute pancreatitis in acute and emergency medicine].","authors":"Philipp Kasper, Guido Michels","doi":"10.1007/s00063-024-01217-w","DOIUrl":"10.1007/s00063-024-01217-w","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"71-73"},"PeriodicalIF":1.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669314","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}