The role of extracorporeal life support (ECLS) in critically ill trauma patients is underutilized, mainly due to concerns of anticoagulation. However, short-term ECLS in these patients can be safely ...performed with no or minimal systemic anticoagulation. Case series show favorable outcomes in trauma patients with veno-venous (V-V) and veno-arterial (V-A) ECMO, respectively, but there are only a few case reports of successful veno-arterio-venous (V-AV) ECMO in polytrauma patients. We report on a 63-year-old female admitted to our emergency department following a severe car accident who was successfully treated in a multidisciplinary approach, including bridging to damage control surgery and recovery with a V-AV ECMO.
Currently, there is a lack of methods for simultaneous assessment of readiness for decannulation of the veno-venous (V-V) and veno-arterial (V-A) components during veno-arteriovenous (V-AV) ...extracorporal membrane oxygenation (ECMO) support. We describe a novel approach using a simultaneous off-sweep and controlled backflow test to assess readiness for decannulation from V-AV ECMO. This method needs testing in future clinical trials.
Background. The diagnosis of acute myocarditis (AMC) and inflammatory cardiomyopathy (DCMi) can be difficult. Speckle tracking echocardiography with accurate assessments of regional contractility ...could have an outstanding importance for the diagnosis. Methods and Results. N=25 patients with clinically diagnosed AMC who underwent endomyocardial biopsies (EMBs) were studied prospectively. Speckle tracking imaging was examined at the beginning and during a mean follow-up period of 6.2 months. In the acute phase patients had markedly decreased left ventricular (LV) systolic function (mean LV ejection fraction (LVEF) 40.4±10.3%). At follow-up in n=8 patients, inflammation persists, correlating with a significantly reduced fractional shortening (FS, 21.5±6.0%) in contrast to those without inflammation in EMB (FS 32.1±7.1%, P<0.05). All AMC patients showed a reduction in global systolic longitudinal strain (LS, −8.36±−3.47%) and strain rate (LSR, 0.53±0.29 1/s). At follow-up, LS and LRS were significantly lower in patients with inflammation, in contrast to patients without inflammation (−9.4±1.4 versus −16.8±2.0%, P<0.0001; 0.78±0.4 versus 1.3±0.3 1/s). LSR and LS correlate significantly with lymphocytic infiltrates (for CD3 r=0.7, P<0.0001, and LFA-1 r=0.8, P<0.0001). Conclusion. Speckle tracking echocardiography is a useful adjunctive assisting tool for evaluation over the course of intramyocardial inflammation in patients with AMC and DCMi.
To evaluate the effect of strategies to reduce the spread of simulated aerosol during chest compressions on manikin and cadaver experimental models.
To evaluate aerosol-spread we nebulized ...ultraviolet sensitive detergents into the artificial airway of a resuscitation dummy and performed CPR. The spread of the visualized aerosol was documented by a camera. In a further approach we applied nebulized detergents into the airways of human cadavers and detected the simulated spread on the same way. Among others we did recordings with undergoing compression-only-CPR, with a surgical mask or an oxygen mask on the patients face and with an inserted supraglottic airway device with and without a connected airway filter.
Most aerosol-spread at the direction of the provider was visualized during compression-only-CPR. The use of a surgical mask and of an oxygen mask on the patient's face deflected the spread. Inserting a supraglottic airway device connected to an airway filter lead to a remarkable reduction of aerosol-spread.
The early insertion of a supraglottic airway device connected to an airway filter before starting chest compression may be beneficial for staff protection during CPR.
Delivery of oxygen to the mitochondrium is a process involving multiple steps. We here present the integration of the mechanisms of oxygen delivery (DO
) during veno-venous (V-V) extracorporal ...membrane oxygenation (ECMO) into a holistic physiological model. The final steps of oxygen transport in this model are the convective transport of oxygen bound to hemoglobin in the arterial blood and the diffusion to the mitochondrium from the microcirculation. Limitation of DO
may occur on both steps. In cases of severe respiratory failure without lung function, ECMO may provide the entire oxygen supply for the patients. If the cardiac output (CO) is significantly higher than the maximal ECMO flow, the addition of deoxygenated venous blood will lead to a low arterial oxygen saturation (SaO
). In this situation the convective transport of oxygen is mostly limited by the maximal ECMO flow. If a bi-caval dual lumen cannula is used, the recirculation may be very low. Lowering the CO in this situation will increase the arterial SaO
. An increased arterial SaO
may increase the oxygen transport to the mitochondrium by diffusion. The hypothesis derived from this model is that lowering the CO during V-V ECMO support in the situation described above might increase DO
to the tissues by improving oxygen diffusion.
In severe posterior bleedings, posterior packing in combination with anterior packing might be placed with various techniques, e.g. a nasal tampon or an inflatable balloon catheter. Intranasal ...application of injectable drugs is used in a variety of medical conditions in emergency medicine, especially in children and uncooperative patients or if venous access is otherwise difficult to obtain. In our opinion, the mucosal atomization device is the ideal device for the application of injectable tranexamic acid in epistaxis on the intensive care unit, if direct pressure or a soaked cotton pledge cannot be applied.
Aerosols and droplets are the main vectors in transmission of highly contagious SARS-CoV-2. Invasive diagnostic procedures like upper airway and gastrointestinal endoscopy have been declared as ...aerosol-generating procedures. Protection of healthcare workers is crucial in times of the COVID-19 pandemic.
We simulated aerosol and droplet spread during upper airway and gastrointestinal endoscopy with and without physico-mechanical barriers using a simulation model.
A clear plastic drape as used for central venous access markedly reduced visualized aerosol and droplet spread during endoscopy.
A simple and cheap drape has the potential to reduce aerosol and droplet spread during endoscopy. In terms of healthcare worker protection, this may be important particularly in low- or moderate-income countries.
Zusammenfassung
Hintergrund
Notaufnahmen werden regelmäßig mit Gewahrsamsfähigkeitsuntersuchungen konfrontiert. Diese sollen dazu beitragen, gesundheitliche Schädigungen im Polizeigewahrsam zu ...vermeiden. Jedoch fehlen Richtlinien über Umfang und Indikation einer Gewahrsamsfähigkeitsuntersuchung sowie entsprechende Qualitätsindikatoren.
Ziel der Arbeit
Retrospektive Analyse der durchgeführten Gewahrsamsfähigkeitsuntersuchungen und Erstellung einer Standardvorgehensweise (standard operating procedure, SOP), die eine strukturierte Untersuchung sowie eine entsprechende Dokumentation gewährleisten soll.
Methode
Retrospektive Auswertung der Gewahrsamsfähigkeitsuntersuchungen im Zeitraum zwischen Januar 2011 und März 2021 in einer großen Stuttgarter Notaufnahme. Die Dokumentation wurde dabei auf die Vollständigkeit folgender Qualitätsmerkmale hin untersucht: Anamnese, Vitalparameter, neurologischer Status, körperliche Untersuchung.
Nach einer Literaturrecherche wurde eine praktikable und strukturierte SOP erarbeitet.
Ergebnisse
Insgesamt wurden 4567 Gewahrsamsfähigkeitsuntersuchungen ausgewertet. In 54,26 % ist eine körperliche Untersuchung dokumentiert worden, eine Anamnese nur in 5,98 %. Die Vitalwerte wurden in nur neun Fällen vollständig erfasst. In 62 % der Untersuchungen wurden keine Vitalwerte dokumentiert. Von den Patienten wurden 80,67 % gewahrsamsfähig erklärt.
Diskussion
Die analysierten Gewahrsamsfähigkeitsuntersuchungen zeigen viele Defizite und insbesondere die Dokumentation muss deutlich verbessert werden. Die systematische Untersuchung dazu, vor allem aus Sicht von klinisch tätigen Ärzten, ist in Deutschland lückenhaft. Die vorgeschlagene SOP orientiert sich an der aktuellen Literatur und bietet ein praktikables und standardisiertes Vorgehen zur Gewahrsamsfähigkeitsuntersuchung und zu deren korrekter Dokumentation an. Hierbei wird sowohl den Ansprüchen der Mediziner als auch der Polizei Rechnung getragen.
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