1,721,032 research outputs found
Out-of-hospital Emergency Anesthesia in Adults If Muscle Relaxation, then with Succinylcholine
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Fluid resuscitation in hemorrhage
No full textHow fluid resuscitation has to be performed for acute hemorrhage situations is still controversially discussed. Although the forced administration of crystalloids and colloids has been and still is practiced, nowadays there are good arguments that a cautious infusion of crystalloids may be initially sufficient. Saline should no longer be used for fluid resuscitation. The main argument for cautious fluid resuscitation is that no large prospective randomized clinical trials exist which have provided evidence of improved survival when fluid resuscitation is applied in an aggressive manner. The explanation that no positive effect has so far been observed is that fluid resuscitation is thought to boost bleeding by increasing blood pressure and dilutional coagulopathy. Nevertheless, national and international guidelines recommend that fluid resuscitation should be applied at the latest when hemorrhage causes hemodynamic instability. Consideration should be given to the fact that damage control resuscitation per se will neither improve already reduced tissue perfusion nor hemostasis. In acute and possibly rapidly progressing hypovolemic shock, colloids can be used. The third and fourth generations of hydroxyethyl starch (HES) are safe and effective if used correctly and within prescribed limits. If fluid resuscitation is applied with ongoing re-evaluation of the parameters which determine oxygen supply, it should be possible to keep fluid resuscitation restricted without causing undesirable side effects and also to administer a sufficient quantity so that survival of patients is ensured
Incidence of invasive medical procedures in emergency medical services. Considerations regarding emergency paramedics
No full textThe 'Notfallsanitater' is a new paramedic-based profession to be introduced into the German emergency medical service. This article discusses the invasive medical procedures to be performed by the 'Notfallsanitater' considering the indications and incidence of these procedures. The incidence of invasive procedures within the district of Gottingen over a time period of 12 months was evaluated analyzing all medical databases used for electronic record keeping of medical emergencies, e.g. EPen, DIVIDOK-Online for the year 2013. A total of 23,118 emergencies where evaluated. In 28 % (n = 6400) of the cases 1 of 32 emergency physicians was called in. The incidence of invasive procedures, considering only the emergency physician-based emergencies, ranged from 76 % (n = 4053) for establishing an i.v. access line to 0.06 % for staunching severe hemorrhage. In 5.8 % (n = 309) of cases the airway was invasively secured and 3,1 % (n = 166) of the patients received non-invasive ventilation. An intraosseous cannulation or a needle thoracostomy was performed each in 0.3 % (n = 16) of cases. In 0.15 % (n = 8) treatment with an external pacemaker was started. In over 90 % of the cases the first ambulance arrived on the scene in less than 10 min. Emergency physicians, if called, arrived at the scene in less than 15 min in over 90 % of the cases. The procedures differ substantially with respect to the incidence, invasiveness and the potential to treat life-threatening conditions. Learning and retention of skills can be assumed only for some invasive procedures. Thus, the catalogue of procedures should be carefully reviewed in order to adapt it to current developments in emergency medicine
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
The Gottingen AED model
No full textDespite all progress in modern medicine, cardiovascular diseases and sudden cardiac death remain one of the most frequent causes of death worldwide. As most of these cases are caused by ventricular fibrillation which rapidly reduces the chances of survival and can only be terminated by defibrillation, inclusion of lay rescuers to perform basic life support and use automated external defibrillators (AED) within a public access defibrillation program according to the latest recommendations of the European Resuscitation Council (ERC) and the American Heart Association (AHA) has become a milestone in combating sudden cardiac death. Nevertheless, correct AED placement is still a problem and implementing a public access defibrillation (PAD) program is still a challenge. Therefore, performing needs assessment should be the first step in identifying suitable sites for placement of AEDs. The Gottingen AED model provides a tool for such a needs assessment. However, this model certainly needs further validation
Guidelines for resuscitation 2005 - What is their effect, what is new?
No full textUnder coordination of the International Liason Committee on Resuscitation (ILCOR) for several years experts all over the world allocated resuscitation measures by their level of evidence, that would lead to improved survival after cardiac arrest. Derived from the "Consensus of Science" in 2005 the European Resuscitation Council (ERC) published the reedited guidelines for cardiopulmonary resuscitation. The most important effect of the guideline changes is that external cardiac compressions can be performed for longer periods without interruptions. This has been possible since resuscitation measures that have not shown to improve survival now have to be done less frequently. Hereby it seems to be easier to perform cardiopulmonary resuscitation more efficiently and structured. But it also had to be noticed that some changes, e.g. immediate continuation of external cardiac compressions following defibrillation, are more difficult to teach. New conclusions indicate that further guideline changes can be expected
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