1,721,010 research outputs found
Severe and fatal cases of poisoning in the emergency medical services—A 5-year analysis from the Poisoning Information Center North
No full textRoessler M, Müller SA, Schaper A. Schwere und letale Vergiftungsfälle im Rettungsdienst – eine 5-Jahres-Analyse des Giftinformationszentrum-Nord. Anaesthesiologie. 2025.BACKGROUND: Cases of poisoning account for 3-7% of all emergency medical services (EMS) calls. At present it is not known which toxins are responsible for severe and fatal poisoning in Germany.; METHODS: In this study, all cases of poisoning with asevere or fatal course reported to the Poisoning Information Center (GIZ) North by the emergency services over a5-year period were analyzed. The severity of poisoning was classified using the poisoning severity score (PSS) [4] and the causative noxious agents were assigned according to the anatomical therapeutic chemical (ATC) classification system [6].; RESULTS: In 259 cases out of 8528 consultations by the EMS the poisoning was severe and in 14cases it was fatal. Most commonly involved were patients between 20and 49years. In 221 (81%) of these cases the poisoning was with suicidal intent and most often at home. In 199 cases the cause was pharmaceuticals, mostly taken by women (60.8%). Most substances were pharmaceuticals with effects on the central nervous system, the second most frequent but only in 16cases were drugs with effects on the cardiovascular system. Chemical products accounted for 29(10.6%) and drugs for 14(5.1%) of the cases. The outcome was fatal in 14(5.1%) patients. Most of these patients were already dead when found and resuscitation efforts were unsuccessful. Of the patients three were transported to hospital but were dead on arrival. In fatal intoxications suitable specific antidotes were principally available only in three cases but resuscitation efforts were either no longer indicated or were unsuccessful.; CONCLUSION: This study shows that most severe and fatal poisonings occur at home with suicidal intent using pharmaceuticals. Due to the possible number of different substances and the possible combinations, it is not possible for EMS personnel to assess all effects and substance interactions. If contacted early, due to their access to large data banks poisoning information centers are able to provide important recommendations with respect to symptomatic and further treatment as well as to suitable target hospitals. © 2025. The Author(s).Hintergrund
Vergiftungsnotfälle machen 3–7 % aller Rettungsdiensteinsätze aus. Welche Toxine zu schweren und letalen Vergiftungen führen, wurde in Deutschland bislang nicht genau analysiert.
Methode
In dieser Untersuchung wurden alle über einen 5‑Jahres-Zeitraum vom Rettungsdienst dem GIZ-Nord gemeldeten Vergiftungen, die einen schweren oder tödlichen Verlauf hatten, analysiert. Die Vergiftungsschwere wurde mittels Poisoning Severity Score (PSS) [4] klassifiziert, und die ursächlichen Noxen wurden nach dem ATC-System [6] zugeordnet.
Ergebnisse
Von 8528 Anfragen waren in 259 Fällen die Intoxikationen schwer, in 14 Fällen letal. Am häufigsten betroffen waren 20- bis 49-Jährige. In 221 (81 %) dieser Fälle erfolgte die Intoxikation in suizidaler Absicht und am häufigsten im häuslichen Umfeld. In 199 Fällen waren Arzneimittel, die mehrheitlich von Frauen (60,8 %) eingenommen wurden, ursächlich. Die häufigsten Substanzen waren Medikamente mit Wirkungen auf das Nervensystem, am zweithäufigsten, aber nur in 16 Fällen, Medikamente mit Wirkung auf das kardiovaskuläre System. In 29 Fällen (10,6 %) waren chemische Produkte auslösendes Agens, und nur bei 14 Fällen (5,1 %) waren es Drogen. Tödliche Verläufe wurden bei 14 Patienten (5,1 %) erfasst. Die meisten dieser Patienten wurden leblos aufgefunden und konnten nicht wiederbelebt werden. Drei Patienten wurden noch in eine Klinik transportiert, starben aber dort. Bei den letalen Intoxikationen waren prinzipiell geeignete Antidota nur in 3 Fällen verfügbar; bei diesen waren Wiederbelebungsmaßnahmen aber nicht mehr indiziert oder nicht erfolgreich.
Schlussfolgerung
Diese Untersuchung zeigt, dass sich die meisten schweren und tödlichen Intoxikationen im häuslichen Umfeld in suizidaler Absicht mithilfe von Arzneimitteln ereignen. Aufgrund der möglichen Zahl unterschiedlicher Substanzen und mit Blick auf die Kombinationsmöglichkeiten ist es Rettungsdienstpersonal nicht möglich, alle Effekte und Stoffinteraktionen einschätzen zu können. Bei einem frühzeitigen Kontakt zu einer GIZ kann diese durch ihren Zugriff auf große Datenbanken wichtige Empfehlungen hinsichtlich symptomatischer oder weiterführender Therapie und zu geeigneten Zielekrankenhäusern geben
Initial ventilation through laryngeal tube instead of face mask in out-of-hospital cardiopulmonary arrest is effective and safe
No full textIntroduction Bag-valve-mask ventilation is recommended as the initial airway management option for paramedics during cardiopulmonary resuscitation, although this technique requires considerable skill and is associated with the risk of stomach insufflation, regurgitation, and aspiration. The present two-phase study investigated the efficacy and safety of the laryngeal tube (LT-D) used by paramedics as the sole technique for ventilation in out-of-hospital cardiac arrest. Methods Paramedics staffing the emergency services' ambulances were selected for the study and trained in the use of the LT-D (phase 1). They were then requested to use the device in patients requiring out-of-hospital cardiopulmonary resuscitation without prior bag-valve-mask ventilation. Patients were evaluated with regard to successful placement and effective ventilation using the airway. On arrival at the scene, the emergency physician replaced the LT-D with an endotracheal tube and assessed the incidence of regurgitation and injuries to the airways (phase 11). Results Forty patients were enrolled into this study. One was excluded from analysis because of protocol violation. Insertion of the LT-D was successful and ventilation was effective in 33 patients (85%). Ventilation was not possible in six patients (15%) because of cuff rupture (n=3) or massive regurgitation and aspiration before LT-D insertion (n=3). No patient regurgitated after tube placement. No airway injuries were observed. The participants rated ventilation using the LT-D as effective. Conclusion The LT-D is feasible and effective for airway management and ventilation when used by paramedics in out-of-hospital cardiopulmonary resuscitation and can be recommended as the sole technique in such situations. European Journal of Emergency Medicine 17:10-15 (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins
Introduction course "Doctors in the air rescue" - From the idea to the course concept
No full textNotärzte, die in der Luftrettung tätig sind, werden häufiger mit bestimmten Notfällen konfrontiert als dies im bodengebundenen Rettungsdienst der Fall ist - wie z.B. mit Polytrauma oder Massenanfall von Verletzten. Darüber hinaus gibt es unterschiedliche Erwartungen des bodengebundenen Rettungsdienstpersonals an Hubschrauber-Notärzte. Ein Hubschrauber-Notarzt muss nicht nur in der Lage sein, Notfallpatienten unter schwierigen Bedingungen adäquat zu behandeln, sondern es sind auch seine Fähigkeiten in Bezug auf Teamführung und Crew Resource Management (CRM) gefordert. Nicht zuletzt muss er mit Sicherheits- und technischen Aspekte im Umgang mit einem Rettungshubschrauber vertraut sein, ebenso wie mit Einsatzstrategien. Da es kein einheitliches oder standardisiertes Training für Ärzte gibt, die in der Luftrettung eingesetzt werden, wurde ein Einführungskurs entwickelt, um Ärzte besser auf diese schwere Aufgabe vorzubereiten.Physicians who take a role as flight physicians in a Helicopter Emergency Medical System (HEMS) will encounter more frequently certain emergencies - such as multiple trauma, mass causalities etc. - compared to physicians in a ground based Emergency Medical System (EMS). Furthermore EMS teams already present on scene have a variance of expectations towards HEMS-Physicians. Therefore HEMS-Physicians not only must have the capabilities to treat patients properly, especially under difficult circumstances. Particularly with regard to leadership and Crew Resource Management (CRM) they will be demanded. Not least HEMS-Physicians need to have knowledge of safety and technical aspects of rescue helicopters and of operation tactics as well. Since there has been no uniform or standardised training for physicians, who will take a role in a HEMS, a course concept has been developed to improve and standardise the preparation for this challenging task
Out-of-hospital airway management with the LMA CTrach (TM)-A prospective evaluation
No full textAim of the study: Airway management in an out-of-hospital setting is a critical and demanding skill. Previous studies evaluated the intubating laryngeal mask airway (ILMA) as a valuable toot in this area. The LMA CTrach (TM) Laryngeal. Mask Airway (CTrach) may increase intubation success. Therefore, we evaluated the CTrach as the primary toot for airway management in the out-of-hospital setting in adult patients. Methods: From October 2006 until September 2007 EAN and SGR included all patients who needed advanced airway management during out-of-hospital emergency medicine service. Ventilation and intubation has been performed via the CTrach as the primary choice. Before intubation, visualization of the vocal cords was optimized under continuous ventilation via the CTrach. The time needed, manoeuvres to optimize vision, grades of vision and success rates have been documented. Results: 16 patients have been included. Ventilation and intubation via the CTrach was possible in all patients. Ventilation was mostly established in less than 15 s and was established in 15 of 16 (94%) patients at the first attempt. Intubation was successful in 15 of 16 (94%) patients on the first attempt. Visualization of the laryngeal structures was achieved in 69% of patients, while intubation without sight was performed in 31%, respectively. Conclusion: In this study, ventilation and intubation via the CTrach was successful and could be rapidly established in all patients. Our data suggest that the use of the CTrach may be suitable for the out-of-hospital setting as it provides ventilation and facilitates intubation with a very high success rate. (C) 2008 Elsevier Ireland Ltd. All rights reserved
Reply to Letter: Paediatric tracheal prehospital intubation-What makes different our practice across the Ocean?
No full textCharacteristics and outcome of prehospital paediatric tracheal intubation attended by anaesthesia-trained emergency physicians
No full textAim: To collect data regarding prehospital paediatric tracheal intubation by emergency physicians skilled in advanced airway management. Methods: A prospective 8-year observational study of a single emergency physician-staffed emergency medical service. Self-reporting by emergency physicians of all children aged 0-14 years who had prehospital tracheal intubation and were attended by either anaesthesia-trained emergency physicians (group 1) or by a mixture of anaesthesia and non-anaesthesia-trained emergency physicians (group 2). Results: Eighty-two out of 2040 children (4.0%) had prehospital tracheal intubation (58 in group 1). The most common diagnoses were trauma (50%; in school children, 73.0%), convulsions (13.4%) and SIDS (12.2%: in infants, 58.8%). The overall tracheal intubation success rate was 57 out of 58 attempts (98.3%). Compared to older children, infants had a higher number of Cormack-Lehane scores of 3 or 4, "difficult to intubate" status (both 3 Out of 13; 23.1%) and a lower first attempt Success Fate for tracheal intubation (p = 0.04). Among all 82 children 71 (86.6%) survived to hospital admission and 63 (76.8%) to discharge. Of the 63 survivors, 54 (85.7%) demonstrated a favourable OF Unchanged neurological outcome (PCPC 1-3). The survival and neurological outcomes of infants were inferior compared to older children (p < 0.001). On average an emergency physician performed one prehospital tracheal intubation in 3 years in a child and one in 13 years in an infant. Conclusions: Anaesthesia-trained emergency physicians working in our system report high success rates for prehospital tracheal intubation in children. Survival and neurological Outcomes were considerably better than reported in previous Studies. (C) 2009 Elsevier Ireland Ltd. All rights reserved
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
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