Verzögerte Defibrillation nach Basismaßnahmen der kardiopulmonalen Wiederbelebung bei außerklinischen Patienten mit Kammerflimmern

Ohne Zusammenfassung     

Einfache Maßnahmen zur Sicherung der Asepsis

Ohne Zusammenfassung Vortragender:M. Schmidt-Mende-München.     

Maßnahmen zur Einschränkung des Staphylokokken-Hospitalismus

Ohne Zusammenfassung     

Skelettale und dentoalveoläre Maßnahmen zur Profiloptimierung

In the lower third of the face the position of the bases of the jaws and the dentoalveolar relationship influence the soft tissue profile in a crucial manner. The lack of adequate skeletal and dentoalveolar support in the perioral region and the chin will lead to adverse changes in this area. Awareness of the importance of these correlations and knowledge of surgical techniques to influence these relationships can be of help in finding the appropriate treatment plan. A technique for correction of the labiomental fold is, for example, chin visor osteotomy in combination with other measures if necessary, by which an esthetic profile can be achieved.     

Maßnahmen zur Normalisierung des Herzrhythmus nach Kreislaufstillstand in Hypothermie

Ohne Zusammenfassung Mit 1 Textabbildung     

Maßnahmen zur Erkennung irreparabler Schäden am Oberarmplexus

Ohne Zusammenfassung     

„Statistische Prozesskontrolle“ als Monitoring-Tool zur Evaluierung von Reorganisationsmaßnahmen

INTRODUCTION: The German health care system is currently in a constant state of flux owing to enhanced competition and to the increasing focus on economic aspects. Medical services, especially treatment processes, are being reorganised in an attempt to adapt them to the new economic challenges. Ideally, radical reorganisation and streamlining of medical therapy processes should be accompanied by controlling and quality management systems. The purpose of this is to monitor the intensity of any economic and any patient-related (side)-effects. Business management techniques are needed that allow online and long-term performance reviews of reorganisation measures once initiated. METHODS: In industry, the method applied for this purpose is statistical process control (SPC). The present study demonstrates for the first time that use of this monitoring tool can be extended to the medical sector. In an intensive care unit (ICU) the following process parameters were monitored: duration of sedation, time to persisting spontaneous breathing, length of stay in ICU, length of stay in hospital, patient mortality in ICU and in the next 30 days after admission to the ICU. Group 1 was made up of 87 patients examined before and group 2, 93 patients after process optimisation. The main feature of the reorganisation was application of a new analgo-sedation technique and of the weaning concept. RESULTS: In group 2 duration of sedation, time to spontaneous breathing and length of stay on the ICU were significantly shorter than in group 1. The length of stay in hospital, patient mortality in the ICU and 30 days after the initiation of intensive care did not differ significantly between the two groups. CONCLUSION: Economic and patient-related key figures can be evaluated with SPC. It allows online assessment both before and during process optimisation, and especially in the long term afterprocess optimisation.     

Prehospital Trauma Life Support® (PHTLS®)

Introduction

There is clinical evidence that standardized management of trauma patients in the emergency department improves outcome. Standardized prehospital management has been established for stroke patients and those suffering acute coronary syndrome. Prehospital treatment of trauma patients differs quite significantly from one system to another. The data from the German Trauma Registry show that the average time from accident until arrival in the emergency department is 72 min. This needs improvement.

Results

PHTLS® is a training course that teaches a systematic approach to the trauma patient in the preclinical setting. The aim is to rapidly and accurately assess the patient’s physiologic status, treat according to priorities, and decide whether the patient is critical and needs rapid rescue and transport. Above all, it is important for caregivers to prevent secondary injury, to realize the relevance of timing in the initial treatment, and to assure a high standard of care. PHTLS® provides the participant with knowledge, skills, and necessary behaviors. The course is open to persons in all specialties involved in the initial management of severely injured patients. The German Board of Emergency Technicians e.V. inaugurated the course concept in cooperation with the National Association of Emergency Medical Technicians (NAEMT) and the American College of Surgeons (ACS) and is authorized to organize PHTLS® courses in Germany.

Conclusion

PHTLS® teaches a standardized and established approach to the trauma patient in the emergency department. It has been established in 36 countries and the content is reviewed regularly to consider new scientific evidence. Healthcare personnel in Germany have the chance to participate in this international standard of care and to introduce their own experiences into the review process.     

Einfache Maßnahmen zur Refluxverhütung und Ersatzinagenbildung nach totaler Gastrektomie

Zusammenfassung Es konnte gezeigt werden, da? es auch mit einfachen, rasch ausführbaren und wenig eingreifenden Ma\sBnahmen gelingen kann, die Refluxoesophagitis nach totaler Gastrektomie zu verh\:uten und den Ausfall der Reservoirfunktion des Magens wenigstens teilweise zu kompensieren. Diese Ma\sBnahmen bestehen in der Herstellung einer zweiten kleinen Enteroanastomose am Fu\sBpunkt der obersten D\:unndarmschlinge (Mandl) und der Ligatur und \:Ubern\:ahung des zuf\:uhrenden Schenkels zwischen den beiden Jejuno-Jejunostomien. Galle und Verdauungssekrete des Duodenums werden dadurch gezwungen, die kleine Kurzschlu\sBanastomose am Fu\sBpunkt der Schlinge zum \:Ubertritt in den abf\:uhrenden Schenkel zu ben\:utzen. Diese Umleitung erfolgt also zwangsl\:aufig und in optimaler Entfernung sowohl von der Oesophago-Jejunostomie als auch von der breiten, als Magenersatz fungierenden Enteroanastomose. Das operativ technische Grundkonzept der totalen Gastrektomie mit der sichersten und bew\:ahrtesten Methode der Nahtvereinigung zwischen Speiser\:ohre und D\:unndarm kann bei der von uns beschriebenen Vorgangsweise in vollem Umfang zur Anwendung gebracht werden, ein Vorteil, dessen praktische Bedeutung nicht unter- sch\:atzt werden sollte. Die technisch so einfache und gefahrlose Durchf\:uhrbarkeit der beschriebenen Ma\sBnahmen l\:a\sBt es berechtigt erscheinen, die Methode zur Diskussion zu stellen und ihre \:Uberpr\:ufung anzuregen. Herrn Prof. Dr.. W. DENK zum 80. Geburtstag.     

Plastische Maßnahmen zur Erzielung einer deutlichen Sprechweise bei Lippen-, Kiefer-, Gaumenspalten

Ohne Zusammenfassung     

Über Maßnahmen zur Berufsvorbereitung Querschnittsgelähmter im Rahmen der medizinischen Rehabilitation

Ohne Zusammenfassung     

Richtige und falsche Sofortmaßnahmen bei postoperativer Anurie (p. An.)

Ohne Zusammenfassung     

MCQ tests in Advanced Trauma Life Support (ATLS©): Development and revision

BackgroundIn Advanced Trauma Life Support (ATLS©) courses, multiple choice question (MCQ) tests are used to assess student's post course knowledge. As part of the ninth Edition Revision Process, existing MCQ tests were reviewed and revised by an International MCQ Revision group. The aim of this study was to evaluate the revision procedure and its effects.MethodsBased on psychometric data and evidence based guidelines for adequate MCQ item and test development, a detailed stepwise approach was determined and followed to evaluate the existing MCQs, and to guide test item revision or replacement.ResultsThe MCQ Revision group composed three new draft test versions comprising of 40 MCQs each. These were beta-tested among ATLS Instructors in various countries involved in ATLS. Psychometric analysis demonstrated that a minority of MCQ items required revision to create three equally balanced tests. After these final adjustments, a new set of three validated MCQ tests was available for use in 9th edition ATLS provider courses. Beta testing was performed using instructors but not students. The failure rate amongst students of ATLS provider courses increased significantly after introduction of the new MCQ tests.ConclusionATLS tests were revised and updated using current evidence based guidelines and psychometric analysis. Difficulty of the tests was not initially beta-tested on students. Increasing test item discrimination and quality resulted in lower test scores by students.     

Evaluierung der Maßnahmen zur Reduktion von Notarzteinsätzen in Tirol während der COVID-19-Pandemie

Die Anaesthesiologie - Die COVID-19-Hochphase im österreichischem Bundesland Tirol war für den Rettungs- und Notarztdienst sehr herausfordernd. Hauptziel war, unter Aufrechterhaltung der...     

Extrakorporale Stoßwellenlithotripsie (ESWL)

Ohne Zusammenfassung