Tauchunfälle

Diving accidents include all diseases associated with diving and are potentially life-threatening events. Any manifestation of new symptoms within 24?h after scuba diving is considered to be associated with diving. Pathophysiologically, decompression accidents involve a rapid decline in ambient pressure when surfacing from scuba diving, resulting in the formation of gas bubbles in the blood and tissues. This can result in decompression sickness (DCS) or arterial gas embolism (AGE). The most important immediate measures at the site of the accident are administration of highly concentrated oxygen, adequate rehydration and treatment for hypothermia. Furthermore, following primary treatment the patient should be referred to a suitable target hospital as soon as possible. The causal treatment of decompression accidents involves treatment with hyperbaric oxygen in a pressurized treatment chamber.     

Narkosezwischenfälle

During the last 30 years a great number of case reports presented severe anaesthetic complications with sudden cardiac arrest in patients with muscular dystrophies, mostly unsuspected at the time of the event. As succinylcholine was involved in the majority of the intractable incidents with lethal outcome the Food and Drug Administration (FDA) of the United States recommended a warning of the administration of succinylcholine in young children and adolescents in 1992 and an extensive international discussion on the routine use of succinylcholine in paediatric anaesthesia. Epidemiological studies on this issue are rare. We projected an inquiry about the incidence rate and type of severe anaesthetic complications in an utmost large number of patients and families with Duchenne (DMD) and Becker type (BMD) muscular dystrophy. METHODS: With the approval of the ethic committee of the university Witten/Herdecke and informed consent of the participants we investigated all patients and families who were diagnosed, controlled and treated for DMD or BMD as inpatients or outpatients in a "Muscle Centre" since 1983. The questionnaire asked for the number of patients per family, classification of the disease DMD or BMD, number and date of anaesthetics in the patients and eventual complications, anaesthetics and eventual complications in the parents, siblings and relatives and the occurrence of malignant hyperthermia (MH) in the family or relatives. Statistical assessments were done by Fisher's exact test for stratified 2 x 2 tables and Zelen's test for homogeneity of odds ratios. RESULTS: 200 out of 224 questionnaires could be evaluated. The diagnosis was confirmed by molecular genetic and immunohistochemical investigations. In 147 families it turned out to be DMD, in 53 families BMD. The 212 male and 9 female patients in the 200 families were given 444 anaesthetics. Sudden cardiac arrest occurred in 6 patients, all successfully resuscitated. Nine less severe incidents consisted of fever, symptoms of rhabdomyolysis (CK-elevation, dark coloured urine, hyperkalemia) and masseter spasm. The statistical assessment revealed that the occurrence of an event was highly dependent whether the diagnosis of muscular dystrophy was established or not (p < 0.0001, Fisher's exact test). All six cardiac arrests occurred in the 45 families with undiagnosed disease and no event happened in the 134 families with already known DMD/BMD. There was evidence that the number of anaesthetics without prior establishment of the diagnosis decreased after 1992 (p = 0.004, Fisher's exact test). CONCLUSIONS: Our results demonstrate that severe incidents and cardiac arrests occurred only in young children with undiagnosed DMD or BMD who received inhalational agents and succinylcholine. A cardiac arrest in 6 out of 200 families was found much more frequently than in the normal paediatric population (about 1:1000 to 1:3000). The decrease of events after 1992 (warning of the FDA) and disappearance of sudden cardiac arrests in our group of patients might be due to the world wide discussion on routine use of succinylcholine in children or the much earlier establishment of the diagnosis in our population. An early diagnosis of DMD and BMD and the avoidance of the triggering agents succinylcholine and volatile anaesthetics can reduce the risk of severe anaesthetic complications.     

Präklinische Kindernotfälle

Background

Out-of-hospital (OOH) pediatric emergencies have a relatively low prevalence. In Germany the vast majority of cases are attended by non-specialized emergency physicians (EPs) for whom these are not routine procedures. This may lead to insecurity and fear. However, it is unknown how EPs perceive and assess pediatric emergencies and how they could be better prepared for them.

Methods

All active EPs (n=50) of the Department of Anaesthesiology, Emergency and Intensive Care Medicine at the University Medical Centre of Göttingen were presented with a structured questionnaire in order to evaluate their perception and assessment of OOH pediatric emergencies.

Results

The 43 participating EPs made highly detailed statements on the expected characteristics of OOH pediatric emergencies. Their confidence level grew with the children’s age (p<0.03) and with their own experience (p<0.01). The EPs felt particular deficits in the fields of cardiopulmonary resuscitation (n=18) and trauma management (n=8). The preferred educational strategies included simulator-based training (n=24) as well as more exposure to pediatric intensive care and pediatric anesthesia (n=12).

Conclusions

Despite their own limited experience EPs can realistically assess the incidence and severity of pediatric emergencies. They felt the greatest deficits were in the care of infrequent but life-threatening emergencies. Three educational groups can be differentiated: knowledge and skills to be gained with children in hospital, clinical experience from adult care also applicable in children and rare diagnoses and interventions to be trained with manikins or simulators.     

Gemischte Todesfälle

Ohne Zusammenfassung     

Lachgasbedingte Todesfälle

Despite inspiratory oxygen fraction measurement being regulated by law in the European norm EN 740, fatal errors in nitrous oxide delivery still occur more frequently than expected, especially after construction or repair of gas connection tubes. Therefore, if nitrous oxide is to be used further in a hospital, all technical measures and system procedures should be employed to avoid future catastrophes. Among these are measurement of the inspiratory oxygen fraction (F(I)O(2)) and an automatic limitation of nitrous oxide. Also all anaesthetists involved should be informed about repair or construction of central gas supply tubes. Additionally, more awareness of this problem in daily routine is necessary. Furthermore, a system of detecting and analysing errors in anaesthesia has to be improved in each hospital as well as in the anaesthesia community as a whole. Measures for a better "error culture" could include data exchange between different critical incident reporting systems, analysis of closed claims, and integration of medical experts in examination of recent catastrophes.     

Verkehrsunfälle in Entwicklungsländern

Road traffic crashes pose a major threat to individuals and national health systems. Developing countries account for 48% of motorized vehicles, but for 91% of the 1.3 million fatalities per annum. While ranked ninth among the causes of disabilities adjusted life years lost in 2004, crash injuries are projected to rise to third position by 2030. This article reviews current prognoses of deaths and disabilities, the characteristics of crashes in low and middle income countries and evidence-based road safety interventions. This article is considered a wake-up call for trauma, orthopaedic, and emergency surgeons in high-income countries to join the global community in fighting the neglected yet potentially curable epidemic named road traffic injuries.     

Todesfälle durch Propofolmissbrauch

Previous references suggesting a high mortality of propofol addiction in medical personnel were mostly based on surveys of the heads of medical departments or case reports; therefore, a questionnaire was sent to 48 forensic medicine departments in Germany, Austria and Switzerland concerning the number of autopsies carried out between 2002–2112 on medical personnel with the suspicion of abuse of propofol or other analgesics. The response rate was 67%. In 16 out of the 32 responding departments 39 deaths (27 males) were observed with previous connections to anesthesiology, intensive care or emergency departments of which 22 were physicians, 13 nurses, 2 other personnel and 2 were unknown. Propofol was the major cause of death in 33 cases (85%), in 8 cases including 7 with propofol, an unintentional accident was recorded and 29 were determined to be suicide. In 14 cases chronic abuse was denied but actually excluded by toxicological analysis in only 2 cases. In 11 cases involving suicide the question of abuse was not investigated. This survey confirmed previous data about the central role of propofol for the fatal outcome of addiction and suicide of anesthetists and other medical personnel. A dual prevention strategy with low-threshold offers for persons at risk and strategies for early detection is urgently needed including a stricter control of dispensing, improvement in forensic medical documentation and the use of toxicological investigations in every case of suspected abuse.     

Tauch- und Ertrinkungsunfälle

Decompression injuries are potentially life-threatening incidents, generated by a rapid decline in ambient pressure in scuba diving, which results in formation of gas bubbles in the blood and tissues. Regardless whether decompression sickness (DCS) or arterial gas embolism (AGE) is present, the most important therapy in the field is oxygen resuscitation with the highest possible concentration and volume delivered. The definitive treatment is rapid recompression with hyperbaric oxygen therapy. Drowning is one of the most common cause of death in children and young adults world wide. The leading problem in drowning is hypoxia, caused by an increased right to left shunting. Therefore, after a quick rescue, oxygenation is the most important initial treatment. In many cases, drowning is accompanied by hypothermia, which per se can be life-threatening, but also may prolong the time for a successful resuscitation.     

Kindernotfälle im Luftrettungsdienst

In this retrospective analysis of an airbound emergency rescue system the extraclinical primary treatment of 274 injured (58%) or diseased (42%) children up to the age of 14 years of age were examined concerning response time, distribution of age and gender, severity, cause and type of injury, character of acute paediatric disease, preclinical emergency diagnosis and treatment, as well as mean of transportation and target hospital, by evaluating the extraclinical documentation of the emergency physician. By investigating the hospital charts of 193 of these 274 young patients the diagnosis made by the emergency physician could be verified in 92% and the clinical cause could be followed. After questioning a representative group of 157 patients an outcome with substantial restitution in 94,3%, a complete absence of patients in need of permanent care and a lethality of 5,7% could be determined. We present a database which can be called upon for future comparisons with an earthbound emergency rescue system.     

Notfälle im Mund-Kiefer-Gesichtsbereich

Notfall + Rettungsmedizin - Notfälle im Mund-Kiefer-Gesichtsbereich begegnen uns im Rettungsdienst und in der Notaufnahme eher selten, sodass das Wissen zu Diagnostik und...     

Einige seltene Echinococcusfälle

Ohne Zusammenfassung     

Neue Fälle von Schädelverletzungen

Ohne Zusammenfassung     

Die Häufigkeit der Tetanus-Todesfälle

Ohne Zusammenfassung