Lärm auf der Intensivstation

Introduction

Cardiovascular monitoring alarms are frequent in intensive care units (ICUs) and lead to noise levels often exceeding 80 dB. The aim of this study was to evaluate if there are relevant differences between ICUs with different subspecialties in the frequency and distribution of alarm signals, their occurrence during the day, the types of alarms and the underlying vital parameters.

Methods

All alarm signals of the cardiovascular monitoring systems from randomly chosen patients at five different ICUs of the university hospital of Regensburg were evaluated.

Results

No significant differences between the ICUs regarding the frequency of alarm signals and only slight differences in the time distribution could be recognized (p=0.02). The most frequent alarm signals were from threshold alarms (61%) followed by technical alarms. The majority of alarms generated were related to invasive arterial blood pressure measurement.

Conclusions

The frequency and distribution of ICU alarm signals seem to be comparable on different ICUs. Therefore, implementation of universal concepts for alarm reduction seems to be applicable regardless of the subspecialty of the ICU.     

Gesundheitsbezogene Lebensqualität nach Beatmung auf der Intensivstation

Die Anaesthesiologie - Es ist derzeit unklar, wie die gesundheitsbezogene Lebensqualität bei deutschen Patienten ein Jahr nach Beatmung auf einer Intensivstation ist. Das Ziel dieser Studie...     

Sedierung mit volatilen Anästhetika auf der Intensivstation

The use of volatile anaesthetics in intensive care medicine has so far been limited by the lack of equipment suitable for daily routine use and the need for an anaesthetic machine. The new Anaesthetic Conserving Device (AnaConDa) enables the routine use of volatile anaesthetics for long-term sedation via intensive care ventilators. The Anaesthetic Conserving Device replaces the common heat and moisture exchanger in the ventilation circuit. The volatile anaesthetic is continuously applied in liquid status via a syringe pump to a form of mini-vaporiser where the anaesthetic agent is vaporised. The expired anaesthetic gas is stored in the carbon filter and approximately 90% of the gas is resupplied into the breathing cycle. The current experiences suggest that volatile anaesthetics present an alternative for long-term sedation in intensive care units, providing optimised pathways, from a medical as well as from an economical point of view. It must, however, be emphasized that the use of volatile anaesthetics for longer periods of time is an off-label use and should only undertaken by medical professionals at their own risk.     

Distale Radiusfraktur – Ist der nicht-gelenküberbrückende Fixateur externe eine therapeutische Alternative? Eine prospektiv randomisierte Studie

A randomised prospective study was carried out to compare non-bridging external fixation using a small A0 external fixator with percutaneous Kirschner wire fixation and plaster in the treatment of distal radial fractures (A2/A3 in the A0 classification). The study involved 40 patients, 20 in each group. The advantages of the non-bridging fixation are: (1) early functional therapy of the wrist, (2) simplified reduction of the fracture, and (3) considerable less restriction of wrist mobility in day-to-day situations. Although the final examination 6 months after treatment showed almost identical functional results, the patients treated with the external fixator benefited from the fact that use of the wrist was virtually free throughout the entire treatment period.     

MRSA-Infektion – eine moderne Pest?

Background

In Germany the number auf MRSA-colonized persons in the population and of MRSA-infected patients in hospitals is rising.

Methods

In the BG Trauma Clinic in Duisburg the number of days patients are confined to bed and nursed in isolation because of MRSA is recorded for each year and broken down by department and by site of infection. Treatment and behaviour guidelines for management of patients contaminated/infected with MRSA have been drawn up for each department and deposited in the hygiene folder on all wards and in all functional sectors.

Results

Comparison of the figures for isolation nursing in bed for MRSA in the BG Trauma Clinic in 2005 and 2006 shows a rise of almost 25%. The daily additional expense per MRSA patient come to 108,-- EUR, and the annual additional expense for 4,514 such isolation nursing-days in 2006, to 488.821,-- EUR.

Conclusion

The incidence of MRSA among German patients can be expected to continue to rise in the future. Only consistent and hygienically correct management of contaminated and infected patients can affect this prognosis for the better. Radical staphylectomie remains a dream.

     

Zur Segmentanatomie der Leber – eine sonomorphologische Sicht

Zusammenfassung. Aufgrund ihrer Struktur und Lage ist die Leber ein ideales Organ für sonographische Untersuchungen. In diesem Zusammenhang erlauben die intrahepatischen Strukturen eine sehr genaue sonographische Einteilung in die segmentale Architektur nach Couinaud. Vorliegende Arbeit stellt Schritt für Schritt sonographische Einstellungen vor, die eine rasche und sichere Zuordnung der Lebersegmente erlauben.      

Zur Segmentanatomie der Leber – eine sonomorphologische Sicht

Aufgrund ihrer Struktur und Lage ist die Leber ein ideales Organ für sonographische Untersuchungen. In diesem Zusammenhang erlauben die intrahepatischen Strukturen eine sehr genaue sonographische Einteilung in die segmentale Architektur nach Couinaud. Vorliegende Arbeit stellt Schritt für Schritt sonographische Einstellungen vor, die eine rasche und sichere Zuordnung der Lebersegmente erlauben.     

Chopart-Luxation – eine einfache Diagnose?

The case of an initially overlooked transligamentary Chopart dislocation following distorsion trauma of the foot is presented and the treatment and long-term course are discussed. A 55-year-old female patient sustained severe injury to the left foot after falling from a height of 4 m.. The instep was severely swollen and there was deformity with adduction of the forefoot and supination position. The peripheral pulse and sensitivity were intact. The conclusion from local radiographic investigations was that there were no signs of fracture or dislocation. The patient travelled home in pain 1 week after the accident and registered in the casualty department at our hospital. Assessment of the radiographs revealed a transligamentary Chopart dislocation with dorsolateral dislocation of the talus head, avulsed navicular fragments and a depressed fracture at the medial talus head. Treatment was initiated immediately after diagnosis with closed reduction and percutaneous K-wire fixation and 8 weeks immobilization in a lower leg plaster cast. Chopart dislocation is a rare consequence of accidental distortion trauma of the foot. Peritarsal dislocations represent approximately 15% of tarsal injuries and 1% of joint dislocations overall. Therefore, if a high energy accident has occurred, it is necessary to specifically search for dislocations and fractures. Immediate reduction reduces the risk of complications.     

Welchen Weg nimmt die Laboratoriumsdiagnostik in der Chirurgie?

Ohne Zusammenfassung     

Notfallmedizin – Medizin für eine alternde Gesellschaft

Due to fundamental demographic as well as social changes, the emergency medical services (EMS) have to respond to an increasing number of geriatric emergencies. By means of some typical case histories the practical problems arising in preclinical emergency medical intervention and the central role of context factors like social isolation, reduced mental capabilities and the resulting need for help are demonstrated. It is discussed how emergency medical services (EMS) can contribute to the problems of an ageing society beyond the scope of a system which is dedicated only to the individual. One possibility is the epidemiological analysis of geriatric emergencies, the accompanying context factors and the development of an adequate infrastructure which is adapted to the needs of the elderly. The EU project EMERGE is an example of how emergency medical expertise is utilized in an interdisciplinary cooperation. An automatically working system based on ambient sensor technology is developed for early detection and prevention of emergency situations in the home environment. Supportive technology ("assisted living") should enable the elderly to live a safe and self-determined life as long as possible. Integration of this additional information into the processes of Emergency Medical Services (EMS) is the logistic prerequisite to establish a social medical assistance tailored to the needs of an ageing society.     

Vorsichtung durch Rettungsassistenten auf der Gro?übung SOGRO?MANV?500

Background

The article describes the triage procedure during a large mass casualty incident exercise ??SOGRO MANV 500??. Deploying a PDA 25 paramedics triaged more than 500 casualties and documented the results.

Study objectives

The aim was to analyze the assigned triage level of casualties and compare paramedic??s performance.

Method

Inappropriate triage levels were identified and calculated for each paramedic and compared to self-assessments, the latter being obtained from a standardized questionnaire.

Results

Altogether 81.5% of casualties were assigned the appropriate triage levels. Percentages of inappropriately assigned triage levels ranged from 0% to 60%. A conspicuous finding was the discrepancy between fire brigade paramedics (12.3%) and other emergency services paramedics (38.5%) but the low number of cases in the study should be taken into consideration.

Discussion

The authors discuss possible reasons for assigning inappropriate triage levels and how the discrepancy between the paramedics and the other organizations could potentially be explained.     

Welchen Einfluss hat Übergewicht auf die Ergebnisse von Hüft- und Knieendoprothesen

Zusammenfassung Der Effekt von Übergewicht auf die klinischen und radiologischen Ergebnisse von Hüft- oder Knieendoprothesen wird unterschiedlich beurteilt. Einige Autoren glauben, dass Übergewicht zu schlechteren klinischen und radiologischen Ergebnissen einer Hüft- und Knieendoprothese führt. Als Begründung führen sie an, dass das erhöhte Gewicht zu einer erhöhten Belastung der Prothesenkomponenten und des umgebenden Knochens führt. Diese Annahme müsste zu einer vermehrten aseptischen Lockerungsrate der Prothesenkomponenten bei adipösen Patienten führen. Es hat sich jedoch gezeigt, dass sich dieser direkte Zusammenhand häufig nicht in den klinischen Ergebnissen dieser Patienten wiederspiegelt. Ein Grund hierfür könnte die geringere Aktivität übergewichtiger Patienten sein, die eine vermehrte Belastung der Prothesenkomponenten ausgleicht.Trotz häufig nicht signifikanter Unterschiede erscheinen die Ergebnisse im Vergleich zu den normalgewichtigen Prothesenpatienten unterlegen. Aus diesem Grunde wäre eine Multicenterstudie mit großer Patientenzahl sinnvoll, in der möglicherweise ein signifikanter Unterschied herausgearbeitet werden könnten. Dies könnte die Forderung nach präoperativer Gewichtsreduktion maßgeblich unterstützen.     

Über eine Modifikation der Schnittführung bei der Lipeenspaltenoperation

Ohne Zusammenfassung     

Pr?vention nosokomialer Infektionen in der Intensivstation und im OP

bei Intensivpatienten liegen h?ufig bereits bei der Aufnahme auf die Intensivstation wesentliche pr?disponierende Faktoren für das Entstehen von NI vor,