Larynxtubus beim Traumapatienten

A multiply injured patient’s airway is primarily secured with a laryngeal tube by the responding EMS. For helicopter transfer the flight physician decides not to intubate the patient’s trachea. Mechanical ventilation was performed without complications.     

Das Dilatationsverhalten von Polyesterprothesen

In a prospective, randomized multicenter trial, 175 patients with abdominal aortic aneurysms were treated by conventional operation. Two types of polyester prostheses (Gelsoft Plus, Vascute Terumo Corp., Hamburg, Germany or Microvel, Boston Scientific, Ratingen, Germany) were selected randomly for implantation. Diameters ranged from 14 to 20 mm. The diameters of the grafts were measured by ultrasound postoperatively, as well as 6, 12, and 24 months after operation. Local and systemic complications were recorded. Dilation of the main body of the “Gelsoft plus” prosthesis was 19% within the first 12 months and 30% for the Microvel prosthesis. Extreme dilation was not observed. Thus, vascular prostheses must be chosen small enough and the dilation of 20–30% should be considered. The most frequent complication was incisional hernia (32%).     

Lebensentwürfe junger Frauen

Initially, data are presented which describe the difficulties which young women have in obtaining economic independence and earning their own living. Next, the vocational orientation of young women will be described. We hope to make clear that young women are more oriented towards grounding a family, in addition to making a career, than young men. The difficulties of having both children and a career will be discussed. Until now, an egalitarian responsibility of mother and father has not been reached. Mothers have the main responsibility in almost all cases. Finally, the article will list some urgent measures required to give women equal opportunities in work and to ease a young couple’s decision to have children.     

Seltene Verletzung bei stumpfem Bauchtrauma im Kindesalter

Presented in this work is a rare injury of a blunt abdominal trauma in a child. Besides a partial rupture of the kidney and a retro-/intraperitoneal haematoma, a further injury occurred from the accident: an initially clinically indetectable tear of the A. iliaca communis which was found intraoperatively and with systematic CT analysis. Traumatic blood vessel lesions of the abdominal aorta and in particular the iliac blood vessels are very rare in children. By such violent impact injuries, it is therefore vital to perform a clinical examination of the foot pulse, systematic analysis of radiology diagnostics, and intraoperative exploration. The growth phase should be considered for therapy of the blood vessels depending on the child's age group. As the long-term results of graft implants are practically unknown, if possible a primary suture or vein patch should be performed.     

Chirurgische Behandlung benigner Läsionen und Strikturen der Gallenwege

Benign strictures of the biliary ducts are treated surgically in 90% of cases. Usually they are caused by trauma to the choledochous duct during gallbladder operations. Younger patients are frequently affected and, particularly if the strictures go untreated, can suffer from secondary complications such as cholangitis or secondary biliary cirrhosis with the serious dangers of portal hypertension and even hepatic failure and death. Although immediate treatment by end-to-end anastomosis has sometimes been described, this method is reasonable only for smooth cuts to the choledochous duct. Good long-term results have been achieved in 86% of cases with Roux-en-Y hepaticojejunostomy. In general, the best way to avoid complications is the all-important surgical maxim of correct indication for the primary operation. The best course is to limit the decision for surgery to symptomatic gallstones.     

Das Liquid-oxygen-System (LOX)

By oxygen concentration measurements (Oximeter Oxydig Dräger, Lübeck) in the EC 145 helicopter two oxygen transport and application systems were compared. The new liquid oxygen system (LOX) for the oxygen therapy was assessed in an application observation. For physical reasons fluid oxygen evaporates during the stand-by phase and an increased concentration (22.8% O₂) in the exhaust valve of LOX arises. On the other hand a high oxygen concentration (22.7% O₂) was measured in the operation mode of the conventional pressure flask gas system (GAS). No increased concentration could be measured within the helicopter cabin (HEMS, PAX) comparing both oxygen systems. For transport and application of oxygen with a very big reserve for the air dependent intensive transport the results show that LOX is a sure low pressure system (3.4 bar).     

Präklinische Intubation

Endotracheal intubation is required in 5–10% of all prehospital emergencies. Poor environmental conditions (e.g. limited space, poor or excessive lighting etc.), unfavorable patient-related factors (e.g. trauma, bleeding, pulmonary aspiration etc.) and the pressure of time make prehospital airway management a challenging procedure even for experienced emergency physicians. The incidence of difficult endotracheal intubation is significantly higher than in-hospital. Profound clinical practice, recognition and adequate treatment of complications of intubation, and ongoing clinical practice are essential for successful and responsible prehospital airway management. A brief physical examination helps to identify predictors for difficult intubation, thereby modifying treatment strategies. Every emergency physician must be closely familiar with at least one supraglottic airway device and the recent algorithms to manage the unanticipated difficult airway.     

Mittelhandfrakturen

Isolated fractures of the metacarpal and phalangeal bones are common injuries of the upper extremities. They usually occur at the age of 10–40, whereas the highest incidence is observed in childhood. The results of treatment have an important impact for the practical value of the hand. This article aims to give a brief overview of the different fracture types and their treatment options.