Der ältere Rettungspatient in der Notfallaufnahme

The elderly account for an ever-increasing proportion of emergency department patients. Demographic data show that the population which is 80 years of age or older will be further increasing in coming years. Due to this fact we sought the reasons of using of the emergency department by elderly patients (≥80 years), admitted by ambulance service, and to analyse the general management of this collective according to a younger comparison group. We used the data from a prospective registry, in which all consecutive patients admitted to the emergency department by ambulance service were included, to process this retrospective analysis. In this registry, diagnosis (in the ICD-10 classification), age, sex, and inpatient/outpatient treatment were documented. In addition further management, intensive care treatment, and outcome during emergency department stay were registered. The patients were stratified by age into two groups (< 80 years; ≥80 years). The observation period lasted from January 1, 2005 to December 31, 2005. During the study 6590 patients were observed of whom 5670 patients (86.0%) were under 80 years (PG<80) and 920 (14.0%) were 80 years of age or older (PG≥80). Comparing inpatient treatment (PG<80: 40.1%; PG≥80: 39.8%) vs outpatient treatment (PG<80: 59.9%; PG≥80: 60.2%) no significant difference between both groups was registered. In comparing the ICD- 10 main diagnosis categories, no relevant difference could be ascertained. By contrast a significantly higher mortality (3.0% vs 1.6%; p≤0.01) in the emergency department was shown within the PG≥80, especially if the diagnosis was myocardial infarction or stroke. The most frequent discharge diagnosis in the PG≥80 was acute myocardial infarction (6.7%). A percutaneous coronary intervention and artificial respiration was less frequently used in the elderly group. Patients beyond 80 years of age nowadays constitute a remarkable proportion of emergency department patients admitted by ambulance service. This group does not differ substantially from younger patients, neither in questions of inpatient or outpatient treatment nor in types of diagnosis. Elderly patients in the emergency department showed a higher mortality. Invasive interventions were less frequently used in this collective in comparison to younger patients. In consideration of the fact that the proportion of elderly will further increase in our population, this analysis may give basis for development of new strategies for the treatment of old patients in emergency departments.     

Interdisziplin?re Leitlinien zur Diagnostik und Therapie der extrazerebralen Amyloidosen

Ohne Zusammenfassung     

Short-term lack of cerebral perfusion with good outcome. Advantages of early intracranial pressure monitoring

A 21-year-old man was injured by a tailboard of a truck. He suffered a severe head injury with bilateral depressed skull fractures necessitating surgical decompression. On admission to the hospital the patient showed bending to pain stimuli (Glasgow Coma Score 5). Anisocoria was noticed from the beginning. Initial intracranial pressure (ICP), measured 3 hours after injury, was 30 mm Hg, and the cerebral perfusion pressure (CPP) was 70 mm Hg. During surgical elevation of the skull fracture on the right side an unexplainable rise of ICP to values of 100 mm Hg occurred, which corresponded to the mean arterial blood pressure (MAP). At the same time both pupils were dilated and fixed indicating a lack of cerebral perfusion. Due to immediate trephination of the opposite side, the ICP was lowered to values below 20 mm Hg, and sufficient cerebral perfusion (above 50 mm Hg) was regained. The patient showed a good recovery and was transferred to a rehabilitation center 5 weeks after injury.This case report emphasizes the importance of early and continuous intracranial pressure monitoring for adequate therapy in neurosurgical emergencies.     

Cooling improves the writing performance of patients with writer's cramp.

Cooling of hand and forearm muscles by immersion in 15 degrees C cold water for 5 minutes improved the writing performance of patients with writer's cramp. Since abnormal processing of muscle spindle afferent discharges contributes to the pathology of writer's cramp, this effect might result from a reduction in muscle spindle activity by lowering muscle temperature. Cooling is a simple, cheap, and safe procedure, providing temporary relief for patients with writer's cramp.