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Notfall + Rettungsmedizin - Anfang September 2019 wurde ein neuer Dual-use-RTH/ITH-Standort in der Westpfalz etabliert. Während der Einarbeitung der medizinischen Crew entstand bei den Autoren...     

Pädiatrische Notfälle in der prähospitalen Notfallmedizin

Background

In emergency medical services (EMS) systems, life-threatening pediatric emergencies comprise a rare indication but represent a particularly emotional and stressful situation for the personnel involved. This study aimed at evaluating the incidence of pediatric emergencies and the measures performed in ground-based and air-based German EMS systems and deriving the necessary skills and qualification of emergency physicians working within EMS systems.

Method

In a retrospective, multicenter study at three physician-staffed EMS systems with four ground based vehicles and one air-based EMS system the patient charts of patients over 18 years of age in 2005 and 2006 were analyzed regarding demography, the type and severity of emergency (NACA score), state of awareness (GCS) and emergency measures performed.

Results

Overall 20,386 patient charts were evaluated. Pediatric emergencies in the air-based EMS system comprised 11.5% of all missions, which is 2-3 fold higher compared to ground-based EMS system with 4.3%. The percentages of children with a NACA score of IV-VII or a GCS<9 in air-based EMS services (55.4% and 13.9%, respectively) exceeded by far the corresponding figures observed in the ground-based EMS systems (20.4%, p<0.01 and 5.8%, p<0.01). Non-traumatic emergencies represented the majority of missions in children aged <1 year and 1?? years. However, with increasing age injuries had a rising impact in the type of rescue mission. Whereas the frequency of certain emergency measures rose in both systems with increasing age of the pediatric patients, others remained constant, intubation of the trachea (7%) and emergency anesthesia (7%), or even declined along with increasing age, CPR (4% vs. 0.3%) and intraosseous access (3% vs. 0.0%). In comparison to the ground-based EMS systems, in the air-based EMS system the ECG monitoring (77% vs 32%, p<0.01), manual blood pressure measurement (80% vs. 51%, p<0.01), pulsoxymetry (96% vs. 73%, p<0.01)] and i.v. access (79% vs. 46%, p<0.01) were used more often and oxygen (73% vs. 32%, p<0.01) and drugs (80% vs. 49%, p<0.01) were administered more often. Also the frequency of intubation of the trachea and emergency anesthesia (17% vs 2%, p<0.01) was higher in air-based EMS systems than in ground-based EMS systems.

Conclusion

Ground-based and air-based EMS systems differ significantly regarding the incidence and the type of pediatric emergency missions. Despite the lower incidence of certain life-saving invasive emergency measures in ground-based EMS systems, the data indicate the necessity for both air-based as well as ground-based emergency physicians to undergo comprehensive and repetitive training in pediatric advanced life support.     

Management des Kreislaufstillstands in einer Fu?ballarena Struktur-, Prozess- und Ergebnisqualit?t

Hintergrund  

Es liegen kaum Daten über die Qualität der medizinischen Betreuung von Großveranstaltungen vor. Wir stellen die Organisation der Notfallversorgung und die Ergebnisse der Behandlung des Kreislaufstillstands als zeitkritischstem aller Notfälle in einem Bundesligafußballstadion vor.     

Integrierte Leitstelle als Logistikzentrale

The Dispatch Centre acts as the central control within the process chain of emergency medical care. The Integrated Dispatch Centre is the primary point of contact and coordination centre for all medical and technical emergencies. It is the standard type of all dispatch centres not corresponding to police calls and the principal tasks are to answer all help telephone calls, to categorize them according to priority and to dispatch and to coordinate corresponding medical and technical services. Integrated Dispatch Centers face an increase in the number of emergency missions, a changing spectrum of missions, evolving structures in medical care provision and new concepts of medical care. Specific quality management systems need to be implemented in dispatch centres because of the complex operational processes and the time-critical nature of emergency calls. Besides the implementation of optimized information technologies the developments focus on basic and advanced dispatcher training and on structured dispatch protocols.     

Analyse der Einsatzdaten eines innerklinischen Notfallteams

Background

In-hospital emergencies can lead to unexpected admission to the ICU, cardiac arrest or even death. Therefore, hospitals have to implement an adequate in-hospital emergency management. The results of the deployment of the in-hospital emergency team of a hospital providing maximum medical care will be presented.

Patients and methods

In 2003 the Westpfalz-Klinikum, Kaiserslautern introduced a central emergency team. The data of the emergency teams on alarm calls and the patient records from 2004 to 2007 were evaluated.

Results

There were 241 alarm calls (9 alarm calls/100 beds and year). The mean age of the patients was 67 years and 56% were male. In 79% of all alarm calls the vital functions were compromised and in 37% cardiac arrest had occurred. When the emergency team arrived all cardiac arrest patients had received basic life support, however, no early defibrillation had been applied. On arrival of the emergency team 41% of the patients could be left on-site after emergency treatment, 40% had to be admitted to an intensive care or intermediate care unit and 21% died or were already dead (5 patients). In 27% of all cardiac arrests ventricular fibrillation/pulseless ventricular tachycardia was the first detected sign. Restoration of spontaneous circulation could be established in 53% and 20% of all resuscitated patients could be discharged. Respiratory emergencies (21%) and altered states of consciousness (20%) were other leading causes for calling the emergency team.

Conclusions

The high proportion of patients in a life-threatening condition and cardiac arrests indicates the necessity for closer patient monitoring, more intensive emergency training including early defibrillation and continuing education of hospital staff in the prevention and early detection of emergencies, in addition to the provision of an emergency team.     

Medizinische Gefahrenabwehr anlässlich der Fußballweltmeisterschaft 2006

With regard of the upcoming FIFA World Cup in Germany safety precautions will play a predominant role. Despite all conceivable measures to prevent such an incident the institutions responsible for hazard control will have to prepare for a possible mass casualty incident. According to a resolution of the German Secretaries of the Interior the12 venues must guarantee standardized medical care for up to 2% of the spectators. For Kaiserslautern – by far the smallest venue with just one Level I Trauma Center – the necessary logistic efforts to treat up to 1.000 patients will be tremendous. The City of Kaiserslautern will therefore receive considerable financial, logistic and personal support by the state of Rhineland-Palatinate and the adjoining Saarland. The presented paper describes the multitude of preparations concerning medical hazard control, with special regard to the coordination of the efforts.     

Sozialepidemiologie einer neuen Einsatzkategorie

Psychiatric and psychosocial problems have become more and more important for German Emergency Medical Services. Investigating prevalence of psychiatric and psychosocial emergencies and their potential dependence from demographic and socioeconomic factors, this study intends to present socioepidemiologic data referring to this development in Germany. To this end, 2691 calls performed by a physician staffed mobile intensive care unit at Kaiserslautern/Germany (25 jobs/1000 inhabitants) in 1999 were analyzed in a retrospective and anonymous manner. Considering socioeconomic factors such as unemployment, social care and proportion of migrants, a socioeconomic index was calculated for each district. This index was used to stratify the 18 districts of Kaiserslautern into 3 socioeconomic regions. The socioeconomic index of each region was correlated with the referring prevalence of psychiatric and psychosocial emergencies. In contrast to the fact that older patients (>60 years) are responsible for 56% of all emergency calls, the majority of psychosocial and psychiatric emergencies were caused by patients of the lower age group between 30 and 50 years. Improved socioeconomic situation in 1999 (reduction of the unemployment rate from 16,1% to 14,2% and of the social care dependence rate from 4,9% to 3,9% compared with 1997) was paralleled by a decrease of psychosocial and psychiatric emergencies (3,4 to 2,6/1000 inhabitants). For verification of these retrospective data prospective studies are necessary.     

Does the efficacy of supplemental oxygen for the prevention of postoperative nausea and vomiting depend on the measured outcome,observational period or site of surgery?

High intra-operative oxygen concentration reportedly reduces postoperative nausea and vomiting (PONV), but recent data are conflicting. Therefore, we tested whether the effectiveness of supplemental oxygen depends on the endpoint (nausea vs. vomiting), observation interval (early vs. late) or surgical field (abdominal vs. non-abdominal). We randomly assigned 560 adult patients undergoing various elective procedures with a PONV risk of at least 40% to intra-operative 80% (supplemental) or 30% oxygen (control). Potential confounding factors were similar between groups. Incidences of nausea were similar in the groups during early (12% (supplemental) vs. 10% (control), p = 0.43) and late intervals, 26%vs. 20%, p = 0.09, as were the incidences of vomiting (early: 2%vs. 3%, p = 0.40; late: 8%vs. 9%, p = 0.75). Supplemental oxygen was no more effective at reducing PONV in abdominal (40%vs. 31%, p = 0.37) than in non-abdominal surgery (25%vs. 21%, p = 0.368). Thus, supplemental oxygen was unable to reduce PONV independent of the endpoint, observational period or site of surgery.     

Hypothyreotes Koma (Myxödemkoma) im Notarztdienst

The present case report describes the occurrence of myxedema coma, a rare but severe manifestation of hypothyroidism with a high mortality rate. The diagnostics of unclear unconsciousness are often difficult in the preclinical setting. A thorough assessment of the medical history is of great importance when a metabolic or endocrinological cause is assumed. During the emergency treatment of comatose patients stabilization of the vital functions, e.g. airway, breathing and circulation, is of high priority. The key for a beneficial outcome in patients with myxedema coma is the early treatment with hormones.