Association between prehospital FPS and ROSC in adults with OHCA : A retrospective multicenter study using the German Resuscitation Registry and Intubation Registry (FiPS-CPR).

Background: Advanced airway management (AAM) is part of the standard treatment during advanced cardiac life support (ACLS). Current studies underline the importance of a first-pass intubation success (FPS) during in-hospital ACLS. It was shown that a failed initial intubation attempt in out-of-hospital cardiac arrest (OHCA) patients in the emergency department is an independent risk factor for the decreased effectiveness of ACLS measured by the return of spontaneous circulation (ROSC).

Predictors for Prehospital First-Pass Intubation Success in Germany.

(1) Background: Endotracheal intubation in the prehospital setting is an important skill for emergency physicians, paramedics, and other members of the EMS providing airway management. Its success determines complications and patient mortality. The aim of this study was to find predictors for first-pass intubation success in the prehospital emergency setting.

Knowledge and skills of emergency physicians in managing traumatic dental injuries.

Purpose: Emergency departments are frequently confronted with traumatic dental injuries (TDIs). The prognosis of the injured tooth is related to early dental trauma management. For this reason, physicians must be familiar with the appropriate management of TDI.

Quantification of pleural effusions on thoracic ultrasound in acute heart failure.

Background: Although pleural effusions are common among patients with acute heart failure, the relevance of pleural effusion size assessed on thoracic ultrasound has not been investigated systematically.

Methods: In this prospective observational study, we included patients hospitalised for acute heart failure and performed a thoracic ultrasound early after admission (thoracic ultrasound 1) and at discharge (thoracic ultrasound 2) independently of routine clinical management. A semiquantitative score was applied offline blinded to clinical findings to categorise and monitor pleural effusion size.

[Handling posttraumatic stress disorder : Showing weakness means you lose].

Background: In prehospital medicine, psychological stress is common and part of the profession. On the one hand, this implies resilience; on the other hand, posttraumatic stress disorder (PTSD) can develop under the high psychological strain.

Objectives: The goal was to obtain an overview of the problem awareness among health care workers in prehospital medicine and identify possible networks for psychological trauma in Germany.

Effect of positive end-expiratory pressure and positioning on jugular vein expansion in emergency department patients.

Objective: Guidelines recommend Trendelenburg position for central venous cannulation. Critically ill patients in the emergency department often do not tolerate this positioning or have contraindications. Thirty-degree dorsal elevated position with positive end-expiratory pressure by noninvasive ventilation could pose an alternative.

[Miscommunication as a risk focus in patient safety : Work process analysis in prehospital emergency care].

Background: In an analysis of a critical incident reporting system (CIRS) in out-of-hospital emergency medicine, it was demonstrated that in 30% of cases deficient communication led to a threat to patients; however, the analysis did not show what exactly the most dangerous work processes are. Current research shows the impact of poor communication on patient safety.

Objectives: An out-of-hospital workflow analysis collects data about key work processes and risk areas.

Unscheduled return visits by patients to a german emergency department are a high risk group for initial wrong diagnosis.

The aim was to classify patients who returned unscheduled to an emergency department within 7 days. We categorized the patients' cases arbitrarily according to the underlying cause of the return. The main causes for returning unscheduled were: "patient related" (24,2%), "illness related" (35,4%), "physician related" (18,3%), "system related" (3,8%) and "other" (21,7%).

Trendelenburg position in the ED: many critically ill patients in the emergency department do not tolerate the Trendelenburg position.

Objectives: Critically ill patients in emergency departments (ED) frequently require catheterization of the internal jugular vein. For jugular insertion, the Trendelenburg position (TP) is recommended. However, many patients in the ED do not tolerate lying in the supine or even the head-down position, or TP is contraindicated for other reasons.

Elevated serum lactate in emergency department patients predicts hospital admission unrelated to diagnosis - but not more.

Purpose: The value of lactate as a screening biomarker in the emergency department is debated. We analysed all unselected patients in the emergency department with serum lactate measured with regard to different outcome parameters.

Material And Methods: In a retrospective single centre study, we analysed all digitalized patient data of a two-week period of all patients ≥18 where a serum lactate was measured.

German critical incident reporting system database of prehospital emergency medicine: Analysis of reported communication and medication errors between 2005-2015.

Background: Communication failure in prehospital emergency medicine can affect patient safety as it does in other areas of medicine as well. We analyzed the database of the critical incident reporting system for prehospital emergency medicine in Germany retrospectively regarding communication errors.

Methods: Experts of prehospital emergency medicine and risk management screened the database for verbal communication failure, non-verbal communication failure and missing communication at all.

An Early Warning Scoring System to Identify Septic Patients in the Prehospital Setting: The PRESEP Score.

Objectives: The objective was to develop and evaluate an early sepsis detection score for the prehospital setting.

Methods: A retrospective analysis of consecutive patients who were admitted by emergency medical services (EMS) to the emergency department of the Jena University Hospital was performed. Because potential predictors for sepsis should be based on consensus criteria, the following parameters were extracted from the EMS protocol for further analysis: temperature, heart rate (HR), respiratory rate (RR), oxygen saturation (SaO2 ), Glasgow Coma Scale score, blood glucose, and systolic blood pressure (sBP).

[The golden hour of sepsis: initial therapy should start in the prehospital setting].

Background: Sepsis is a common, time-urgent emergency that is still associated with a high mortality and morbidity rate. A strong correlation between the onset of therapy and survival has been shown. With every hour of delay, survival decreases by 7.

[Critical incidents in preclinical emergency airway management : Evaluation of the CIRS emergency medicine databank].

Background: Many patients are victims of disastrous incidents during medical interventions. One of the obligations of physicians is to identify these incidents and to subsequently develop preventive strategies in order to prevent future events. Airway management and prehospital emergency medicine are of particular interest as both categories frequently show very dynamic developments.

Critical incident reporting in emergency medicine: results of the prehospital reports.

Background: Medical errors frequently contribute to morbidity and mortality. Prehospital emergency medicine is prone to incidents that can lead to immediate deadly consequences. Critical incident reporting can identify typical problems and be the basis for structured risk management in order to reduce and mitigate these incidents.

[Comparison of pedicle and free tissue transfers in the German DRG system].

Diagnosis-Related Groups (DRGs) are a patient classification system grouping related types of patients to the resources they have consumed. In this analysis, we compared pedicle and free flaps in plastic and reconstructive surgery in the actual German DRG system. After grouping common flaps while systematically modifying the diagnosis, the operative procedure(s), and the receptor site, reimbursement and thresholds of length of stay were identified.

Synthesis and characterization of tetramethylammonium trifluorosulfate.

[Me(4) N](+) [SO(2) F(3) ](-) , the first example of a [SO(2) F(3) ](-) salt, has been prepared from Me(4) NF and SO(2) F(2) . The colorless, microcrystalline solid was characterized by its infrared and Raman spectra. The trigonal bipyramidal structure of C(2v) symmetry of the [SO(2) F(3) ](-) anion is predicted by ab initio calculations.

Preparation and properties of dimethyltetrafluorophosphate.

Dimethyltrifluorophosphorane reacts with strong fluoride donors, such as CsF, Me(4)NF, and Me(4)PF, under formation of dimethyltetrafluorophosphates. The salts were characterized by infrared and Raman spectroscopy and in acetonitrile solutions by NMR spectroscopy. The experimental results show that only the trans isomer is formed.

Comparison of Web-versus classroom-based basic ultrasonographic and EFAST training in 2 European hospitals.

Study Objective: Training physicians in new skills through classroom-based teaching has inherent cost and time constraints. We seek to evaluate whether Web-based didactics result in similar knowledge improvement and retention of basic ultrasonographic principles and the Extended Focused Assessment with Sonography for Trauma (EFAST) compared with the traditional method.

Methods: Physicians from 2 German emergency departments were randomized into a classroom group with traditional lectures and a Web group who watched narrated lectures online.

Critical incidents during prehospital cardiopulmonary resuscitation: what are the problems nobody wants to talk about?

We wanted to identify incidents that led or could have led to patient harm during prehospital cardiopulmonary resuscitation. A nationwide anonymous and Internet-based critical incident reporting system gave the data. During a 4-year period we received 548 reports of which 74 occurred during cardiopulmonary resuscitation.