Sublingual microcirculatory assessment on admission independently predicts the outcome of old intensive care patients suffering from shock.

Shock is a life-threatening condition. This study evaluated if sublingual microcirculatory perfusion on admission is associated with 30-day mortality in older intensive care unit (ICU) shock patients. This trial prospectively recruited ICU patients (≥ 80 years old) with arterial lactate above 2 mmol/L, requiring vasopressors despite adequate fluid resuscitation, regardless of shock cause.

Direct assessment of microcirculation in shock: a randomized-controlled multicenter study.

Purpose: Shock is a life-threatening condition characterized by substantial alterations in the microcirculation. This study tests the hypothesis that considering sublingual microcirculatory perfusion variables in the therapeutic management reduces 30-day mortality in patients admitted to the intensive care unit (ICU) with shock.

Methods: This randomized, prospective clinical multicenter trial-recruited patients with an arterial lactate value above two mmol/L, requiring vasopressors despite adequate fluid resuscitation, regardless of the cause of shock.

Personality traits of emergency physicians and paramedics.

Objective: Personality influences behaviour and decision-making. This may play a particular role in emergency medical personnel (EMP) dealing with critical situations. So far very little is known about personality traits that distinguish paramedics (PM) and emergency physicians (EP) from other medical staff.

[First therapy of decompression injuries].

The diving accident is a rare incident for an emergency physician which requires special physical and patho-physiological knowledge. With increasing recreational activities and the fascination of diving also for older persons diving accidents are expected to occur more often. There can be several reasons for diving accidents such as the ignorance of the physics of diving, a trauma under water as well as internistical illnesses like heart attach, stroke or hypoglycaemia.

[First therapy of drowning accident].

Rescue and medical care of people in a drowning accident is a rather rare incident which still needs special attention. The rescue process can be technically challenging and only a well experienced team will be able to act professionally without any time loss. At a first step all team members have to protect themselves.

The current state of hospital-based emergency medicine in Germany.

Germany has a long tradition of having physicians, often anesthesiologists with additional training in emergency medicine, deliver prehospital emergency care. Hospital-based emergency medicine in Germany also differs significantly from the Anglo-American model, and until recently having separate emergency rooms for different departments was the norm. In the past decade, many hospitals have created "centralized emergency departments" [Zentrale Notaufnahme (ZNAs)].

The anesthesiologist in prehospital and hospital emergency medicine.

Purpose Of Review: The German emergency medical system is different from the Anglo-American system. Emergency medicine is no distinct specialty in Germany. Physicians are involved in prehospital emergency medicine.

[Assessment of psychiatric emergencies by physicians in the pre-hospital emergency medical system. A re-evaluation after 7 years].

Objective: In the German emergency medical system (EMS) psychiatric emergency situations (PES) are now responsible for up to 15% of all calls for the emergency physician (EP). A survey which was first conducted in 1996 to reveal knowledge about PES, reported a significant need for training. Seven years later it is interesting to investigate whether different conditions in the EMS may have changed assessments and attitudes.

[Psychiatric emergencies in preclinical emergency service; incidence, treatment and evaluation by emergency physicians and staff].

Preclinical psychiatric emergency situations (PES) rank third in frequency of calls in the German emergency medical system (EMS). However, few data exist concerning relevance and treatment of PES. The aim of this study was to investigate this relevance in preclinical EMS and its appraisal by emergency physicians and paramedics.

[Psychiatric emergencies in the physician-based system of a German city].

Objective: Pre-clinical Psychiatric Emergency Situations (PES) gain more scientific interest. First investigations revealed them to be the third major cause for emergency physician (EP) calls. However, there is still very little data concerning prevalence, diagnosis and therapy.

[Evaluation of a training program "Psychiatry for EmergencyPhysicians"].

Objective: Psychiatric education was neglected in emergency medicine until lately. Although measures for assuring the quality of care are established, there are up to now no investigations about the effectiveness of the psychiatric programs which are used in the German Emergency Physicians' Basic Training Program (EPTP-B, "Fachkundenachweis Rettungsdienst"). Herewith a first evaluation of a training program for psychiatric emergencies is presented.

[Massive acute hypotonic hyperhydration following arthroscopic synovectomy].

We report the case of a 4 year old boy who developed a massive water intoxication as a complication during knee arthroscopy. The sodium plasma concentration dropped to 100 mmol/l postoperatively. This complication may be triggered by prolonged surgery time, excessive intra-articular pressure, capsular tears and low body weight.

Postoperative pain control following remifentanil-based anaesthesia for major abdominal surgery.

Eighty patients undergoing major abdominal surgery using remifentanil-based anaesthesia were randomly allocated in a double-blind manner to receive an intravenous bolus of fentanyl, buprenorphine, morphine or piritramide 20 min before the end of surgery. A reduced dose was administered postoperatively when patients reported moderate pain. Subsequent analgesia was provided by patient-controlled analgesia (PCA).

[Psychiatric emergencies from the viewpoint of the emergency physician].

Objective: In the German physician-based emergency medical system (EMS) psychiatric emergency situations (PES) rank on third place contradictory to it's importance during emergency physician training program. The aim of our study was to examine the relevance of PES and the stress which PES imposes upon EMS physicians. Further, the interest of training programs on that issue was determined.

Emergency medicine in Germany.

During the last 25 years the German EMS system has developed into a professional organization that covers the whole country with essentially the same standards. Standardized ambulances and rescue helicopters, equipment, dispatch centers, and training requirements characterize the system. The challenge for the future will be the development and implementation of a creative quality management system to improve system performance in spite of pending budget reductions.

[Quality management in emergency medicine].

Although the need for the implementation of a quality management concept for the German emergency medical system (EMS) has been discussed for more than 10 years, such a concept has not been realised on a broad scale. Standardised national data sheets were developed many years ago. They are used by many local agencies, but a data-gathering system on a state or national basis is still lacking.

Epidemiology of invasive mycosis in ICU patients: a prospective multicenter study in 435 non-neutropenic patients. Paul-Ehrlich Society for Chemotherapy, Divisions of Mycology and Pneumonia Research.

Objective: To determine the epidemiological and clinical significance of invasive fungal infections in non-neutropenic patients in intensive care who stay longer than 10 days on the intensive care unit (ICU).

Design: Prospective epidemiological multicenter study over a period of 11 months, based on strict clinical, bacteriological, serological and histological criteria.

Setting: Six surgical and two medical ICUs units in five university and two municipal hospitals.