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Uzun DD, Lang K, Saur P, Weigand MA, Schmitt FCF. Pediatric cardiopulmonary resuscitation in infant and children with chronic diseases: A simple approach? Front Pediatr 2022; 10:1065585. [PMID: 36467490 PMCID: PMC9714453 DOI: 10.3389/fped.2022.1065585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022] Open
Abstract
Infants and children with complex chronic diseases have lifelong, life-threatening conditions and for many, early death is an unavoidable outcome of their disease process. But not all chronic diseases in children are fatal when treated well. Cardiopulmonary resuscitation is more common in children with chronic diseases than in healthy children. Resuscitation of infants and children presents significant challenges to physicians and healthcare providers. Primarily, these situations occur only rarely and are therefore not only medically demanding but also associated with emotional stress. In case of resuscitation in infants and children with chronic diseases these challenges become much more complex. The worldwide valid Pediatric Advanced Life Support Guidelines do not give clear recommendations how to deal with periarrest situations in chronically ill infants and children. For relevant life-limiting illnesses, a "do not resuscitate" order should be discussed early, taking into account medical, ethical, and emotional considerations. The decision to terminate resuscitative efforts in cardiopulmonary arrest in infants and children with chronic illnesses such as severe lung disease, heart disease, or even incurable cancer is complex and controversial among physicians and parents. Judging the "outcome" of resuscitation as a "good" outcome becomes complex because for some, life extension itself and for others, quality of life is a goal. Physicians often decide that a healthy child is more likely to have a reversible condition and thereby have a better outcome than a child with multiple comorbidities and chronic health care needs. Major challenges in resuscitation infants and children are that clinicians need to individualize resuscitation strategies in light of each chronic disease, anatomy and physiology. This review aims to highlight terms of resuscitation infants and children with complex chronic diseases, considering resuscitation-related factors, parent-related factors, patient-related factors, and physician-related factors.
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Affiliation(s)
- Davut D. Uzun
- Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Kristin Lang
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
| | - Patrick Saur
- Department of Pediatric Cardiology and Congenital Heart Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus A. Weigand
- Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix C. F. Schmitt
- Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
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Breuer F, Dahmen J, Malysch T, Poloczek S. Strukturqualität im Berliner Notarztdienst: Funktionen, Qualifikationen und Kompetenzerhalt. Notf Rett Med 2022. [DOI: 10.1007/s10049-022-01020-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
ZusammenfassungDie Voraussetzungen zum Einsatz im Notarztdienst sind in Deutschland unterschiedlich geregelt, allein die Rahmenbedingungen zur Erlangung der Zusatzbezeichnung Notfallmedizin variieren in den Bundesländern. Diese stellt nur die Mindestvoraussetzung zur ärztlichen Teilnahme am Rettungsdienst dar und ist nach aktueller Literatur und Rechtsprechung, ebenso wie die alleinige Teilnahme am Notarzt- oder Klinikdienst zum Kompetenzerhalt, längst nicht mehr ausreichend. Im Rahmen der erneuten Ausschreibung des Notarztdiensts im Land Berlin im Jahr 2020 wurden die Voraussetzungen zur Teilnahme am Notarztdienst an den Stand der medizinischen Wissenschaft und aktuellen Rechtsprechung angepasst, die Definition von ärztlichen Kompetenzniveaus und deren strukturierter Erwerb inklusive festgelegter Einarbeitungs- und Einsatzzeiten entsprechend definiert sowie supervidierende Komponenten festgelegt. Bereits existierenden ärztlichen Führungsfunktionen wie dem Oberarzt vom Dienst (OAVD) kommt als operativer Vertreter der Ärztlichen Leitung Rettungsdienst in der Notfallrettung der Hauptstadt eine zentrale Rolle bei der Etablierung und Sicherung dieser gebotenen Anpassungsmaßnahmen zu.
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Bollinger M, Mathee C, Shapeton AD, Thal SC, Russo SG. Differences in training among prehospital emergency physicians in Germany. Notf Rett Med 2022; 25:23-30. [PMID: 35431644 PMCID: PMC8990269 DOI: 10.1007/s10049-022-01021-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 12/16/2022]
Abstract
Background Germany has an interdisciplinary physician-based emergency medical service. Differences in training likely lead to different levels of expertise. Objectives We assessed the number of manual procedures performed at the completion of training to determine level of experience of prehospital emergency physicians of different primary specialties. Materials and methods Immediately after passing the board examination each examinee was asked to estimate the number of performed procedures for 26 manual skills. We compared the results with recommendations and data on learning manual skills. Results are presented as mean (standard deviation). Results Endotracheal intubation via direct laryngoscopy was performed 1032 (739) times by anesthesiologists. Surgeons and internists performed 89 (89) and 77 (65) intubations, respectively. Intubation via video laryngoscopy was performed 79 (81) times by anesthesiologists, 11 (17) times by surgeons and 6 (11) times by internists. Surgeons had little experience in non-invasive ventilation, with 9 (19) performed procedures and had rarely used external pacemaker therapy or electrical cardioversion. In comparison, among all participants non-invasive ventilation was performed 152 (197) times, electrical cardioversion was performed 41 (103) times and an external pacemaker was used 6 (15) times. For other procedures the numbers did not markedly differ between the different specialties. Conclusion The number of performed procedures markedly differed for some skills between different primary specialties. Recommendations regarding a procedural volume were not always met, suggesting missing expertise for some skills. A defined number of procedures should therefore be a formal requirement to be eligible for board certification in prehospital emergency medicine.
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Affiliation(s)
- Matthias Bollinger
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Schwarzwald-Baar Hospital, Klinikstr. 11, 78052 Villingen-Schwenningen, Germany ,grid.412581.b0000 0000 9024 6397Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - C. Mathee
- grid.412581.b0000 0000 9024 6397Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany ,grid.412581.b0000 0000 9024 6397Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - A. D. Shapeton
- Boston Veterans Affairs Healthcare System, Boston, MA USA ,grid.67033.310000 0000 8934 4045Tufts University School of Medicine, Boston, MA USA
| | - S. C. Thal
- grid.412581.b0000 0000 9024 6397Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany ,grid.412581.b0000 0000 9024 6397Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - S. G. Russo
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Schwarzwald-Baar Hospital, Klinikstr. 11, 78052 Villingen-Schwenningen, Germany ,grid.412581.b0000 0000 9024 6397Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany ,grid.411984.10000 0001 0482 5331Faculty of Medicine, University Medical Center Goettingen, Goettingen, Germany
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Kaufmann J, Etspüler A, Wallot P. [Prehospital Resuscitation of Children]. Anasthesiol Intensivmed Notfallmed Schmerzther 2021; 56:760-771. [PMID: 34820814 DOI: 10.1055/a-1330-5211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The majority of professionals involved in pre-hospital emergency care do not have explicit paediatric training and have limited experience in the care of life-threatening paediatric emergencies. There is often a fear of being overwhelmed. However, no special paediatric expertise is primarily required to successfully perform resuscitation in children. In addition, the scope of the measures required for successful paediatric resuscitation is on average significantly smaller than for adults. It is essential to know clear and easy-to-implement courses of action, such as those provided by the resuscitation guidelines. For the technical implementation of airway protection, mask-bag ventilation and the laryngeal mask are essential, and for access to the venous system, the intraosseous needle is an aid that overcomes all difficulties almost without exception. With additional support from reference sources, calculation aids and length-related systems, a high level of drug therapy safety can be achieved. In summary, through thorough individual and institutional preparation for paediatric emergencies, safe primary care is feasible by emergency service personnel of any speciality.
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Schmucker M, Haag M. Automated Size Recognition in Pediatric Emergencies Using Machine Learning and Augmented Reality: Within-Group Comparative Study. JMIR Form Res 2021; 5:e28345. [PMID: 34542416 PMCID: PMC8491115 DOI: 10.2196/28345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/25/2021] [Accepted: 06/19/2021] [Indexed: 01/26/2023] Open
Abstract
Background Pediatric emergencies involving children are rare events, and the experience of emergency physicians and the results of such emergencies are accordingly poor. Anatomical peculiarities and individual adjustments make treatment during pediatric emergency susceptible to error. Critical mistakes especially occur in the calculation of weight-based drug doses. Accordingly, the need for a ubiquitous assistance service that can, for example, automate dose calculation is high. However, few approaches exist due to the complexity of the problem. Objective Technically, an assistance service is possible, among other approaches, with an app that uses a depth camera that is integrated in smartphones or head-mounted displays to provide a 3D understanding of the environment. The goal of this study was to automate this technology as much as possible to develop and statistically evaluate an assistance service that does not have significantly worse measurement performance than an emergency ruler (the state of the art). Methods An assistance service was developed that uses machine learning to recognize patients and then automatically determines their size. Based on the size, the weight is automatically derived, and the dosages are calculated and presented to the physician. To evaluate the app, a small within-group design study was conducted with 17 children, who were each measured with the app installed on a smartphone with a built-in depth camera and a state-of-the-art emergency ruler. Results According to the statistical results (one-sample t test; P=.42; α=.05), there is no significant difference between the measurement performance of the app and an emergency ruler under the test conditions (indoor, daylight). The newly developed measurement method is thus not technically inferior to the established one in terms of accuracy. Conclusions An assistance service with an integrated augmented reality emergency ruler is technically possible, although some groundwork is still needed. The results of this study clear the way for further research, for example, usability testing.
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Affiliation(s)
- Michael Schmucker
- GECKO Institute, Heilbronn University of Applied Sciences, Heilbronn, Germany
| | - Martin Haag
- GECKO Institute, Heilbronn University of Applied Sciences, Heilbronn, Germany
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Das brandverletzte Kind. Notf Rett Med 2019. [DOI: 10.1007/s10049-018-0485-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Schneider N, Küßner T, Weilbacher F, Göring M, Mohr S, Rudolph M, Popp E. Invasive Notfalltechniken – INTECH Advanced. Notf Rett Med 2018. [DOI: 10.1007/s10049-018-0475-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Ondruschka B, Baier C, Siekmeyer M, Buschmann C, Dreßler J, Bernhard M. Cardiopulmonary resuscitation-associated injuries in still-/newborns, infants and toddlers in a German forensic collective. Forensic Sci Int 2017; 279:235-240. [PMID: 28926779 DOI: 10.1016/j.forsciint.2017.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cardiopulmonary resuscitation (CPR) may lead to injuries. Forensic experts are sometimes confronted with claims that fatal injuries were caused by chest compressions during CPR rather than by assaults. We want to answer, how often CPR-associated injuries are present in younger children and if they may mimic injuries caused by abuse. MATERIAL AND METHODS All autopsy records of the Institute of Legal Medicine in Leipzig, Germany in a 6-year study period were used (2011-2016). There were 3664 forensic autopsies in total, comprising 97 autopsies of children ≤4 years. After exclusion criteria we were able to include 51 cases in the study. Following this, all CPR-related variables were collected according to the 'Utstein style'. Standard procedures were used for statistical evaluation of the data. RESULTS The most common cause of cardiac arrest was SIDS. The mean duration of CPR was 50min. Bystander CPR was performed in 43.1%. In no single case death was declared without at least partly professional CPR. Most of the children were first resuscitated out-of-hospital (41.2%). 27.5% of the children had at least one CPR injury without preference to an age group. None of the recorded CPR-associated injuries were considered significant or life-threatening. The duration of CPR or presence of bystander CPR did not correlate to the presence of any detected injury. CONCLUSION Skeletal injuries and relevant injuries to the soft tissue and organs seem to occur only very rarely after pediatric CPR. Whenever such injuries are diagnosed, the children should be examined thoroughly for potential abuse.
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Affiliation(s)
- B Ondruschka
- University of Leipzig, Institute of Legal Medicine, Leipzig, Germany.
| | - C Baier
- University of Leipzig, Institute of Legal Medicine, Leipzig, Germany
| | - M Siekmeyer
- University Clinic of Leipzig, Department of Pediatrics Hospital for Children and Adolescents, Leipzig, Germany
| | - C Buschmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Legal Medicine and Forensic Sciences, Berlin, Germany
| | - J Dreßler
- University of Leipzig, Institute of Legal Medicine, Leipzig, Germany
| | - M Bernhard
- University of Leipzig, Emergency Department, Leipzig, Germany
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Trieschmann U, Böttiger B. Kinderanästhesie und Kinderanalgesie. Notf Rett Med 2014. [DOI: 10.1007/s10049-013-1807-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kessler J, Moriggl B, Grau T. Ultrasound-guided regional anesthesia: learning with an optimized cadaver model. Surg Radiol Anat 2013; 36:383-92. [DOI: 10.1007/s00276-013-1188-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 08/12/2013] [Indexed: 11/28/2022]
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Kaufmann J, Laschat M, Wappler F. Medication errors in pediatric emergencies: a systematic analysis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:609-16. [PMID: 23093991 DOI: 10.3238/arztebl.2012.0609] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 06/05/2012] [Indexed: 01/12/2023]
Abstract
BACKGROUND Errors in drug administration are among the commonest medical errors. Children are particularly at risk for such errors because of the need to calculate doses individually. Doses that are ten times the correct amount (1000% of the correct dose) are occasionally given and can be life-threatening. In a simulated resuscitation in a pediatric emergency room, an error of this type occurred for one of the 32 medications that were ordered. The highest error rates are to be expected in prehospital emergency medicine. In this review, we analyze the process of ordering medications and describe the potential interventions for lowering error rates that have been evaluated to date. METHOD Systematic literature review RESULTS We found 32 original publications that concerned the evaluation of interventions for lowering error rates in the ordering of medications for children. Error rates can be lowered by interventions that improve prescribers' knowledge of pediatric pharmacotherapy (courses, immediately accessible sources of information) and by aids to the cognitive process of ordering medication (calculators, computer programs, tables of doses by weight). They can also be lowered by raising awareness of the problem of erroneous medication ordering and by monitoring medication orders, as well as by structured communication and standardized, unambiguously labeled drug preparations. In the hospital setting, computer programs for medication orders with a built-in pediatric pharmacological database are highly recommended. In the prehospital setting, the "pediatric emergency ruler" enables accurate estimation of the patient's weight, provides age-appropriate dosage recommendations, and directly indicates the steps needed for calculation of the correct dose. CONCLUSION Children in medical emergency situations are at significant risk for medication errors. The measures described here can markedly lower the rate of dangerous errors.
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Affiliation(s)
- Jost Kaufmann
- Institute of Anesthesiology at Witten/Herdecke University, Department of Paediatric Anesthesia, Cologne Children's Hospital, Germany.
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Praxisorientiertes Ausbildungskonzept für invasive Notfalltechniken. Notf Rett Med 2011. [DOI: 10.1007/s10049-010-1401-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gries A, Michel A, Bernhard M, Martin J. [Personnel planning in the emergency department. Optimized patient care round the clock]. Anaesthesist 2011; 60:71-8. [PMID: 21184036 DOI: 10.1007/s00101-010-1830-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In recent years the number of interdisciplinary emergency departments (ED) at hospitals in Germany has increased. The model of decentralized first contact units for each medical discipline has been abandoned, last but not least due to economic considerations. While decentralized units could be staffed with personnel from each discipline there is much controversy surrounding the question of which kind of doctor is best suited for a centralized ED. The development of programs providing the necessary qualification for German ED physicians in the future by working groups of several specialties is still nascent and has not yet produced concrete results. However, even without these special training programs, the management of critically ill or severely injured patients in the ED is paramount. The smooth operation of centralized EDs is therefore important. Therefore, taking into account economical aspects, qualification and number of available personnel, this article introduces a staffing concept as a rational basis for an optimized patient management in centralized EDs in Germany. Taking the patient characteristics, the specific treatment modalities and the number of admissions to the ED into account, this paper will determine treatment time per patient and the necessary number of physicians, as well as an optimized staffing model for EDs.
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Affiliation(s)
- A Gries
- Zentrale Notaufnahme, Klinikum Fulda gAG, Pacelliallee 4, Fulda, Germany.
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Bernhard M, Helm M, Luiz T, Biehn G, Kumpch M, Hainer C, Meyburg J, Gries A. Pädiatrische Notfälle in der prähospitalen Notfallmedizin. Notf Rett Med 2010. [DOI: 10.1007/s10049-010-1402-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Helm M, Biehn G, Lampl L, Bernhard M. Pädiatrischer Notfallpatient im Luftrettungsdienst. Anaesthesist 2010; 59:896-903. [DOI: 10.1007/s00101-010-1759-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 05/31/2010] [Accepted: 06/01/2010] [Indexed: 11/24/2022]
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Meyburg J, Bernhard M, Hoffmann GF, Motsch J. Principles of pediatric emergency care. DEUTSCHES ARZTEBLATT INTERNATIONAL 2009; 106:739-47; quiz 748. [PMID: 19997587 PMCID: PMC2788902 DOI: 10.3238/arztebl.2009.0739] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 09/17/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND Children account for only a small percentage of pre-hospital emergency patients but are a special challenge for the treating physician. METHODS The Medline database was selectively searched for articles appearing up to June 2009. The authors added other important literature of which they were aware. RESULTS The broad spectrum of diseases, the wide age range with the physiological and anatomical changes that occur in it, and the special psychological, emotional, and communicative features of children make pediatric emergencies a special challenge for emergency physicians. CONCLUSIONS A mastery of basic emergency techniques including clinical evaluation of the child, establishment of venous access, airway management, resuscitation, and drug dosing is essential for the successful emergency treatment of children. We recommend classifying the common non-traumatic pediatric emergencies by four cardinal manifestations: respiratory distress, altered consciousness, seizure, and shock. Classifying these rare emergency situations in this way helps assure that their treatment will be goal-oriented and appropriate to the special needs of sick children.
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Affiliation(s)
- Jochen Meyburg
- Abteilung Allgemeine Pädiatrie, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Heidelberg, Germany.
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Pearce AP. Chest drain insertion: Improving techniques and decreasing complications. Emerg Med Australas 2009; 21:91-3. [DOI: 10.1111/j.1742-6723.2009.01170.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Prähospitale geburtshilfliche Notfälle in einem bodengebundenen städtischen Notarztsystem. Anaesthesist 2009; 58:353-61. [DOI: 10.1007/s00101-009-1510-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bernhard M, Aul A, Helm M, Mutzbauer T, Kirsch J, Brenner T, Hainer C, Gries A. Invasive Notfalltechniken in der Notfallmedizin. Notf Rett Med 2008. [DOI: 10.1007/s10049-008-1037-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Russo SG, Eich C, Barwing J, Nickel EA, Braun U, Graf BM, Timmermann A. Self-reported changes in attitude and behavior after attending a simulation-aided airway management course. J Clin Anesth 2007; 19:517-22. [DOI: 10.1016/j.jclinane.2007.04.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Revised: 04/14/2007] [Accepted: 04/27/2007] [Indexed: 10/22/2022]
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Waydhas C. Thoraxtrauma – notfallmedizinische Versorgung von Schwerverletzten. Notf Rett Med 2007. [DOI: 10.1007/s10049-007-0917-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Waydhas C, Sauerland S. Pre-hospital pleural decompression and chest tube placement after blunt trauma: A systematic review. Resuscitation 2006; 72:11-25. [PMID: 17118508 DOI: 10.1016/j.resuscitation.2006.06.025] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2006] [Revised: 06/13/2006] [Accepted: 06/20/2006] [Indexed: 02/01/2023]
Abstract
Pre-hospital insertion of chest tubes or decompression of air within the pleural space is one of the controversial topics in emergency medical care of trauma patients. While a wide variety of opinions exist medical personnel on the scene require guidance in situations when tension pneumothorax or progressive pneumothorax is suspected. To ensure evidence based decisions we performed a systematic review of the current literature with respect to the diagnostic accuracy in the pre-hospital setting to identify patients with (tension) pneumothorax, the efficacy and safety of performing pleural decompression in the field and the choice of method and technique for the procedure. The evidence found is presented and discussed and recommendations are drawn from the authors' perspective.
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Affiliation(s)
- Christian Waydhas
- Department of Trauma Surgery, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany.
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Gries A, Zink W, Bernhard M, Messelken M, Schlechtriemen T. Realistic assessment of the physican-staffed emergency services in Germany. Anaesthesist 2006; 55:1080-6. [PMID: 16791544 DOI: 10.1007/s00101-006-1051-2] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In Germany the emergency medical services, which include dispatching emergency physicians to the scene, are considered to be among the best in the world. However, the hospitals admitting these patients still report shortcomings in prehospital care. The quality of an emergency medical service depends on both formal qualification and experience in managing such emergencies. Therefore, we determined how frequently emergency medical service physicians in Germany actually encountered complex and demanding emergency situations outside the hospital and how often they had to carry out emergency interventions. We therefore evaluated data from more than 82,000 ground emergency medical service scene calls registered in the MIND ("minimaler Notarztdatensatz") data base of the state of Baden-Wuerttemberg, Germany and more than 47,000 helicopter emergency medical service scene calls from the "Luftrettungs-, Informations- und Kommunikationssystem" (LIKS) data base of the German ADAC air rescue service. The results, which were unexpectedly distinct, impressively demonstrate that in part emergency medical service staff only encountered some emergencies very rarely. In particular, patients with life-threatening conditions such as acute coronary syndrome, stroke, head trauma, as well as multiple trauma were only treated once every 0.4-14.5 months and cardiopulmonary resuscitation and intubation were only carried out once every 0.5-1.5 months. Furthermore, a time period of 6 months to more than 6 years may pass before a chest tube has to be placed. There are, of course, considerable differences between ground and helicopter emergency medical services. Particularly in areas where the frequency of such emergency cases is low, the clinical experience required to competently manage a demanding emergency situation cannot be gained or maintained just by working in the emergency medical system. As a result of the general pressure to cut costs and also of changes in hospital politics, however, only highly qualified and experienced emergency medical services may survive in Germany in the long term. In addition to formal qualifications and accompanying practice-related courses, future emergency medical service personnel should be drafted from clinical department staff that are experienced in treating severely ill and severely injured patients.
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Affiliation(s)
- A Gries
- German Air Rescue (Deutsche Rettungsflugwacht), Filderstadt, Germany
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Gries A, Zink W, Bernhard M, Messelken M, Schlechtriemen T. Einsatzrealität im Notarztdienst. Notf Rett Med 2005. [DOI: 10.1007/s10049-005-0756-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bernhard M, Zink W, Sikinger M, Aul A, Helm M, Mutzbauer TS, Doll S, Völkl A, Gries A. Das Heidelberger Seminar „Invasive Notfalltechniken“ (INTECH) 2001–2004. Notf Rett Med 2005. [DOI: 10.1007/s10049-005-0761-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Döhnert J, Auerbach B, Wyrwich W, Heyde CE. [The preclinical care of polytraumatized patients]. DER ORTHOPADE 2005; 34:837-51. [PMID: 16049722 DOI: 10.1007/s00132-005-0843-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In industrially developed countries, trauma is the major mortality factor for people younger than 40 years. The preclinical management of polytraumatized patients influences the prognosis of mortality and morbidity. In this period, a number of decisions have to be made under unfavourable conditions and with limited time. This situation represents a great challenge for the whole rescue team. Diagnostic overview, protection of the vital functions under the special situation of shock, immobilization of the spine and the treatment of the isolated injuries are part of the preclinical management efforts. Rescue of the polytraumatized patient, organization and announcement of transfer and the protection of the rescue team have to be taken into account.
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Affiliation(s)
- J Döhnert
- Neurochirurgische Praxisklinik Leipzig, Johannisplatz 1, 04103 Leipzig, Germany.
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