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Rott N, Dirks B, Böttiger BW. [The German translation of the new 2021 resuscitation guidelines-the BIG FIVE survival strategies gain significantly in importance]. Notf Rett Med 2021; 24:271-273. [PMID: 34093074 PMCID: PMC8170433 DOI: 10.1007/s10049-021-00882-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/17/2022]
Affiliation(s)
- N. Rott
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln, 50937 Köln, Deutschland
- Deutscher Rat für Wiederbelebung – German Resuscitation Council (GRC) e. V., c/o Sektion Notfallmedizin, Universitätsklinikum Ulm, 89070 Ulm, Deutschland
| | - B. Dirks
- Deutscher Rat für Wiederbelebung – German Resuscitation Council (GRC) e. V., c/o Sektion Notfallmedizin, Universitätsklinikum Ulm, 89070 Ulm, Deutschland
| | - B. W. Böttiger
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln, 50937 Köln, Deutschland
- Deutscher Rat für Wiederbelebung – German Resuscitation Council (GRC) e. V., c/o Sektion Notfallmedizin, Universitätsklinikum Ulm, 89070 Ulm, Deutschland
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Dirks B, Wingen S, Rücker G, Greif R, Papaspyrou H, Böttiger BW. Modularer Lehrerausbildungskurs des Deutschen Rates für Wiederbelebung (GRC) für den Wiederbelebungsunterricht in Schulen. Notf Rett Med 2019. [DOI: 10.1007/s10049-019-0609-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Böttiger B, Baubin M, Mauri R, Dirks B. Leitlinien
zur Reanimation 2015 des European Resuscitation Council. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0111-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wepler M, Stahl W, von Baum H, Wildermuth S, Dirks B, Georgieff M, Hafner S. Prevalence of nosocomial pathogens in German ambulances: the SEKURE study. Emerg Med J 2015; 32:409-11. [PMID: 25714107 DOI: 10.1136/emermed-2013-202551] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 11/16/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The increasing prevalence of multidrug resistant bacteria is a problem in the inpatient care setting, and in the emergency care system. The aim of this observational, cross-sectional study was to evaluate the prevalence of pathogens on well-defined surfaces in German ambulances that have been designated as 'ready for service'. METHODS After informed consent was obtained, ambulance surfaces were sampled with agar plates for microbiological examination during an unannounced visit. A standardised questionnaire was used to obtain information regarding the disinfection protocols used at each rescue station. RESULTS Methicillin resistant staphylococcus aureus contamination was present in 18 sampling surfaces from 11 out of 150 ambulance vehicles (7%) that were designated as ready for service. Contact surfaces directly surrounding patients or staff were most frequently contaminated with pathogens. However, bacterial contamination was not related to annual missions, methods or frequency of disinfection. CONCLUSIONS In accordance with previous studies, disinfection and cleaning of areas with direct contact to patients or staff seem to be the most challenging. This should also be reflected in disinfection guidelines and the related continuing education.
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Affiliation(s)
- M Wepler
- Department of Anaesthesiology, University Hospital Ulm, Ulm, Germany
| | - W Stahl
- Department of Anaesthesiology, University Hospital Ulm, Ulm, Germany
| | - H von Baum
- Institute of Medical Microbiology and Hygiene, University Hospital Ulm, Ulm, Germany
| | - S Wildermuth
- Institute of Medical Microbiology and Hygiene, University Hospital Ulm, Ulm, Germany
| | - B Dirks
- Department of Anaesthesiology, University Hospital Ulm, Ulm, Germany
| | - M Georgieff
- Department of Anaesthesiology, University Hospital Ulm, Ulm, Germany
| | - S Hafner
- Department of Anaesthesiology, University Hospital Ulm, Ulm, Germany
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Adler L, Raychaudhuri A, Dirks B. EPA-0682 – Investigator-rated symptomatological outcomes in a phase 4 study of lisdexamfetamine dimesylate in adults with attention-deficit/hyperactivity disorder and impaired executive function. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78049-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Arntz HR, Dirks B. Kontoversen in der Reanimatologie. Notf Rett Med 2012. [DOI: 10.1007/s10049-011-1564-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wenzel V, Russo SG, Arntz HR, Bahr J, Baubin MA, Böttiger BW, Dirks B, Kreimeier U, Fries M, Eich C. [Comments on the 2010 guidelines on cardiopulmonary resuscitation of the European Resuscitation Council]. Anaesthesist 2011; 59:1105-23. [PMID: 21125214 DOI: 10.1007/s00101-010-1820-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
ADULTS Administer chest compressions (minimum 100/min, minimum 5 cm depth) at a ratio of 30:2 with ventilation (tidal volume 500-600 ml, inspiration time 1 s, F(I)O₂ if possible 1.0). Avoid any interruptions in chest compressions. After every single defibrillation attempt (initially biphasic 120-200 J, monophasic 360 J, subsequently with the respective highest energy), chest compressions are initiated again immediately for 2 min independent of the ECG rhythm. Tracheal intubation is the optimal method for securing the airway during resuscitation but should be performed only by experienced airway management providers. Laryngoscopy is performed during ongoing chest compressions; interruption of chest compressions for a maximum of 10 s to pass the tube through the vocal cords. Supraglottic airway devices are alternatives to tracheal intubation. Drug administration routes for adults and children: first choice i.v., second choice intraosseous (i.o.). Vasopressors: 1 mg epinephrine every 3-5 min i.v. After the third unsuccessful defibrillation amiodarone (300 mg i.v.), repetition (150 mg) possible. Sodium bicarbonate (50 ml 8.4%) only for excessive hyperkaliemia, metabolic acidosis, or intoxication with tricyclic antidepressants. Consider aminophylline (5 mg/kgBW). Thrombolysis during spontaneous circulation only for myocardial infarction or massive pulmonary embolism; during on-going cardiopulmonary resuscitation (CPR) only when indications of massive pulmonary embolism. Active compression-decompression (ACD-CPR) and inspiratory threshold valve (ITV-CPR) are not superior to good standard CPR. CHILDREN Most effective improvement of outcome by prevention of full cardiorespiratory arrest. Basic life support: initially five rescue breaths, followed by chest compressions (100-120/min depth about one third of chest diameter), compression-ventilation ratio 15:2. Foreign body airway obstruction with insufficient cough: alternate back blows and chest compressions (infants), or abdominal compressions (children >1 year). Treatment of potentially reversible causes: ("4 Hs and 4 Ts") hypoxia and hypovolaemia, hypokalaemia and hyperkalaemia, hypothermia, and tension pneumothorax, tamponade, toxic/therapeutic disturbances, thrombosis (coronary/pulmonary). Advanced life support: adrenaline (epinephrine) 10 µg/kgBW i.v. or i.o. every 3-5 min. Defibrillation (4 J/kgBW; monophasic or biphasic) followed by 2 min CPR, then ECG and pulse check. NEWBORNS: Initially inflate the lungs with bag-valve mask ventilation (p(AW) 20-40 cmH₂O). If heart rate remains <60/min, start chest compressions (120 chest compressions/min) and ventilation with a ratio 3:1. Maintain normothermia in preterm babies by covering them with foodgrade plastic wrap or similar. POSTRESUSCITATION PHASE: Early protocol-based intensive care stabilization; initiate mild hypothermia early regardless of initial cardiac rhythm [32-34°C for 12-24 h (adults) or 24 h (children); slow rewarming (<0.5°C/h)]. Consider percutaneous coronary intervention (PCI) in patients with presumed cardiac ischemia. Prediction of CPR outcome is not possible at the scene, determine neurological outcome <72 h after cardiac arrest with somatosensory evoked potentials, biochemical tests and neurological examination. ACUTE CORONARY SYNDROME: Even if only a weak suspicion of an acute coronary syndrome is present, record a prehospital 12-lead ECG. In parallel to pain therapy, administer aspirin (160-325 mg p.o. or i.v.) and clopidogrel (75-600 mg depending on strategy); in ST-elevation myocardial infarction (STEMI) and planned PCI also prasugrel (60 mg p.o.). Antithrombins, such as heparin (60 IU/kgBW, max. 4000 IU), enoxaparin, bivalirudin or fondaparinux depending on the diagnosis (STEMI or non-STEMI-ACS) and the planned therapeutic strategy. In STEMI define reperfusion strategy depending on duration of symptoms until PCI, age and location of infarction. TRAUMA: In severe hemorrhagic shock, definitive control of bleeding is the most important goal. For successful CPR of trauma patients a minimal intravascular volume status and management of hypoxia are essential. Aggressive fluid resuscitation, hyperventilation and excessive ventilation pressure may impair outcome in patients with severe hemorrhagic shock. TRAINING Any CPR training is better than nothing; simplification of contents and processes is the main aim.
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Affiliation(s)
- V Wenzel
- Univ.-Klinik für Anaesthesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
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Abstract
AIMS In this article, a quantitative real-time PCR assay for detection and enumeration of the spoilage yeast Dekkera anomala in beer, cola, apple cider, and brewing wort is presented as an improvement upon existing detection methods, which are very time-consuming and not always accurate. METHODS AND RESULTS Primers were designed to exclude other organisms common in these beverages, and the assay was linear over 6 log units of cell concentrations. The addition of large amounts of non-target yeast DNA did not affect the efficiency of this assay. A standard curve of known DNA was established by plotting the C(t) values obtained from the QPCR against the log of plate counts on yeast peptone dextrose medium and unknowns showed exceptional correlation when tested against this standard curve. The assay was found to detect D. anomala at levels of 10-14 CFU ml⁻¹ in either cola or beer and at levels of 9·4-25·0 CFU ml⁻¹ in apple cider. The assay was also used to follow the growth of D. anomala in brewing wort. CONCLUSIONS The results indicate that real-time PCR is an effective tool for rapid, accurate detection and quantitation of D. anomala in beer, cola and apple cider. SIGNIFICANCE AND IMPACT OF THE STUDY This method gives a faster and more efficient technique to screen beer, cola, and cider samples and reduce spoilage by D. anomala. Faster screening may allow for significant reduction in economic loss because of reduced spoilage.
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Affiliation(s)
- S R Gray
- Department of Food, Bioprocessing and Nutrition Sciences, North Carolina State University, Raleigh, NC 27695-7624, USA
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Schorl M, Dirks B, Klingler W. Hirnstammblutungen. Notf Rett Med 2010. [DOI: 10.1007/s10049-009-1237-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Baubin M, Dirks B, Holzer M, Wenzel V. ILCOR hot topics. Notf Rett Med 2009. [DOI: 10.1007/s10049-009-1220-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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W. Böttiger B, Dirks B. Education. Notf Rett Med 2009. [DOI: 10.1007/s10049-009-1210-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Schönfeldt-Lecuona C, Dirks B, Wolf R, Pajonk F, Freudenmann R, Höse A, Connemann B. Psychiatrische Notfälle im Notfall- und Rettungswesen. Notf Rett Med 2008. [DOI: 10.1007/s10049-008-1074-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dinse-Lambrecht A, Haaken I, Schmidt C, Dirks B. Ultimate lysis: Thrombolysis for out of hospital cardiac arrest resuscitation in ULM 1995 – 2002. Resuscitation 2008. [DOI: 10.1016/j.resuscitation.2008.03.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Klingler W, Dirks B. Untersuchung des Bewusstlosen. Notf Rett Med 2007. [DOI: 10.1007/s10049-007-0906-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wenzel V, Russo S, Arntz HR, Bahr J, Baubin MA, Böttiger BW, Dirks B, Dörges V, Eich C, Fischer M, Wolcke B, Schwab S, Voelckel WG, Gervais HW. [The new 2005 resuscitation guidelines of the European Resuscitation Council: comments and supplements]. Anaesthesist 2007; 55:958-66, 968-72, 974-9. [PMID: 16915404 DOI: 10.1007/s00101-006-1064-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The new CPR guidelines are based on a scientific consensus which was reached by 281 international experts. Chest compressions (100/min, 4-5 cm deep) should be performed in a ratio of 30:2 with ventilation (tidal volume 500 ml, Ti 1 s, FIO2 if possible 1.0). After a single defibrillation attempt (initially biphasic 150-200 J, monophasic 360 J, subsequently with the respective highest energy), chest compressions are initiated again immediately for 2 min. Endotracheal intubation is the gold standard; other airway devices may be employed as well depending on individual skills. Drug administration routes for adults and children: first choice IV, second choice intraosseous, third choice endobronchial [epinephrine dose 2-3x (adults) or 10x (pediatric patients) higher than IV]. Vasopressors: 1 mg epinephrine every 3-5 min IV. After the third unsuccessful defibrillation attempt amiodarone IV (300 mg); repetition (150 mg) possible. Sodium bicarbonate (1 ml/kg 8.4%) only in excessive hyperkalemia, metabolic acidosis, or intoxication with tricyclic antidepressants. Consider atropine (3 mg) and aminophylline (5 mg/kg). Thrombolysis during spontaneous circulation only in myocardial infarction or massive pulmonary embolism; during CPR only during massive pulmonary embolism. Cardiopulmonary bypass only after cardiac surgery, hypothermia or intoxication. Pediatrics: best improvement in outcome by preventing cardiocirculatory collapse. Alternate chest thumps and chest compression (infants), or abdominal compressions (>1-year-old) in foreign body airway obstruction. Initially five breaths, followed by chest compressions (100/min; approximately 1/3 of chest diameter): ventilation ratio 15:2. Treatment of potentially reversible causes (4 "Hs", "HITS": hypoxia, hypovolemia, hypo- and hyperkaliemia, hypothermia, cardiac tamponade, intoxication, thrombo-embolism, tension pneumothorax). Epinephrine 10 microg/kg IV or intraosseously, or 100 microg (endobronchially) every 3-5 min. Defibrillation (4 J/kg; monophasic oder biphasic) followed by 2 min CPR, then ECG and pulse check. Newborns: inflate the lungs with bag-valve mask ventilation. If heart rate<60/min chest compressions:ventilation ratio 3:1 (120 chest compressions/min). Postresuscitation phase: initiate mild hypothermia [32-34 degrees C for 12-24 h; slow rewarming (<0.5 degrees C/h)]. Prediction of CPR outcome is not possible at the scene; determining neurological outcome within 72 h after cardiac arrest with evoked potentials, biochemical tests and physical examination. Even during low suspicion for an acute coronary syndrome, record a prehospital 12-lead ECG. In parallel to pain therapy, aspirin (160-325 mg PO or IV) and in addition clopidogrel (300 mg PO). As antithrombin, heparin (60 IU/kg, max. 4000 IU) or enoxaparine. In ST-segment elevation myocardial infarction, define reperfusion strategy depending on duration of symptoms until PCI (prevent delay>90 min until PCI). Stroke is an emergency and needs to be treated in a stroke unit. A CT scan is the most important evaluation, MRT may replace a CT scan. After hemorrhage exclusion, thrombolysis within 3 h of symptom onset (0.9 mg/kg rt-PA IV; max 90 mg within 60 min, 10% of the entire dosage as initial bolus, no aspirin, no heparin within the first 24 h). In severe hemorrhagic shock, definite control of bleeding is the most important goal. For successful CPR of trauma patients, a minimal intravascular volume status and management of hypoxia are essential. Aggressive fluid resuscitation, hyperventilation, and excessive ventilation pressure may impair outcome in severe hemorrhagic shock. Despite bad prognosis, CPR in trauma patients may be successful in select cases. Any CPR training is better than nothing; simplification of contents and processes remains important.
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Affiliation(s)
- V Wenzel
- Univ.-Klinik für Anaesthesie und Allgemeine Intensivmedizin, Medizinische Universität, Anichstrasse 35, 6020, Innsbruck, Austria.
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Tuskan GA, Difazio S, Jansson S, Bohlmann J, Grigoriev I, Hellsten U, Putnam N, Ralph S, Rombauts S, Salamov A, Schein J, Sterck L, Aerts A, Bhalerao RR, Bhalerao RP, Blaudez D, Boerjan W, Brun A, Brunner A, Busov V, Campbell M, Carlson J, Chalot M, Chapman J, Chen GL, Cooper D, Coutinho PM, Couturier J, Covert S, Cronk Q, Cunningham R, Davis J, Degroeve S, Déjardin A, Depamphilis C, Detter J, Dirks B, Dubchak I, Duplessis S, Ehlting J, Ellis B, Gendler K, Goodstein D, Gribskov M, Grimwood J, Groover A, Gunter L, Hamberger B, Heinze B, Helariutta Y, Henrissat B, Holligan D, Holt R, Huang W, Islam-Faridi N, Jones S, Jones-Rhoades M, Jorgensen R, Joshi C, Kangasjärvi J, Karlsson J, Kelleher C, Kirkpatrick R, Kirst M, Kohler A, Kalluri U, Larimer F, Leebens-Mack J, Leplé JC, Locascio P, Lou Y, Lucas S, Martin F, Montanini B, Napoli C, Nelson DR, Nelson C, Nieminen K, Nilsson O, Pereda V, Peter G, Philippe R, Pilate G, Poliakov A, Razumovskaya J, Richardson P, Rinaldi C, Ritland K, Rouzé P, Ryaboy D, Schmutz J, Schrader J, Segerman B, Shin H, Siddiqui A, Sterky F, Terry A, Tsai CJ, Uberbacher E, Unneberg P, Vahala J, Wall K, Wessler S, Yang G, Yin T, Douglas C, Marra M, Sandberg G, Van de Peer Y, Rokhsar D. The genome of black cottonwood, Populus trichocarpa (Torr. & Gray). Science 2006; 313:1596-604. [PMID: 16973872 DOI: 10.1126/science.1128691] [Citation(s) in RCA: 2575] [Impact Index Per Article: 143.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
We report the draft genome of the black cottonwood tree, Populus trichocarpa. Integration of shotgun sequence assembly with genetic mapping enabled chromosome-scale reconstruction of the genome. More than 45,000 putative protein-coding genes were identified. Analysis of the assembled genome revealed a whole-genome duplication event; about 8000 pairs of duplicated genes from that event survived in the Populus genome. A second, older duplication event is indistinguishably coincident with the divergence of the Populus and Arabidopsis lineages. Nucleotide substitution, tandem gene duplication, and gross chromosomal rearrangement appear to proceed substantially more slowly in Populus than in Arabidopsis. Populus has more protein-coding genes than Arabidopsis, ranging on average from 1.4 to 1.6 putative Populus homologs for each Arabidopsis gene. However, the relative frequency of protein domains in the two genomes is similar. Overrepresented exceptions in Populus include genes associated with lignocellulosic wall biosynthesis, meristem development, disease resistance, and metabolite transport.
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Affiliation(s)
- G A Tuskan
- Environmental Sciences Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA.
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Affiliation(s)
- J. P. Nolan
- Sektion Notfallmedizin, Universitätsklinik für Anästhesiologie, Ulm
| | - C. D. Deakin
- Sektion Notfallmedizin, Universitätsklinik für Anästhesiologie, Ulm
| | - J. Soar
- Sektion Notfallmedizin, Universitätsklinik für Anästhesiologie, Ulm
| | - B. W. Böttiger
- Sektion Notfallmedizin, Universitätsklinik für Anästhesiologie, Ulm
| | - G. Smith
- Sektion Notfallmedizin, Universitätsklinik für Anästhesiologie, Ulm
| | - M. Baubin
- Klinik für Anästhesie und allgemeine Intensivmedizin, Universität, Innsbruck, Österreich
| | - B. Dirks
- Sektion Notfallmedizin, Universitätsklinik für Anästhesiologie, Ulm
- Sektion Notfallmedizin, Universitätsklinik für Anästhesiologie, Prittwitzstraße 43, 89075 Ulm
| | - V. Wenzel
- Klinik für Anästhesie und allgemeine Intensivmedizin, Universität, Innsbruck, Österreich
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Schlechtriemen T, Dirks B, Lackner CK, Moecke H, Stratmann D, Altemeyer KH. Die „Interdisziplinäre Notaufnahme“ im Zentrum zukünftiger Notfallmedizin. Notf Rett Med 2005. [DOI: 10.1007/s10049-005-0767-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gries A, Bernhard M, Dirks B. Leitbild für die Leitstelle — Gefahren im Einsatz — Notfallmedizin im DRG-Zeitalter. Notf Rett Med 2005. [DOI: 10.1007/s10049-005-0747-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Schlechtriemen T, Dirks B, Lackner CK, Moecke H, Ruppert M, Stratmann D, Altemeyer KH. Deficits in Emergency Care - Are Good Concepts Poorly Realized? Notarzt 2004. [DOI: 10.1055/s-2004-828387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Dirks B, Ellinger K, Genzw�rker H, Henn-Beilharz A, Koberne F, Throm G, Wettig T. Empfehlung f�r die notfallmedizinische Absicherung bei Gro�veranstaltungen. Notf Rett Med 2004. [DOI: 10.1007/s10049-004-0684-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Seekamp A, Dirks B. Gro�veranstaltungen?�LRD/LNA?Recht des Notarztes. Notf Rett Med 2004. [DOI: 10.1007/s10049-004-0671-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lehle B, Nowak R, Dirks B. Fulminante Lungenembolie. Notf Rett Med 2002. [DOI: 10.1007/s10049-002-0489-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Spörri R, Dirks B. Intoxikationen. Notf Rett Med 2000. [DOI: 10.1007/s100490050215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Dirks B. Leitsymptom Stridor. Notf Rett Med 2000. [DOI: 10.1007/s100490050222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Moecke H, Dirks B, Friedrich HJ, Hennes HJ, Lackner CK, Messelken M, Neumann C, Pajonk FG, Reng M, Schächinger U, Violka T. [DIVI emergency medicine protocol, version 4.0]. Anaesthesist 2000; 49:211-3. [PMID: 10788991 DOI: 10.1007/s001010050817] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- H Moecke
- Institut für Notfallmedizin des LBK Hamburg
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Moecke H, Dirks B, Friedrich HJ, Hennes HJ, Lackner CK, Messelken M, Neumann C, Pajonk FG, Reng M, Schächinger U, Violka T. DIVI-Notarzteinsatz-protokoll, Version 4.0. Notf Rett Med 1999. [DOI: 10.1007/s100490050163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schmidt M, Strohmenger U, Dirks B, Lindner K. Effect of cardiac arrest and CPR on cerebral autoregulation after return of spontaneous circulation (ROSC). Resuscitation 1997. [DOI: 10.1016/s0300-9572(97)84260-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dirks B, Öchner W, Weiβer FO, Georgieff M. The ULM emergency training circuit concept, realization and acceptance of the student course in emergency medicine. Resuscitation 1997. [DOI: 10.1016/s0300-9572(97)84270-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lindner KH, Dirks B, Strohmenger HU, Prengel AW, Lindner IM, Lurie KG. Randomised comparison of epinephrine and vasopressin in patients with out-of-hospital ventricular fibrillation. Lancet 1997; 349:535-7. [PMID: 9048792 DOI: 10.1016/s0140-6736(97)80087-6] [Citation(s) in RCA: 313] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Studies in animals have suggested that intravenous vasopressin is associated with better vital-organ perfusion and resuscitation rates than is epinephrine in the treatment of cardiac arrest. We did a randomised comparison of vasopressin with epinephrine in patients with ventricular fibrillation in out-of-hospital cardiac arrest. METHODS 40 patients in ventricular fibrillation resistant to electrical defibrillation were prospectively and randomly assigned epinephrine (1 mg intravenously; n = 20) or vasopressin (40 U intravenously; n = 20) as primary drug therapy for cardiac arrest. The endpoints of this double blind study were successful resuscitation (hospital admission), survival for 24 h, survival to hospital discharge and neurological outcome (Glasgow coma scale). Analyses were by intention to treat. FINDINGS Seven (35%) patients in the epinephrine group and 14 (70%) in the vasopressin group survived to hospital admission (p = 0.06). At 24 h, four (20%) epinephrine-treated patients and 12 (60%) vasopressin-treated patients were alive (p = 0.02). Three (15%) patients in the epinephrine group and eight (40%) in the vasopressin group survived to hospital discharge (p = 0.16). Neurological outcomes were similar (mean Glasgow coma score at hospital discharge 10.7 [SE 3.8] vs 11.7 [1.6], p = 0.78). INTERPRETATION In this preliminary study, a significantly larger proportion of patients created with vasopressin than of those treated with epinephrine were resuscitated successfully from out-of-hospital ventricular fibrillation and survived for 24 h. Based upon these findings, larger multicentre studies of vasopressin in the treatment of cardiac arrest are needed.
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Affiliation(s)
- K H Lindner
- Department of Anesthesiology and Critical Care Medicine, University of Ulm, Germany
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Schneider T, Wik L, Baubin M, Dirks B, Ellinger K, Gisch T, Haghfelt T, Plaisance P, Vandemheen K. Active compression-decompression cardiopulmonary resuscitation--instructor and student manual for teaching and training. Part I: The workshop. Resuscitation 1996; 32:203-6. [PMID: 8923582 DOI: 10.1016/0300-9572(96)00946-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In an attempt to standardize the teaching and training of active compression-decompression cardiopulmonary resuscitation (ACD-CPR), a group of leading emergency physicians, cardiologists, anesthesiologists, paramedics and nurses with practical, theoretical, educational, and scientific experience in the subject met in June 1995. The group was called The International Working Group of Teaching and Training Active Compression-Decompression CPR. The group was 'born' as a result of the first International Conference of Active Compression-Decompression CPR held in Copenhagen in March 1995. The following paper describes the background, development and text of and ACD-CPR course manual for both students and instructors.
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Affiliation(s)
- T Schneider
- Johannes Gutenberg University, Department of Anaesthesiology, Mainz, Germany
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Wik L, Schneider T, Baubin M, Dirks B, Ellinger K, Gisch T, Haghfelt T, Plaisance P, Vandemheen K. Active compression-decompression cardiopulmonary resuscitation--instructor and student manual for teaching and training. Part II: A student and instructor manual. Resuscitation 1996; 32:206-12. [PMID: 8923583 DOI: 10.1016/0300-9572(96)82051-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- L Wik
- Johannes Gutenberg University, Department of Anaesthesiology, Mainz, Germany
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Dirks B, Lindner K, Leber M, Georgieff M. P-64 Quality management of emergencies: Does the “ZEK” concept work? Resuscitation 1996. [DOI: 10.1016/0300-9572(96)83926-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dirks B, Weiβer F, Schmidt M, Georgieff M. O-5 Performance-based assessment of resuscitation skills. Resuscitation 1996. [DOI: 10.1016/0300-9572(96)83789-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Dirks B, Keller AW, Jäger G, Ochsner W, Weisser FO, Georgieff M. [The Ulm Emergency Training Course. 2: Realization and acceptance of the emergency medicine practicum]. Anasthesiol Intensivmed Notfallmed Schmerzther 1996; 31:222-7. [PMID: 8704080 DOI: 10.1055/s-2007-995905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The first part of this publication described the concept of the student course in emergency medicine at the University Hospital Ulm as part of a "vertical curriculum" of education in emergency medicine. METHODS. A training circuit (Fig. 1) was conceptualised using training manikins (i.e. BLS, intubation, megacode training, ATLS training), computer programmes (ECG-simulation) and other means of instruction to simulate twelve realistic situations. These practical skill sessions were linked with case presentation and lectures. Its topics were chosen depending on the prevalence, type and urgency. Separate guidelines for teachers and students were edited prior to the beginning of the course in 1994. RESULTS. Evaluation showed good acceptance by the students for most parts of the course except the ATLS skill station and CPR computer simulations (Table 5). The score of the national board examination (multiple-choice test) of the students from Ulm was nevertheless not better than the mean of all german examinees (72.1 to 71.7%). CONCLUSION. The concept of the course in emergency medicine is well accepted by our students. Results of the national examination were not improved, since the course aims at performance, skills and competence in emergency medicine and not at teaching factual knowledge that is measured by the MCQ examinations.
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Affiliation(s)
- B Dirks
- Universitätsklinik für Anästhesiologie, Universität Ulm
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Dirks B, Krier C. [Education and research in emergency medicine. Responsibilities of the anesthesiology specialty]. Anasthesiol Intensivmed Notfallmed Schmerzther 1996; 31:125-6. [PMID: 8672612 DOI: 10.1055/s-2007-995887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Dirks B, Keller AW, Jäger G, Ochsner W, Weisser FO, Georgieff M. [The Ulm emergency medicine training course. 1: Concept]. Anasthesiol Intensivmed Notfallmed Schmerzther 1996; 31:168-71. [PMID: 8672619 DOI: 10.1055/s-2007-995894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The course in emergency medicine was introduced by the German Federal Government to meet the requirements of the curriculum of the 4th year of medical education in 1992. The Department of Anaesthesiology of the University Hospital Ulm drew up a course consisting of one week of practical instructions (Table 3) for groups of 24 students, case presentation and accompanying lectures that cover the topics of emergency medicine (Table 2). The course is part of continuous education in emergency medicine. It starts with courses in "first aid" and "first medical attendance to emergencies" followed by the "course"in emergency medicine" and further training weeks on the "mobile intensive care unit (MICU)" during the "internship" as well as a course on emergency medicine for ambulance doctors and the training on he job by an emergency physician during residency (Table 1). The aim of the course is training competence (psychomotoric skills and clinical competence) for the primary care of life-threatening emergencies. The following educational methods were included in the concept: problem oriented learning, situation-oriented learning, learning by doing (cognitive apprenticeship).
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Affiliation(s)
- B Dirks
- Universitätsklinik für Anästhesiologie, Klinikum der Universität Ulm
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Pecar A, Dirks B. [Mixtures of infusion solutions and drugs. Compatibility and incompatibility]. Anaesthesist 1995; 44:793-803. [PMID: 8678272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- A Pecar
- Apotheke Klinikum Innenstadt, Ludwig-Maximilians-Universität München
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Dirks B, Georgieff M. [Current developments in preclinical therapy]. Anasthesiol Intensivmed Notfallmed Schmerzther 1995; 30:297-8. [PMID: 7548481 DOI: 10.1055/s-2007-996495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Dirks B. [Resuscitation by active compression and decompression]. Anasthesiol Intensivmed Notfallmed Schmerzther 1995; 30:309-12. [PMID: 7548485 DOI: 10.1055/s-2007-996499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- B Dirks
- Universitätsklinik für Anästhesiologie, Universität Ulm
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Abstract
In pentobarbital-anesthetized rats, responses of single neurons in ventrolateral orbital cortex (VLO) to noxious visceral (colorectal distension, CRD) and cutaneous stimulation were recorded. Of 71 neurons identified on the basis of spontaneous activity, 44 responded to CRD. CRD caused inhibition of neuronal activity in 38, facilitation of activity in four and 'mixed' responses in two of these cells. Cutaneous receptive fields were identified in 31 CRD-responsive and 10 CRD-non-responsive neurons. Cutaneous receptive fields were large and bilateral. 25 CRD-responsive cells responded only to noxious cutaneous stimulation, six had wide dynamic range responses. Six CRD-non-responsive cells responded only to noxious stimuli, four had wide dynamic range responses. No VLO neuron responded only to innocuous stimuli. These data are consistent with involvement of VLO in visceral nociception, possibly in non-discriminative aspects of nociception.
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Affiliation(s)
- K A Follett
- Division of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City 52242
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Gmehlin U, Marx T, Dirks B. Ventricular fibrillation due to hypocalcemia after parathyroidectomy with autotransplantation of parathyroid tissue in a dialysis patient. Nephron Clin Pract 1995; 70:110-1. [PMID: 7617090 DOI: 10.1159/000188554] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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