Die emotionale Zufriedenheit von Patienten mit der anästhesiologischen Betreuung

Objective The evaluation of services by patients is an integral part of continuous quality improvement in anaesthesia. Patient satisfaction is affected by various objective and subjective variables. Individual experiences, impressions and needs represent an important part of overall patient satisfaction. Methods Data of 519 patients were collected in a standardised anonymous questionnaire independent of the post-anaesthetic visit. Results Anaesthesia staff appeared to be friendly to 97 % of patients asked, 95 % of patients wanted to be treated by the same staff in case of another anaesthesia, nearly 87 % felt relaxed and satisfied after anaesthesia. Up to 26 % of patients felt tense after p…

Medical Support for Children's Mass Gatherings

AbstractIntroduction:Medical care must be well-planned for mass gatherings. Events such as fairs, concerts, parades, and rallies cause many people to gather in one place, increasing the chance of injuries and for the development of a disaster. In this study, the level and quality of medical care were evaluated at a mass gathering of approximately 100,000 children. The event was a television-sponsored fun fair.Methods:Every patient contact was documented on printed forms, including data such as the number of patients treated, gender of the patients, presence or absence of a parental escort, time distribution of patient contacts, the diagnoses for the patient contacts, specific therapies appl…

Untersuchung zur Situation der Leitenden Notarztsysteme in Rheinland-Pfalz

In der vorliegenden Untersuchung wurde die Einrichtung eines LNA-Systems in Rheinland-Pfalz mit Stichtag 31.12.97 in Bezug auf Qualitat und Quantitat analysiert. In 24 Landkreisen/kreisfreien Stadten wurde ein tatsachliches LNA-System installiert. In 7 Gebieten wurde noch kein LNA-System installiert, in 4 Fallen waren Ersatzsysteme eingerichtet, die nicht durch den Trager legitimiert worden sind. Die Analyse der 24 existierenden LNA-Systeme zeigte, das nur in 7 Systemen eine geregelte Einsatzbereitschaft vorhanden war, eine schriftliche Dienstordnung wurde nur in 11 Gebieten vertraglich festgehalten. Die essentiellen Hilfsmittel wie personliche Schutzausrustung, drahtlose Kommunikationsmogl…

Notfallmedizinisches Zentrum der Klinik für Anästhesiologie, Johannes Gutenberg-Universität Mainz

Monitoring in der Notfallmedizin

In der modernen Notfallmedizin werden hohe Anspruche an die technische Uberwachung der Patienten gestellt.Diese soll die Sicherheit des Patienten erhohen, die Diagnostik spezifischer medizinischer Probleme erleichtern sowie die Beatmung oder die Gabe potenter Medikamente uberwachen.Die verwendeten Medizingerate mussen an die besonderen Erfordernisse in der Praklinik angepasst sein. Hier sind eine lange Unabhangigkeit von der Stromversorgung, anwenderfreundliche Bedieneroberflache, kompakte Bauweise und geringes Gewicht zu fordern. Zu den Minimalstandards des Monitoring gehoren die nicht invasive Blutdruckmessung, Pulsoximetrie und Elektrokardiographie.Situations- und patientenabhangig konne…

Erstversorgung durch Rettungsassistenten und Rettungssanitäter bei kombinierten Einsätzen von RTW und NAW in einem stationären NAW-System

OBJECTIVE: The present study was conducted to evaluate the quality of paramedic care and the feasibility and cost-effectiveness of sending a well-trained paramedic team to the sight of a medical emergency to initiate active medical treatment prior to the arrival of the mobile intensive care unit (MICU). METHODS: We examined 200 cases of medical treatment initiated by paramedics before arrival of the MICU team at the site of the medical emergency. Using a questionnaire, all emergency procedures performed by the paramedic team on scene were recorded and defined as "required", "carried out", and "accurately performed". The documented emergency procedures were divided into three categories: bas…

Die Transilluminationstechnik

The technique of light-guided intubation is based on the principle that a source of light brought into the trachea results in clearly visible and defined transcutaneous illumination, while no illumination can be observed with the light source in the oesophagus (Fig. 1-7). The Trachlight is a reintroduced instrument for this alternative intubation technique. The essential developments are: a length-adjustable stylet with a removable internal metal wire, a brighter light source, a stable handle with tight fixation of the endotracheal tube, and a time-dependent warning device to avoid extended intubations. One hundred twenty patients (Mallampati I. ASA I-III) were included in the study (conven…

Intubationsnarkosen bei "festsitzenden Zahnprothesen"

Erratum to: R

The EasyTube during general anesthesia for minor surgery

BACKGROUND The EasyTube (EzT) is a supraglottic airway device that is used for emergency airway situations. Ventilation during general anesthesia should also be feasible, but literature on the EzT is scarce. We evaluated the EzT in comparison with the endotracheal tube (ETT) in its use during general anesthesia in a comparative study. METHODS A total of 400 patients with American Society of Anesthesiologists (ASA) physical status I to II scheduled for minor surgery in 4 centers were randomized for ventilation via the ETT or EzT. RESULTS In all patients, the EzT and the ETT could be inserted within 3 attempts. In all EzT patients, the inspiratory and expiratory minute volumes (6.64 ± 0.71 an…

A new device for emergency airway management: the EasyTube.

Videotape Recordings for Evaluation of Quality of Prehospital Trauma Care: First Experiences with a New Technique

Medical Support for Children During Mass Gatherings

Comparison of bystander trauma care for moderate versus severe injury.

At the scene of an accident, the most severely injured patients need trauma care urgently. Bystanders are often present before the emergency medical service arrives and may be able to limit trauma-related damage by providing trauma care at the scene. The aim of this prospective study conducted in Mainz, Germany, and Vienna, Austria, was to compare the frequency and quality of bystander trauma care in moderately versus severely injured patients. Five specific measures (making the scene readily visible for oncoming traffic, extrication and positioning of the trauma patient, control of haemorrhage, and hypothermia protection) were assessed in a questionnaire and evaluated statistically. Bystan…

AIRWAY MANAGEMENT IN TRAUMA PATIENTS

Complications related to airway management in traumatized patients are common and, because of the importance and vulnerability of the ventilatory system, can be life threatening within a very short time. 25,39,48 Therefore, airway management is perhaps the most vital component in the treatment of traumatized patients. Patients who have suffered major trauma can present the most complex airway management problems, especially in the prehospital setting. 19 Because the treatment is time-critical, the evaluation of injuries is usually incomplete at the time airway management is undertaken. If the airway is injured, attempts to secure the airway by performing endotracheal intubation or insertion…

Nasotracheal intubation: look before you leap

Nasotracheal intubation is frequently used for airway management during maxillofacial surgery. Complications such as haemorrhage occur more frequently with this route of intubation than with the orotracheal route. This case report describes a male patient aged 51 yr who developed severe epistaxis after the tube had passed the nares. As an additional complication laryngoscopy and endotracheal intubation failed because of difficult airway (Cormack-Lehane grade 4). Attempts using an intubating laryngeal mask airway and a Bonfils intubating fibrescope did not succeed. The airway was finally managed by cricothyroidotomy. A modified sequence of nasotracheal intubation is proposed to avoid similar…

Totale Spinalan�sthesie im Notarztdienst

Fur die Anwender von paravertebralen Injektionstechniken ergibt sich, dass adaquate personelle und apparative Voraussetzungen zur Abwendung schwerer bleibender Schaden obligat sein mussen.

Totale Spinalanästhesie im Notarztdienst

Die vorliegende Kasuistik beschreibt den auserst seltenen Fall einer auserklinisch aufgetretenen totalen Spinalanasthesie. Neben dem initialen Management werden die weiteren moglichen Komplikationen von paravertebralen Injektionen fur die differenzialdiagnostische Uberlegung erlautert. Das Erkennen der Symptomatik kann neben der lebensrettenden Therapie im weiteren Verlauf bei gesichertem kausalen Zusammenhang eine kostenintensive Ausweitung der Diagnostik und Therapie verhindern. In der Regel behalten die Patienten bei adaquater Notfalltherapie keine bleibenden Schaden zuruck. Fur die Anwender von paravertebralen Injektionstechniken ergibt sich, dass adaquate personelle und apparative Vora…

The Combitube, Self-Inflating Bulb, and Colorimetric Carbon Dioxide Detector to Advance Airway Management in the First Echelon of the Battlefield

Combat lifesavers and Army medics are regular combat soldiers who possess skills that enable them to provide lifesaving assistance to combat casualties. Although their training is not equal to that of paramedics, combat lifesavers and Army medics are trained to assess casualties for airway obstruction, as well as the presence or absence of spontaneous ventilation. They are also familiar with the same basic airway maneuvers that are required for blind insertion of the esophageal-tracheal double-lumen airway (ETDLA). Use of the ETDLA in combination with an esophageal detector device and a colorimetric carbon dioxide detector would require skill similar to that which they already possess in pe…

Two-rescuer CPR results in hyperventilation in the ventilating rescuer.

The "Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care--International Consensus on Science" recommend a tidal ventilation volume of 10 ml/kg body-weight without the use of supplemental oxygen during two-rescuer adult cardiopulmonary resuscitation (CPR). This relates to a ventilation volume of about 6.4 l/min. Additionally, the first aid provider ventilating the victim will breathe for him/herself during the external chest compression period adding another 3.2 l/min of ventilation. Finally, a deep breath is recommended before each ventilation to increase the end-expiratory oxygen concentration of the air exhaled. To investigate the effects of these recommend…

The EasyTube for Airway Management in Emergencies

The EasyTube (EzT) is a new sterile, disposable airway device approved by the European Union in February 2003 and by the U.S. Food and Drug Administration in January 2005. The two-lumen design of the EzT enables it to be used as an endotracheal tube or as a supraglottic emergency airway.To report the preliminary experiences with the EzT airway device in prehospital and in-hospital emergency airway management procedures.All airway management procedures involving the EzT were recorded for a period of 18 months.The EzT was successfully used to intubate 15 patients with unanticipated airway difficulties during either anesthesia induction or prehospital airway management. In all patients, the Ez…

10. Weltkongreß für Notfall- und Katastrophenmedizin

Anlaslich des 20jahrigen Bestehens von WADEM richtete die Klinik fur Anasthesiologie der Johannnes Gutenberg-Universitat Mainz den „10 th World Congress on Emergency and Disaster Medicine” unter der Schirmherrschaft von Bundeskanzler Helmut Kohl erneut am Grundungsort der Gesellschaft aus. Unter der Kongresprasidentschaft von W. F. Dick und S. W. A. Gunn sowie der Ehrenprasidentschaft von P. Safar nahmen in der Zeit vom 24. – 27. September 1997 mehr als 1.000 Teilnehmer aus uber 40 Landern aller Kontinente an der Jubilaumsveranstaltung in Mainz teil.

Bewegungen der Kiefergelenke w�hrend der endotrachealen Intubation

Zwischen der Funktion der Kiefergelenke und der Intubation besteht eine wechselseitige Beziehung: Dysfunktionen konnen ein Intubationshindernis darstellen. Die Intubation kann umgekehrt auch zu Funktionsstorungen im orofazialen System fuhren oder Ausloser akuter Kiefergelenkbeschwerden sein. Eine Aussage zu der nach Aufhebung der physiologischen Schutzmechanismen moglicherweise veranderten Motilitat war bislang nicht moglich. Die Arbeit beschreibt die Anwendung einer Methode zur Erfassung der Kiefergelenkbewegungen sowie typische Befunde wahrend der Intubation. Das Prinzip der elektronischen Achsiographie wurde dahingehend modifiziert, das der Vergleich einer aktiven Mundoffnungsbewegung mi…

Franz Kuhn, his contribution to anaesthesia and emergency medicine.

Franz Kuhn (1866-1929), a German surgeon, made a significant practical and scientific contribution towards the development of modern anaesthesia and emergency medicine. He developed modern, scientifically based concepts in close correlation to practical inventions for every day use. All of his studies and developments were patient orientated and led to remarkable improvements in patient safety. Kuhn was a major protagonist of endotracheal intubation, perfected his flexo-metallic endotracheal tubes, worked on different techniques of intubating the trachea, applied positive pressure to the lungs during thoracic surgery and developed anaesthesia machines. In the early 20th century, he wrote se…

Theoretische Ausbildung für den Notarztdienst

Die Erlangung der in den Rettungsdienstgesetzen der Lander definierten Qualifikation, als Notarzt tatig zu werden, setzt u.a.einen 80-stundigen, interdisziplinaren Kurs “Fachkundenachweis Rettungsdienst” voraus.In diesem Kurs wurde in den letzten Jahren zunehmend deutlich, dass lediglich wenige Teilnehmer die Absicht haben, aktiv im Notarztdienst tatig zu werden, sondern versuchen, allgemeine notfallmedizinische Defizite ausgleichen, die im Rahmen ihrer klinischen Tatigkeit deutlich werden.Kollegen, die vor Beginn ihrer notarztlichen Tatigkeit stehen,beklagen hingegen den zu geringen Anteil spezieller Fragestellungen der praklinischen Notfallmedizin zur Vertiefung des Basiswissens. Hieraus …

Artificial ventilation for basic life support leads to hyperventilation in first aid providers.

The 'Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - International Consensus on Science' recommend an artificial ventilation volume of 10 ml/kg bodyweight (equivalent to a tidal volume of 700-1000 ml) without the use of supplemental oxygen in adults with respiratory arrest. For first aid providers using the mouth-to-mouth or mouth-to-nose-ventilation technique, respectively, a ventilation volume of approximately 9.6 l/min results. Additionally, a deep breath is recommended before each ventilation to increase the end-expiratory oxygen concentration of the air exhaled by the first aid provider. To investigate the effects of these recommendations in health…

Planung deutscher Krankenhäuser für Großschadensfälle

Ausergewohnliche Notfallsituationen in Krankenhausern, bei denen der Bedarf an medizinischer Versorgung den tatsachlichen Bedarf bei weitem ubersteigt, konnen nur mit Hilfe suffizienter und an die personelle und geographische Situation des jeweiligen Krankenhauses angepaste Katastrophenschutzplane (KSP) bewaltigt werden. Ziel dieser Umfrage mit 522 teilnehmenden deutschen Krankenhausern war, einen aktuellen Uberblick uber die Qualitat und Verfugbarkeit von KSP zu erhalten. Dabei stellte sich heraus, das 83,5% aller Krankenhauser uber einen KSP verfugen, welcher jedoch in 54,8% nicht zwischen der internen, das Krankenhaus unmittelbar betreffenden und externen Notfallen unterscheidet. Auch wa…

Comparison of two different techniques of fibreoptic intubation

BACKGROUND AND OBJECTIVE The application of analgesics and sedatives during fibreoptic intubation (FOI) may result in a transient decrease in arterial oxygen saturation.This study evaluates two different techniques of FOI and respective effects on procedural duration, arterial oxygen saturation, and coughing by the patient. METHODS Thirty-four patients received a standardized conscious sedation with fentanyl (1.5 microg kg(-1)) and midazolam (12.5 microg kg(-1)).All patients were randomly allocated to one of the following techniques: the 'vaporization' (VAP) technique included four applications of 2 ml lidocaine 2% administered through the working channel of the fibrescope supplying an oxyg…

Bystander trauma care—effect of the level of training

Background: The bystander is often the first person present at the scene of an accident. Our aim was to determine how often and how well bystanders perform trauma care and whether trauma care is affected by the bystander’s level of training, relationship to the patient and numbers of bystanders present. Patients and methods:In a prospective 1-year study, the emergency medical service in two European cities collected data on trauma calls. Questionnaires were used to document the bystanders’ level of training (none, basic, advanced, professional), the bystander’s relationship to the patient, and the number of bystanders present, and to assess whether five separate measures of trauma care (ens…

Infraglottic airway devices and techniques.

Airway management involves far more than just proficiency with tracheal intubation techniques. There are several infraglottic techniques available and the method chosen will depend on the accessibility of equipment, the level of training and expertise, and the patient's specific injury or disease. Endotracheal intubation is most commonly performed by direct laryngoscopy. Several modifications of laryngoscope blades and a variety of adjuncts such as bougies may help to accomplish even a difficult airway. Rigid intubation fibrescopes do improve the view of the larynx, especially in patients with difficult anatomy. They also permit tracheal intubation with less head and cervical spine movement…

Sicherung der Atemwege bei kardiopulmonaler Reanimation

Im Rahmen der kardiopulmonalen Reanimation ist moglichst rasch fur eine ausreichende Ventilation und Oxygenierung zu sorgen. Die Beatmung mittels Beutel-Ventil-Maskensystemen ist wegen des hohen Aspirationsrisikos und der Notwendigkeit, die Thoraxkompressionen mit der Beatmung zu synchronisieren, lediglich fur kurze Zeit akzeptabel. In jedem Fall sollte zusatzlich der Krikoiddruck nach Sellick durchgefuhrt werden.Die direkte Laryngoskopie und das Einfuhren eines Tubus mit Cuff in die Trachea stellen fur Notarzte die erste Wahl der Sicherung der Atemwege im Rahmen der Reanimation dar. Intubationsfiberskope wie das Bonfils oder das Bullard-Laryngoskop konnen zzt. lediglich fur Spezialisten al…