Neue Aspekte der elektrischen Defibrillation

In allen internationalen Empfehlungen stellt die schnellstmogliche Defibrillation die Masnahme der Wahl bei Kammerflimmern (VF) und pulsloser ventrikularer Tachykardie (VT) dar. Der Defibrillation kommt eine Schlusselrolle bei der Bekampfung des plotzlichen Herztodes zu. Technische Neuerungen: Entwicklungen auf technischem Gebiet haben einerseits eine weitere Miniaturisierung und Vereinfachung der Gerate, andererseits eine Anpassung der Energiemenge an die individuellen Patientenbedingungen zum Ziel. Implantierbare Kardioverter-Defibrillatoren (ICD) und automatisierte externe Defibrillatoren (AED) basieren auf der gleichen Technologie, einer gerateinternen Analyse des EKG-Signals mit nachfo…

A Demonstrator for a new Axial PET Concept

In PET imaging, improving sensitivity while maintaining very good spatial resolution is crucial. To achieve this goal, we propose a novel concept of PET scanner, with axially arranged crystals, providing a high sensitivity and a 3D reconstruction of the gamma interaction point. The trans-axial coordinate is given by the crystal hit, while the z coordinate is reconstructed by the weighted distribution of light escaping the crystal and entering into an array of Wave Length Shifting (WLS) strips interleaving the crystal layers. This novel configuration allows full identification of Compton interactions in the crystals that can be included in image reconstruction thus enhancing the sensitivity.…

A Case Study on the Implementation of Stakeholder Management in Organizational Practice

Recent research makes a strong argument for studying how organizations can implement a strategic stakeholder management approach. In this paper, we analyze an empirical case study in order to gain refined knowledge and develop ‘best’ implementation tactics, building on Plaza-Ubeda et al., (A case study of stakeholder identification and prioritization by managers, Journal of Business Ethics, 75: 1–23, 2010) conceptualization of the implementation of stakeholder integration (SI). The case study draws on a project concerning our own university, a private higher-education provider, which faces a new regulatory environment. In response to new legal measures, which include accounting for stakehol…

Optimal Response to Cardiac Arrest study: Defibrillation waveform effects

Abstract Introduction: Advances in early defibrillation access, key to the “Chain of Survival”, will depend on innovations in defibrillation waveforms, because of their impact on device size and weight. This study compared standard monophasic waveform automatic external defibrillators (AEDs) to an innovative biphasic waveform AED. Material and methods: Impedance-compensated biphasic truncated exponential (ICBTE) and either monophasic truncated exponential (MTE) or monophasic damped sine (MDS) AEDs were prospectively, randomly assigned by date in four emergency medical services. The study design compared ICBTE with MTE and MDS combined. This subset analysis distinguishes between the two clas…

One-step polymerase chain reaction-based typing of Helicobacter pylori vacA gene: association with gastric histopathology.

Heterogeneity of the Helicobacter pylori vacA gene may be associated with bacterial virulence and presentation. In this study, the possible correlation between vacA genotypes and gastric histopathology was investigated. Using a modified one-step polymerase chain reaction (PCR)-based method, 122 of 131 H. pylori isolates obtained from 63 of 67 patients from Germany were classified into distinct vacA genotypes according to their signal sequence (s1 or s2) and their midregion alleles (m1 or m2). A possible subtype of m1, now alluded to as m3, was identified in one-third of the isolates. Signal sequence s1 was significantly associated with higher H. pylori density but not with gastric inflammat…

The carotid pulse check revisited: What if there is no pulse?

This study was undertaken to evaluate the diagnostic accuracy and time required by first responders to assess the carotid pulse in potentially pulseless patients. We conducted a prospective, randomized study of first responders (n = 206; four different training levels) and were blinded as to the patients' conditions in the cardiac operating rooms of a university hospital. Sixteen patients underwent coronary artery bypass surgery on nonpulsatile cardiopulmonary bypasses. Carotid pulse check was performed either during pulsatile (spontaneous) or during nonpulsatile (extracorporeal) circulation. Patients' hemodynamic status at the time of assessment, diagnostic accuracy of the first responders…

Endexspiratorisches Kohlendioxid und Überleben nach präklinischem Herz-Kreislaufstillstand

The AX-PET demonstrator—Design, construction and characterization

Abstract Axial PET is a novel geometrical concept for Positron Emission Tomography (PET), based on layers of long scintillating crystals axially aligned with the bore axis. The axial coordinate is obtained from arrays of wavelength shifting (WLS) plastic strips placed orthogonally to the crystals. This article describes the design, construction and performance evaluation of a demonstrator set-up which consists of two identical detector modules, used in coincidence. Each module comprises 48 LYSO crystals of 100 mm length and 156 WLS strips. Crystals and strips are readout by Geiger-mode Avalanche Photo Diodes (G-APDs). The signals from the two modules are processed by fully analog front-end …

Ventilation volumes with different self-inflating bags with reference to the ERC guidelines for airway management: comparison of two compression techniques.

The 1998 ERC-guidelines for airway-management recommend an tidal volume of 400-600 ml for adults undergoing CPR. As commercially available self-inflating bags were designed to meet former recommendations (800-1200 ml) we investigated how to meet the latest recommendations with these bags. We combined the head of a training manikin (Laerdal Medical) and a standard lung (VTTL; Michigan Instrument), adjusted to a physiological compliance and resistance. Volume was measured with a Wright spirometer (BOC). Seven self-inflating bags were investigated. Tests were carried out by ten people (five female and five male) for 5 min each using two different techniques. Technique 1: standard ventilation w…

Normwerte, Tabellen, Scores, Hygiene/Infektionsschutz

Scores erlauben es, durch Punktwerte den Zustand und den Verlauf des Zustandes eines Patienten naherungsweise »objektiv« zu beschreiben. Je nach Score lassen sich dadurch z. B. anatomische oder physiologische Kenngrosen einschatzen. Scores dienen in der Notfallmedizin vorrangig der zugigen Kategorisierung von Patienten (Triage), der von der Person des Arztes weitgehend unabhangigen Einordnung des Patientenzustandes (→ standardisierte Therapie), der Prognosestellung und der Evaluierung von Studien. Beispiele fur haufig verwendete Scores: Bewusstseinszustand/neurologischer Status: Glasgow Coma Scale (GCS; ⊡ Tab. 17.6). Physiologischer Status des Neugeborenen: APGAR-Score (⊡ Tab. 17.5) Verlauf…

Einsatz, Technik, Taktik

Das Leben (lat. vita) ist unmittelbar von drei Funktionssystemen, den Vital­funktionen, abhangig: Hirnfunktion (Zentralnervensystem ➯ Bewustsein u. Vigilanz = Wachheit), Atmung (respiratorisches System), Herz-Kreislauf-Funktion (kardiozirkulatorisches System).

Solidification behavior of the theta system 2-propanol/poly(n-butyl methacrylate)

Thermoreversible gelation of the system 2-propanol/poly (n-butyl methacrylate) — as detected by D'SC or dielectric experiments — does not manifest itself in a straightforward manner in the dynamic-mechanical properties. Its occurrence can, however, be seen in many ways: i) For constant composition of the system and a reference temperature lower than Tgel, the storage modulus G′ is larger than the loss modulus G″ in the glass transition zone of the master curve and both vary in an almost parallel manner with the angular frequency ω over almost two decades (whereas this feature is normally found for other gelling systems within the rubber plateau or the flow region). ii) The entanglement mole…

Quantum Chemical-Based Protocol for the Rational Design of Covalent Inhibitors.

We propose a structure-based protocol for the development of customized covalent inhibitors. Starting from a known inhibitor, in the first and second steps appropriate substituents of the warhead are selected on the basis of quantum mechanical (QM) computations and hybrid approaches combining QM with molecular mechanics (QM/MM). In the third step the recognition unit is optimized using docking approaches for the noncovalent complex. These predictions are finally verified by QM/MM or molecular dynamic simulations. The applicability of our approach is successfully demonstrated by the design of reversible covalent vinylsulfone-based inhibitors for rhodesain. The examples show that our approach…

Active compression-decompression resuscitation: a prospective, randomized study in a two-tiered EMS system with physicians in the field.

Improved cardiopulmonary circulation with active compression-decompression cardiopulmonary resuscitation (ACD-CPR) has been demonstrated in studies using different animal models and a small number of humans in cardiac arrest (CA). However, prehospital studies have shown both positive and no extra benefit of ACD-CPR on return of spontaneous circulation (ROSC), hospital admission and discharge rates. The aim of our prospective study was to compare standard manual CPR (S-CPR) with ACD-CPR as the initial technique of resuscitating patients with out-of-hospital CA, with respect to survival rates and neurological outcome. Patients with out-of-hospital CA treated by emergency medical services (EMS…

Performance of the AX-PET Demonstrator

The goal of the AX-PET project is to build and test a demonstrator for a high resolution, high sensitivity PET scanner, based on a novel geometrical concept of long axially oriented crystals. The demonstrator comprises two PET modules used in coincidence. The two modules have been constructed and characterized (both individually and in coincidence) in dedicated test setups, with point-like sources. Good performance in terms of energy, spatial and timing resolution have been demonstrated. First measurements with extended phantoms filled with FDG-radiotracers have been recently performed.

Erstversorgung des Notfallpatienten

Fruhestmogliche Erfassung von Storungen oder Bedrohungen der Vitalfunktionen. Es empfiehlt sich das Vorgehen nach feststehenden Algorithmen (ABCDE-Schema ▸ Kap. 9.7.2, ⊡ Tab. 9.8, CPR-Algorithmen fur BLS und ALS ▸ Kap. 5, ⊡ Abb. 5.1 und 5.2).

Development of a High Precision Axial 3-D PET for Brain Imaging

We describe a PET device based on a novel method to extract the coordinates of the interaction point of the 511keV γ rays from 100 mm long and thin LYSO (Lutetium Yttrium OxyorthoSilicate) scintillator bars, positioned axially in the tomograph. The coordinate along the hit crystal is measured by using a hodoscope of Wave Length Shifting (WLS) plastic strips mounted perpendicularly to each plane of scintillators. As photodetectors, new Geiger mode Avalanche PhotoDetectors (G-APDs) with integrated electronics are being used to detect both the hit crystal in a block (x and y coordinates) and the interaction point in the crystal (z coordinate) through the light escaping from the crystal and tra…

Pressure-Induced Binding Sites in Molecularly Imprinted Network Polymers

Molecular imprinting in network polymers under high pressure was studied as a means of inducing selective binding sites for molecular recognition. Network polymers of methacrylic acid and ethylene ...

AX-PET: Concept, proof of principle and first results with phantoms

AX-PET is a novel PET concept based on long crystals axially arranged and orthogonal Wavelength shifter (WLS) strips, both individually readout by Geiger-mode Avalanche Photo Diodes (G-APD). Its design was conceived in order to reduce the parallax error and simultaneously improve spatial resolution and sensitivity. The assessment of the AX-PET concept and potential was carried out through a set of measurements comprising individual module characterizations and scans in coincidence mode of point-like and extended sources. The estimated energy and spatial resolutions from point-like measurements are R FWHM =11.6% (at 511 keV) and 1.7–1.9 mm (FWHM) respectively as measured with point-like sour…

Multicenter, Randomized, Controlled Trial of 150-J Biphasic Shocks Compared With 200- to 360-J Monophasic Shocks in the Resuscitation of Out-of-Hospital Cardiac Arrest Victims

Background —In the present study, we compared an automatic external defibrillator (AED) that delivers 150-J biphasic shocks with traditional high-energy (200- to 360-J) monophasic AEDs. Methods and Results —AEDs were prospectively randomized according to defibrillation waveform on a daily basis in 4 emergency medical services systems. Defibrillation efficacy, survival to hospital admission and discharge, return of spontaneous circulation, and neurological status at discharge (cerebral performance category) were compared. Of 338 patients with out-of-hospital cardiac arrest, 115 had a cardiac etiology, presented with ventricular fibrillation, and were shocked with an AED. The time from the e…

Aktive Kompressions-Dekompressions-Reanimation (ACD-CPR)

□ Hintergrund Aktive Kompression, kombiniert mit aktiver Dekompression (ACD-CPR) mit Hilfe einer Druck-Saugglocke (Cardio Pump®, Ambu Int.), fuhrt zu einer verbesserten Organdurchblutung wahrend der kardiopulmonalen Reanimation im Vergleich zur Standardreanimationstechnik. Die Ergebnisse praklinischer Studien differieren in den verschiedenen Zentren und sind von den logistischen Gegebenheiten des jeweiligen Rettungssystems abhangig: Die Einfuhrung der ACD-CPR fuhrte in einigen Zentren zu einer signifikanten Erhohung der Uberlebensrate, wahrend sie in anderen, Zentren das Reanimationsresultat nicht beeinfluste.

Einfache lebensrettende Sofortma�nahmen beim Erwachsenen ? ,,Ein Helfer-Reanimation`` Eine Rahmenempfehlung der Arbeitsgruppe ,,Einfache lebensrettende Sofortma�nahmen`` des International Liaison Committee on Resuscitation (ILCOR)

Solidification behavior of the theta system 2-propanol/poly(n-butyl methacrylate) I. Influences of thermoreversible gelation on stationary flow

Zero shear viscosities, η0, were determined by means of a magnetoviscometer for melts of poly(n-butyl methacrylate) (M = 8.7 to 450 kg/mol, T =53.5 to 200°C) and for concentrated solutions of the highest molecular weight sample in isopropanol (T = 34.8 to 131.5 °C). Master curves can be constructed in both cases if the reference temperature is set proportional to the gelation temperature of the particular fluid. Special intersegmental interactions (eventually leading to thermoreversible gelation) can above all be felt in η0 (T) and in M c , the critical molecular weight determined in plots of log η0 vs. log M. As the temperature is lowered, the behavior changes from WLF to Arrhenius, and M …

186 Early Defibrillation in a Two-Tier Emergency Medical System (EMS) with Physician Staffed Ambulances

Herz-Kreislauf-Stillstand

CPR (»cardiopulmonary resuscitation«) wird formal untergliedert in BLS (»basic life support«): einfache lebensrettende Masnahmen (Basismasnahmen), die auch durch trainierte Laien und notfalls ohne Hilfsmittel durchgefuhrt werden konnen. Zum BLS gehort auch die Defibrillation mit automatisierten externen Defibrillatoren (AED), z. B. durch entspr. unterwiesene Laien. ALS (»advanced life support«): erweiterte lebensrettende Masnahmen, deren Durchfuhrung eine besondere Ausrustung und Ausbildung erfordert.

Carbon dioxide levels during pre-hospital active compression–decompression versus standard cardiopulmonary resuscitation

Abstract In a prospective randomised study we investigated end-tidal carbon dioxide levels during standard versus active compression–decompression (ACD) cardiopulmonary resuscitation (CPR) assuming that the end-tital carbon dioxide reflects cardiac output during resuscitation. In each group 60 patients with out-of-hospital cardiac arrest were treated either with the standard or the ACD method. End-tidal CO 2 ( p et CO 2 , mmHg) was assessed with a side-stream capnometer following intubation and then every 2 min up to 10 min or restoration of spontaneous circulation (ROSC). There was no difference in p et CO 2 between both patient groups. However, CO 2 was significantly higher in patients wh…

Helicobacter pylori: clonal population structure and restricted transmission within families revealed by molecular typing.

ABSTRACT Helicobacter pylori infects up to 50% of the human population worldwide. The infection occurs predominantly in childhood and persists for decades or a lifetime. H. pylori is believed to be transmitted from person to person. However, tremendous genetic diversity has been reported for these bacteria. In order to gain insight into the epidemiological basis of this phenomenon, we performed molecular typing of H. pylori isolates from different families. Fifty-nine H. pylori isolates from 27 members of nine families were characterized by using restriction fragment length polymorphism analysis of five PCR-amplified genes, by pulsed-field gel electrophoresis (PFGE) of chromosomal DNA, and …

Struktur- und Ergebnisqualit�t eines Rettungssystems

Ziel dieser Untersuchung war es zu klaren, ob die Struktur des Mainzer Rettungssystems eine flachendeckende und fristgerechte Versorgung von Notfallpatienten gewahrleistet. Daruber hinaus wurde der Einflus infrastruktureller Faktoren des Stadtgebietes sowie der Reanimation durch Ersthelfer auf Struktur- und Ergebnisqualitat untersucht. Das zu untersuchende System versorgt 190 000 Einwohner auf einer Flache von 80 km2 mit Hilfe von 4 Rettungs- (RTW) und 1 Notarztwagen (NAW), die in einem gestaffelten System mit den Moglichkeiten eines Fruhdefibrillationsprogramms fur Rettungsassistenten eingesetzt werden.

Checking the carotid pulse check: diagnostic accuracy of first responders in patients with and without a pulse.

International guidelines for cardiopulmonary resuscitation (CPR) in adults advocate that cardiac arrest be recognized within 5-10 s, by the absence of a pulse in the carotid arteries. However, validation of first responders' assessment of the carotid pulse has begun only recently. We aimed (1) to develop a methodology to study diagnostic accuracy in detecting the presence or absence of the carotid pulse in unresponsive patients, and (2) to evaluate diagnostic accuracy and time required by first responders to assess the carotid pulse. In 16 patients undergoing coronary artery bypass grafting, four groups of first responders (EMT-1: 107 laypersons with basic life support (BLS) training; EMT-2…

The AX-PET Concept: New Developments And Tomographic Imaging

The Axial PET (AX-PET) concept proposes a novel detection geometry for PET, based on layers of long scintillating crystals axially aligned with the bore axis. Arrays of wavelength shifting (WLS) strips are placed orthogonally and underneath the crystal layers; both crystals and strips are individually readout by G-APDs. The axial coordinate is obtained from the WLS signals by means of a Center-of-Gravity method combined with a cluster algorithm. This design allows spatial resolution and sensitivity to be decoupled and thus simultaneously optimized. In this work we present the latest results obtained with the 2-module AX-PET scanner prototype, which consists of 6 radial layers of 8 LYSO crys…

CERN-MEDICIS: A Review Since Commissioning in 2017

The CERN-MEDICIS (MEDical Isotopes Collected from ISolde) facility has delivered its first radioactive ion beam at CERN (Switzerland) in December 2017 to support the research and development in nuclear medicine using non-conventional radionuclides. Since then, fourteen institutes, including CERN, have joined the collaboration to drive the scientific program of this unique installation and evaluate the needs of the community to improve the research in imaging, diagnostics, radiation therapy and personalized medicine. The facility has been built as an extension of the ISOLDE (Isotope Separator On Line DEvice) facility at CERN. Handling of open radioisotope sources is made possible thanks to i…

EKG-Diagnostik im Notfall

Aufgaben des EKG im RD: uberwachung der Herzfrequenz. Differenzialdiagnostik der Herzrhythmusstorungen. Differenzialdiagnostik der Formen des Herz-Kreislauf-Stillstandes. Unterstutzung der Herzinfarkt- und Lungenemboliediagnostik.

Vinyl sulfone building blocks in covalently reversible reactions with thiols

In the present study we use quantum-chemical calculations to investigate how the reactivity of vinyl sulfone-based compounds can be modified from an irreversible to a reversible reaction with thiols. Based on the predictions from theory, an array of nine different vinyl sulfones with systematically varying substitution pattern was synthesized and their crystal structures were determined. Subsequent Hirshfeld surface analyses employing the principle of electrostatic complementarity aid the understanding of the crystal packing of the synthesized compounds. Reactivity studies against the nucleophile 2-phenylethanethiol mirror the properties predicted by the quantum-chemical computations in sol…

The Significance of Ionic Bonding in Sulfur Dioxide: Bond Orders from X-ray Diffraction Data

A novel refinement technique for X‐ray diffraction data has been employed to derive S-O bond orders in sulfur dioxide experimentally. The results show that ionic S-O bonding dominates over hypervalency.

Active compression-decompression cardiopulmonary resuscitation — Instructor and student manual for teaching and training

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 stu…

Normwerte — Scores — DIN — Vorschriften

Die Bedeutung ionischer Bindungsanteile in Schwefeldioxid - Bindungsordnungen aus Röntgenbeugungsdaten

Chirurgische und traumatologische Notfälle

Eine gezielte und systematische Erstuntersuchung (Basischeck und Bodycheck ▸ Kap. 2.1, 3.2.5, ABCDE-Schema ▸ Kap. 9.7, ⊡ Tab. 9.8) und regelmasige Reevaluationen mussen sicherstellen, dass bei einer eindrucksvollen Wunde nicht eine Vitalbedrohung oder ein prognostisch relevanter Befund (z. B. peripherer Nervenschaden) ubersehen wird. Bereits im Rahmen der ersten Annaherung muss eingeschatzt werden, ob eine ausere Gefahrdung, ein bedrohlicher Unfallmechanismus, eine vitale Storung oder ein gefahrliches Verletzungsmuster vorliegt und daher lebensrettende Sofortmasnahmen notig sind.

A Monte-Carlo based model of the AX-PET demonstrator and its experimental validation

AX-PET is a novel PET detector based on axially oriented crystals and orthogonal wavelength shifter (WLS) strips, both individually read out by silicon photo-multipliers. Its design decouples sensitivity and spatial resolution, by reducing the parallax error due to the layered arrangement of the crystals. Additionally the granularity of AX-PET enhances the capability to track photons within the detector yielding a large fraction of inter-crystal scatter events. These events, if properly processed, can be included in the reconstruction stage further increasing the sensitivity. Its unique features require dedicated Monte-Carlo simulations, enabling the development of the device, interpreting …

Long axial crystals for PET applications: The AX-PET demonstrator and beyond

The usage of long, axially oriented scintillator crystals in a PET scanner has been shown by the AX-PET Demonstrator as a possible solution for a high resolution and high sensitivity PET detector. In the AX-PET implementation, arrays of wavelength shifting (WLS) strips, placed orthogonally behind every crystal layer, are used to define the axial coordinate. After extensive characterization measurements, the AX-PET Demonstrator has been successfully used for the reconstruction of several phantoms and a few rodents. Possible extensions of the AX-PET concept towards Time Of Flight capabilities have been investigated, using Philips digital SiPMs as alternative photodetector. Promising CRT value…

Einsatz, Technik, Taktik, Recht

In Deutschland zahlt der Rettungsdienst (RD) zu den Obliegenheiten der Bundeslander. Er ist in den einzelnen Landern durch die Landesrettungsdienstgesetze und weitere regionale und lokale Vorschriften geregelt, sodass sich der Notarzt uber die vor Ort gultigen Regelungen informieren muss (z. B. Mindestqualifikation der nichtarztlichen RDMitarbeiter, Vorgehen bei Todesfeststellung, Alarmierungskriterien fur den LNA, Verhalten bei MANV). Innerhalb der Landergrenzen wurden RD-Bereiche festgelegt, deren Landkreise und kreisfreie Stadte den Rettungszweckverband bilden. Dieser ist i. d. R. kommunalen Behorden zugeordnet. Von diesen wird die Aufgabe des RD auf gemeinnutzige Hilfsorganisationen, Fe…

AX-PET: A novel PET concept with G-APD readout

Abstract The AX-PET collaboration has developed a novel concept for high resolution PET imaging to overcome some of the performance limitations of classical PET cameras, in particular the compromise between spatial resolution and sensitivity introduced by the parallax error. The detector consists of an arrangement of long LYSO scintillating crystals axially oriented around the field of view together with arrays of wave length shifter strips orthogonal to the crystals. This matrix allows a precise 3D measurement of the photon interaction point. This is valid both for photoelectric absorption at 511 keV and for Compton scattering down to deposited energies of about 100 keV. Crystals and WLS s…