0000000000280694
AUTHOR
A. Michalsen
Ethik im Rettungsdienst
Gesundheitsfursorge in Notfallen ist ein soziales Gut und Ausdruck der Humanitat einer Gesellschaft. Ihr ethisches Grundwerteverstandnis mus allen notfallmedizinischen Entscheidungen zugrundeliegen. Rettungsdienstliche Ethik ist Teil einer allgemeinen medizinischen Ethik, deren Grundlagen umrissen und deren Entscheidungs- und Handlungsanweisungen anhand rettungsdienstlicher Dilemmata gepruft werden. Da der Rettungsdienst aufgrund sich verknappender Ressourcen zunehmend unter wirtschaftlichen Rechtfertigungsdruck gerat, werden als Moglichkeiten zur Rationalisierung ohne Qualitatseinbuse die Abgrenzung nichtiger Masnahmen („futile therapy”) und die Pravention diskutiert. Soll der Rettungsdien…
Status epilepticus in der Spätschwangerschaft - Eklampsie oder Subarachnoidalblutung?
After a largely inconspicuous pregnancy, a 31-year old primipara suffered from a status epilepticus in the third trimenon. The convulsions could not be terminated by emergency medical services, resulting in aspiration of gastric contents. Assuming eclampsia, an emergency caesarean section was performed immediately in a central hospital. Postoperatively, a pathological pattern of tendon reflexes was noticed. A CT scan revealed subarachnoid haemorrhage. The causal aneurysm of the right A. pericallosa was clipped subsequently. Eclampsia is the leading cause of epileptic seizures during pregnancy. However, a different aetiology should always be considered, especially if medical history does not…
The use of esmolol in whole-body hyperthermia: Cardiovascular effects
Whole-body hyperthermia (WBH) is a well-described investigational adjunct to systemic chemotherapy for the treatment of advanced malignancies. The hemodynamic consequences of this physiologic state may include tachycardia, which can produce acute myocardial ischemia in patients with coronary artery disease. Ischemic heart disease is currently considered a contraindication to WBH. We chose to investigate the consequences of using a new beta 1-adrenergic antagonist, esmolol, to attempt to control the tachycardia associated with WBH. After institutional approval and patient consent, nine consecutive patients with normal cardiac function presenting for WBH with carboplatin infusion were studied…