Prophylaxis and Therapy for Atrial Fibrillation after General Thoracic Surgery

Following thoracic surgery atrial fibrillation (AF) frequently occurs in 12 to 44% of cases postoperatively and is related to an increased morbidity and mortality. In 2011, the Society of Thoracic Surgeons of the United States published guidelines for the prophylaxis and treatment of postoperative AF. High evidence levels are provided for continuing beta-blocker treatment despite its known negative inotropic effects. Alternatively, the calcium channel blocker diltiazem, or amiodarone for patients without pneumonectomy are recommended for prophylactic therapy. For rate control of AF occurring post surgery, not only selective beta 1-blockers, calcium channel blockers, but also magnesium or digoxin are suitable in haemodynamically stable patients. Amiodarone, beta(1)-blockers and flecainide are preferred for rhythm control in case of haemodynamic stability in regard to possible side effects and contraindications. In contrast, electrical cardioversion is indicated in those patients with haemodynamic instability. Persistent AF of > 48 hours is a target for anticoagulation treatment depending on the individual aspects of the patient and in accordance to the CHADS2 score. The present review article further discusses the evidence for the recommended medical therapy and treatment strategies

Successful prehospital hemostasis with chitosan gauze. Multiple self-inflicted stab wounds to the chest and abdomen

This article presents the case of apatient with haemorrhagic shock due to self-inflicted stab wounds to the chest and upper abdomen during asuicide attempt. Prehospital packing with chitosan gauze resulted in hemostasis and stabilisation of the patient during transport to the hospital. For uncontrolled bleeding from penetrating trauma the use of hemostyptic agents is an important option. The authors believe that hemostyptic agents should be introduced into clinical praxis of emergency medical services (EMS) and their use should be trained by EMS personnel