Invasive Techniken in der Notfallmedizin: IV. Koniotomie im Notarztdienst

Zusammenfassung: Die Koniotomie im Notarztdienst ist eine sehr invasive Methode zur Atemwegssicherung. Sie ist aber unabdingbar, wenn andere weniger invasive Verfahren der Atemwegssicherung misslingen oder sich situationsabhängig als nicht zweckmäßig erweisen. Für die Durchführung wurden verschiedene Verfahren beschrieben, die in anatomisch-chirurgische Präpariertechniken und Punktionsverfahren unterteilt werden können. Das im jeweiligen Notarztsystem bevorzugte Verfahren orientiert sich meist an abteilungsüblichen Standards, die vom klinischen Vorgehen abgeleitet werden. Ausbildungs- und Trainingsmöglichkeiten für die einzelnen Verfahren bestehen in der Intensivmedizin, am Leichenpräparat und am Phantom. In dieser Arbeit werden verschiedene Methoden der Koniotomie besprochen sowie eine anatomische Präpariertechnik und 2Punktionsverfahren im Detail dargestell

Pennsylvania Folklife Vol. 46, No. 1

• The Mennonites of Pennsylvania: A House Divided • Not Only Tradition, but Truth : Legend and Myth Fragments Among Pennsylvania Mennonites • Mennonite Women and Centuries of Change in America • It is Painful to Say Goodbye : A Mennonite Family in Europe and Americahttps://digitalcommons.ursinus.edu/pafolklifemag/1147/thumbnail.jp

HCC recurrence in HCV-infected patients after liver transplantation: SiLVER Study reveals benefits of sirolimus in combination with CNIs - a post-hoc analysis

Factors affecting outcomes in liver transplant (LTx) recipients with hepatocellular carcinoma (HCC) and hepatitis C viral (HCV) infection include the choice of immunosuppression. Here, we analyzed the HCV+ subgroup of patients from the randomized controlled, international SiLVER Study. We performed a post hoc analysis of 166 HCV+ SiLVER Study patients regarding HCC outcome after LTx. Control patients (group A: n = 88) received mTOR inhibitor (mTORi)-free, calcineurin inhibitor (CNI)-based versus sirolimus-based immunosuppression (group B: n = 78). We found no significant difference regarding HCV-RNA titers between group A and B. Since no effect in group B could be due to variable sirolimus dosing, we split group B into patients receiving sirolimus-based immunosuppression + CNIs for >50% (B1; n = 44) or <50% (B2; n = 34) of the time. While there remained no difference in HCV-RNA titer between groups, HCC recurrence-free survival in group B1 (81.8%) was markedly better versus both group A (62.7%; P = 0.0136) and group B2 (64.7%; P = 0.0326); Interestingly, further subgroup analysis revealed an increase (P = 0.0012) in liver enzyme values in group B2. Taken together, in HCV-infected patients with HCC and LTx, mTORi immunosuppression + CNIs yields excellent outcomes. Unexpectedly, higher levels of liver inflammation and poorer outcomes occur with mTORi monotherapy in the HCV+ subgroup

Präventiver und therapeutischer Einsatz von Antibiotika in der Zahnheilkunde

In dentistry antibiotics are used as a prophylactic measure as well as for therapeutic reasons. For the general practitioner, antibiotic prophylaxis of infectious diseases of dental or oral origin is more prevalent than the antibiotic treatment of such infections. Patients suffering from bacterial infections of oral origin should be referred to a dentist or to an oral surgeon. This review aims to precisely describe the indications for antibiotic preventive measures before dental or oral surgical treatments. Theses measures should be commonly planned by the general practitioner and the dentist. The actual treatment of the infection should, however, be left to the dentist, oral or maxillofacial surgeon

Zahnärztliche Eingriffe bei antikoagulierten Patienten

It has long been a standard procedure to replace coumarin by heparin if a patient using this oral anticoagulant had to undergo dental surgery. The Quick-Value had then to exceed a certain limit before surgery could be safely performed. Today this procedure has changed in that a switch to heparin is only made for invasive and large area surgery. Simple dental extractions, small biopsies and periodontal treatments are performed under continuous oral anticoagulation and local hemostyptic measures are applied. It has been shown that the likelihood of postoperative bleeding complications after adequate local hemostasis during dental surgery is much lower than is the risk of thrombosis or embolic complication following cessation of anticoagulant medication before surgery

Usporedba intramuskularno primijenjenog i inhaliranog epinefrina: eksperimentalno istraživanje

Purpose: The intravenous or intramuscular administration of epinephrine is recommended treatment in systemic anaphylaxis. The goal was to evaluate epinephrine plasma levels after intramuscular injection into the buccinator muscle in comparison to inhaled epinephrine. Methods: In this pilot study in humans, we measured plasma epinephrine concentrations before and after epinephrine administration by intramuscular injection, or by inhalation, with intramuscular saline and intravenous epinephrine as the negative and positive controls, respectively. Results: Peak plasma epinephrine concentrations were higher after epinephrine was injected intramuscularly with a maximum plasma epinephrine concentration of 3367.2 pg/ml. After administration by inhalation epinephrine peak level was 151.89 pg/ml. Conclusions: In cases of respiratory distress when anaphylaxis is a possible cause, at first the application of epinephrine by inhalation may be of value. Manifest major cardiovascular reactions according to anaphylaxis without availability of a venous access can only be treated by titration of epinephrine intramuscularly. The buccinator muscle is a useful site for dentists involved on treatment of anaphylaxis

Device capable of reducing gastric inflation during artificial ventilation in a manikin model

Gastric inflation is a significant issue when ventilation is performed in cases of unprotected airway. The objective of this study was to compare the amounts of gastric insufflation and tidal volumes produced by a hose-extended bag-valve-mask (BVM) device supplemented by an interposed reservoir bag with a similar BVM without the reservoir in a simulated human model. Fourteen academic dental staff members performed 10 ventilations on a manikin using the reservoir-supplemented device in comparison to the control BVM in a randomized order. Lung compliance was adjusted to 45 (high) and 4.5 mL/mbar (low), and the lower esophageal sphincter pressure (LOSP) simulator to a pressure of 15 and 3 mbar, respectively, in different settings. Lower tidal volumes were observed with the new device than with the control BVM at high compliance with LOSP of 15 mbar (median 506 vs. 787 mL, respectively; p = 0.0002) and LOSP of 3 mbar (median 544 vs. 794 mL, respectively; p = 0.0006), as well as during ventilation at low lung compliance and LOSP of 3mbar (median 131 vs. 163 mL, respectively; p = 0.0342). No differences were detected at low lung compliance and LOSP of 15 mbar (median 175 vs. 194 mL; p = 0.3804). Gastric inflation almost exclusively occurred in case of low lung compliance, being markedly lower with the new device than with the control device at 15 mbar LOSP (300 vs. 2225 mL, respectively; p = 0.0006), and at 3 mbar LOSP (1138 vs. 3050 mL, respectively; p = 0.0001). Application of the hose-extended bag-valve-mask device supplemented with a reservoir bag reduces tidal volumes. Marked reduction of gastric inflation by use of this device becomes effective under conditions with low lung compliance