Certification of cardiac arrest centers Presentation and guidance of cardiac arrest center certification in Germany

The treatment of patients with cardiac arrest is very complex. The therapy of these critically ill patients in a designated center improves their prognosis. Thus, cardiac arrest center (CAC) certification has been established, which requires re-certification at specified audits. The certification procedure is a multistage process and takes about one year in total. A CAC combines all important pre- and in-hospital multidisciplinary players. Infrastructure, evidence-based treatment algorithms, structured training as well as repeating evaluations within conferences with statistical observations including process optimization have to be established. The main goal is the focused organization of the center. Every patient with comparable conditions and prerequisites should, thus, receive a similar treatment pathway without being dependent on individual actors. Multidisciplinary cooperation, accurate procedures with high standards for patient safety and exact documentation are required. The result of these measures leads to treatment optimization and outcome improvement of patients with or after cardiac arrest. In the updated international resuscitation guidelines of 2020/21, this led to a stronger recommendation for the establishment of cardiac arrest centers

Analgesia for trauma patients in emergency medicine

Adequate analgesia is one of the most important measures of emergency care in addition to treatment of vital function disorders and, if indicated, should be promptly undertaken; however, a large proportion of emergency patients receive no or only inadequate pain therapy. The numeric rating scale (NRS) is recommended for pain assessment but is not applicable to every group of patients; therefore, vital signs and body language should be included in the assessment. Pain therapy should reduce the NPRS to <5 points. Ketamine and fentanyl, which have an especially rapid onset of action, and also morphine are suitable for analgesia in spontaneously breathing patients. Basic prerequisites for safe and effective analgesia by healthcare professionals are the use of adequate monitoring, the provision of well-defined emergency equipment, and the mastery of emergency procedures. In a structured competence system, paramedics and nursing personnel can perform safe and effective analgesia

Analgesia in Patients with Trauma in Emergency Medicine A Systematic Review and Meta-analysis

Background: Suitable analgesic drugs and techniques are needed for the acute care of the approximately 18 200-18 400 seriously injured patients in Germany each year. Methods: This systematic review and meta-analysis of analgesia in trauma patients was carried out on the basis of randomized, controlled trials and observational studies. A systematic search of the literature over the 10-year period ending in February 2016 was carried out in the PubMed, Google Scholar, and Springer Link Library databases. Some of the considered trials and studies were included in a meta-analysis. Mean differences (MD) of pain reduction or pain outcome as measured on the Numeric Rating Scale were taken as a summarizing measure of treatment efficacy. Results: Out of 685 studies, 41 studies were considered and 10 studies were included in the meta-analysis. Among the drugs and drug combinations studied, none was clearly superior to another with respect to pain relief. Neither fentanyl versus morphine (MD -0.10 with a 95% confidence interval of [-0.58; 0.39], p = 0.70) nor ketamine versus morphine (MD -1.27 [-3.71; 1.16], p = 0.31), or the combination of ketamine and morphine versus morphine alone (MD -1.23 [-2.29; -0.18], p = 0.02) showed clear superiority regarding analgesia. Conclusion: Ketamine, fentanyl, and morphine are suitable for analgesia in spontaneously breathing trauma patients. Fentanyl and ketamine have a rapid onset of action and a strong analgesic effect. Our quantitative meta-analysis revealed no evidence for the superiority of any of the three substances over the others. Suitable monitoring equipment, and expertise in emergency procedures are prerequisites for safe and effective analgesia by healthcare professionals.