Publications (16)18.62 Total impact
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Article: Kenntnisse angehender Notfallmediziner über die Tumorschmerztherapie bei Palliativpatienten
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ABSTRACT: HintergrundPatienten mit Tumorerkrankungen im palliativen Stadium können unter starken Schmerzexazerbationen leiden. Diese bedürfen einer schnellen, differenzierten und effektiven Therapie. Im Einsatz werden Notfallmediziner bei Patienten unter palliativer Therapie regelmäßig mit Tumorschmerzen konfrontiert. Ziel der vorliegenden Untersuchung war die Evaluation der Vorkenntnisse angehender Notärzte über die Tumorschmerztherapie. MethodenIm Untersuchungszeitraum 2007 bis 2009 wurden 471Teilnehmer standardisierter Notarztausbildungskurse (nach den Empfehlungen der Bundesärztekammer) zu Kenntnissen der Tumorschmerztherapie befragt. Die Auswertung erfolgte bezogen auf die Gesamtgruppe deskriptiv sowie in Abhängigkeit von Berufserfahrung, Gebietsbezeichnung und Erfahrungen in der Therapie von Patienten mit Tumorerkrankungen. Insgesamt wurden 24Wissensfragen zur Tumorschmerztherapie (Antwortmöglichkeiten: Skalierung, offen) anhand eines für die Untersuchung erstellten Fragebogens („mixed methods design“) erhoben. ErgebnisseAusgewertet wurden 469Fragebögen aus 5Kursen. Im Mittel wurden 10,8 der 24Wissensfragen (SD±5,7; Range 2–24) richtig beantwortet. Ärzte in Weiterbildung konnten unabhängig von der Gebietsausbildung signifikant mehr Wissensfragen korrekt beantworten als Ärzte mit Gebietsbezeichnung (p=0,02). Entsprechend den Gebietsausbildungen konnten lediglich Ärzte der inneren Medizin signifikant mehr Wissensfragen richtig beantworten als Ärzte sonstiger Gebietsbezeichnungen (p=0,01). Ärzte mit einer Berufserfahrung ≤5Jahren beantworteten signifikant mehr Wissensfragen korrekt als Ärzte mit >5Jahren Berufserfahrung (p=0,004). SchlussfolgerungDie vorliegende Untersuchung zeigt, dass angehende Notfallmediziner unzureichend in der differenzierten Tumorschmerztherapie ausgebildet sind. Änderungen in der Weiterbildung und frühzeitige Integration relevanter schmerztherapeutischer Themen in die medizinische Ausbildung sind daher weiter zu empfehlen und scheinen bereits erste positive Effekte zu zeigen. Die allgemeine notfallmedizinische Qualität der Versorgung von Patienten mit Tumorschmerzen und der Erfolg der Umsetzung der Empfehlungen müssen in folgenden klinischen Studien untersucht werden. BackgroundCancer diseases are often associated with acute and chronic pain. Therefore, cancer pain is a symptom frequently reported by palliative care patients with cancer diseases. Prehospital emergency physicians may be confronted with exacerbation of pain in cancer patients. The aim of this study was to evaluate the knowledge of prehospital emergency physicians in training concerning cancer pain therapy. MethodsA total of 471 prehospital emergency physicians received a questionnaire (period of time: 2007–2009). The questionnaire was prepared for the study (“mixed methods design”). Twenty-four questions concerning cancer pain therapy (response options: scaling, open) were designed. The evaluation was done descriptively according to professional experience, field name and experience in treating patients with cancer as well. ResultsA total of 469 participants completed the questionnaire (response rate 99%). On average, 10.8 (SD +5.7, range 2–24) questions were answered correctly. Resident physicians answered statistically significantly more questions correctly than consultants (p=0.02). Only physicians working in internal medicine achieved statistically significantly better results than other disciplines (e.g., surgery; p=0.01). Physicians with professional experience of less than 5years answered statistically significantly more questions correctly (p=0.004). ConclusionsThe results of this study verify that emergency physicians in training have insufficient knowledge of pain therapy and end-of-life decisions. The data of this investigation suggest that more attention should be paid to education on pain therapy and end-of-life care in medical curricula. Prehospital emergency physicians may thus be better prepared to provide quality care for palliative patients. SchlüsselwörterPalliative Versorgung-Notfallversorgung, präklinische-Ausbildung-Karzinom-Schmerz KeywordsPalliative care-Emergency care, prehospital-Curriculum-Cancer-PainDer Schmerz 05/2012; 24(5):508-516. · 0.88 Impact Factor -
Article: Präklinische Kindernotfälle
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ABSTRACT: HintergrundPräklinische Kindernotfälle sind aufgrund ihrer relativ niedrigen Prävalenz keine notärztliche Routine, zumal sie in Deutschland überwiegend von nichtspezialisierten Notärzten versorgt werden. Dies führt häufig zu Unsicherheit oder gar Angst. Unklar ist, wie Notärzte Kindernotfälle wahrnehmen und einschätzen bzw. wie sie besser darauf vorbereitet werden können. Material und MethodeMithilfe eines strukturierten Fragebogens wurden alle zum Studienzeitpunkt aktiven Notärzte (n=50) des Zentrums Anaesthesiologie, Rettungs- und Intensivmedizin der Universitätsmedizin Göttingen bezüglich ihrer Wahrnehmung und Einschätzung von präklinischen Kindernotfällen befragt. ErgebnisseDie 43 teilnehmenden Notärzte machten sehr differenzierte Angaben zu den mutmaßlichen Charakteristika präklinischer Kindernotfälle. Das Sicherheitsempfinden stieg mit zunehmendem Alter der Kinder (p<0,03) und der eigenen Erfahrung (p<0,01). Persönliche Defizite wurden vor allem in der kardiopulmonalen Reanimation (n=18) und der Traumaversorgung (n=8) gesehen. Simulatortraining (n=24) sowie Praktika in der Kinderanästhesie und -intensivmedizin (n=12) wurden als Fortbildungsstrategien favorisiert. SchlussfolgerungenNotärzte können die Häufigkeit und Schwere von Kindernotfällen realistisch einschätzen, auch wenn sie selbst damit selten konfrontiert werden. Das größte Erfahrungsdefizit wurde im Bereich eher seltener, jedoch vitalbedrohlicher Notfälle gesehen. Es können drei Ausbildungsbereiche unterschieden werden: innerklinisch an Kindern erlernbare Kenntnisse und Fertigkeiten; an Erwachsenen erworbene, auch an Kindern anwendbare Expertise sowie Training am Phantom oder Simulator von seltenen Krankheitsbildern und Interventionen. BackgroundOut-of-hospital (OOH) pediatric emergencies have a relatively low prevalence. In Germany the vast majority of cases are attended by non-specialized emergency physicians (EPs) for whom these are not routine procedures. This may lead to insecurity and fear. However, it is unknown how EPs perceive and assess pediatric emergencies and how they could be better prepared for them. MethodsAll active EPs (n=50) of the Department of Anaesthesiology, Emergency and Intensive Care Medicine at the University Medical Centre of Göttingen were presented with a structured questionnaire in order to evaluate their perception and assessment of OOH pediatric emergencies. ResultsThe 43 participating EPs made highly detailed statements on the expected characteristics of OOH pediatric emergencies. Their confidence level grew with the children’s age (p<0.03) and with their own experience (p<0.01). The EPs felt particular deficits in the fields of cardiopulmonary resuscitation (n=18) and trauma management (n=8). The preferred educational strategies included simulator-based training (n=24) as well as more exposure to pediatric intensive care and pediatric anesthesia (n=12). ConclusionsDespite their own limited experience EPs can realistically assess the incidence and severity of pediatric emergencies. They felt the greatest deficits were in the care of infrequent but life-threatening emergencies. Three educational groups can be differentiated: knowledge and skills to be gained with children in hospital, clinical experience from adult care also applicable in children and rare diagnoses and interventions to be trained with manikins or simulators.Der Anaesthesist 04/2012; 58(9):876-883. · 0.99 Impact Factor -
Article: Medizinische Notfallteams
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ABSTRACT: Bei bis zu 10% aller hospitalisierten Normalstationpatienten treten während ihres Krankenhausaufenthalts schwerwiegende medizinische Zwischenfälle auf. Diese Zwischenfälle gehen mit einer innerklinischen Letalität von 5–8% einher. Wie im präklinischen Bereich auch, können bei der Mehrzahl dieser Patienten Vorzeichen eines lebensbedrohlichen Ereignisses frühzeitig erkannt werden. Studien legen nahe, dass die Einführung eines innerklinischen, medizinischen Notfallteams („medical emergency team“, MET), das bei mehr oder minder objektivierbaren Abweichungen physiologischer Parameter aktiviert wird, die Inzidenz von innerklinischen Kreislaufstillständen sowie unerwarteten bzw. erneuten Aufnahmen auf die Intensivstation wirkungsvoll reduzieren kann. Diesem Konzept entsprechend sollen MET gefährdete Patienten außerhalb von Intensivpflegestationen frühzeitig evaluieren und behandeln, bevor es zu einer ggf. fatalen Progredienz der Symptomatik kommt. Der vorliegende Artikel gibt einen Überblick über die aktuelle Datenlage zur präventiven innerklinischen Intensivmedizin und reflektiert die Rahmenbedingungen für die Etablierung eines MET-Konzeptes im deutschsprachigen Raum. Severe clinical incidents occur in up to 10% of all non-intensive care unit (ICU) patients, which have an estimated mortality of 5–8%. As in the prehospital setting, early clinical warning signs can be identified in the majority of cases. Studies suggest that introduction of an in-hospital medical emergency team (MET) which responds to objective criteria of physiological deterioration, may effectively reduce the incidence of in-hospital cardiac arrests as well as unanticipated or readmissions to the ICU. According to this concept, METs would evaluate and treat non-ICU patients at risk at an early stage before a potentially fatal deterioration of cardiorespiratory parameters occurs. This article reviews available data on preventive in-hospital intensive care medicine and reflects on the circumstances for an implementation of METs in Germany, Austria and Switzerland.Der Anaesthesist 04/2012; 57(1):70-80. · 0.99 Impact Factor -
Article: Foudroyante Meningokokkensepsis im Notarztdienst
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ABSTRACT: Es wird über einen pädiatrischen Notarzteinsatz des Rettungshubschraubers mit der Einsatzmeldung „Kreislaufstillstand unklarer Genese bei einem 4-jährigen Kind“ berichtet. Anhand dieses Einsatzes bei Meningokokkensepsis mit dem Verdacht auf ein Waterhouse-Friderichsen-Syndrom werden Symptome und Therapie der Meningokokkensepsis und des Waterhouse-Friderichsen-Syndroms im Notarztdienst sowie die erforderliche Postexpositionsprophylaxe diskutiert. A paediatric emergency case with a rescue helicopter, which was reported as unexpected cardiac arrest of a 4-year-old child will be described. Based on this case, the symptoms and therapy of meningococcal sepsis and Waterhouse-Friderichsen-Syndrome under emergency conditions will be discussed as well as aspects of post-exposure prophylaxis.Der Anaesthesist 04/2012; 57(4):369-373. · 0.99 Impact Factor -
Article: [Interhospital transport of intensive care patients in Lower Saxony : statewide need-based and effective management].
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ABSTRACT: Since 2007 interhospital transport of intensive care patients in Lower Saxony appertains to the performance requirements of emergency medical services. Against this background the Working Group for Evaluation of Intensive Care Transport (Arbeitsgemeinschaft Evaluation Intensivverlegung) was established. This group formulated standardized definitions for the requirements of intensive care transport vehicles and a federal statewide monitoring of intensive care transport was implemented to analyze if simultaneously on-call intensive care transport systems (intensive care helicopter and ground based mobile intensive care units) can be deployed need-based and efficiently. A prospective follow-up study and evaluation of intensive care transport in Lower Saxony between April 1(st) 2008 and July 31(st) 2010 was carried out. A total of 6,779 data records were evaluated in this study of which 4,941 (72.9%) missions were located in Lower Saxony, 2,928 (43.2%) missions were carried out by helicopters and 3,851 (56.8%) by ground based mobile intensive care units. The mean duration of a mission was 3 h 59min±2 h 25 min, 4 h 39 min±2 h 23 min by ground based mobile intensive care units and 2 h 21 in±30 min by helicopter units. All systems proved to be feasible for intensive care transport. The degree of urgency was estimated correctly in 94.8% of the evaluated missions and 58.0% of the transfers could not be deployed. In 76.8% patients were transferred to hospitals with a higher level of medical care, 51.7% of patients were transferred for intensive care therapy and 40.4% for an operation/intervention. Of the patients 38.2% required mechanical ventilation and in 48.3% invasive monitoring was carried out. Interhospital transfer of intensive care patients can be carried out need-based with a limited number of intensive care transport vehicles if the missions are deployed effectively by standardized disposition in accordance with performance requirements.Der Anaesthesist 08/2011; 60(8):759-71. · 0.99 Impact Factor -
Article: [Cancer pain therapy in palliative care patients: knowledge of prehospital emergency physicians in training. Prospective questionnaire-based investigation].
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ABSTRACT: Cancer diseases are often associated with acute and chronic pain. Therefore, cancer pain is a symptom frequently reported by palliative care patients with cancer diseases. Prehospital emergency physicians may be confronted with exacerbation of pain in cancer patients. The aim of this study was to evaluate the knowledge of prehospital emergency physicians in training concerning cancer pain therapy. A total of 471 prehospital emergency physicians received a questionnaire (period of time: 2007-2009). The questionnaire was prepared for the study ("mixed methods design"). Twenty-four questions concerning cancer pain therapy (response options: scaling, open) were designed. The evaluation was done descriptively according to professional experience, field name and experience in treating patients with cancer as well. A total of 469 participants completed the questionnaire (response rate 99%). On average, 10.8 (SD +5.7, range 2-24) questions were answered correctly. Resident physicians answered statistically significantly more questions correctly than consultants (p=0.02). Only physicians working in internal medicine achieved statistically significantly better results than other disciplines (e.g., surgery; p=0.01). Physicians with professional experience of less than 5 years answered statistically significantly more questions correctly (p=0.004). The results of this study verify that emergency physicians in training have insufficient knowledge of pain therapy and end-of-life decisions. The data of this investigation suggest that more attention should be paid to education on pain therapy and end-of-life care in medical curricula. Prehospital emergency physicians may thus be better prepared to provide quality care for palliative patients.Der Schmerz 09/2010; 24(5):508-16. · 0.88 Impact Factor -
Article: [Out-of-hospital pediatric emergencies. Perception and assessment by emergency physicians].
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ABSTRACT: Out-of-hospital (OOH) pediatric emergencies have a relatively low prevalence. In Germany the vast majority of cases are attended by non-specialized emergency physicians (EPs) for whom these are not routine procedures. This may lead to insecurity and fear. However, it is unknown how EPs perceive and assess pediatric emergencies and how they could be better prepared for them. All active EPs (n=50) of the Department of Anaesthesiology, Emergency and Intensive Care Medicine at the University Medical Centre of Göttingen were presented with a structured questionnaire in order to evaluate their perception and assessment of OOH pediatric emergencies. The 43 participating EPs made highly detailed statements on the expected characteristics of OOH pediatric emergencies. Their confidence level grew with the children's age (p<0.03) and with their own experience (p<0.01). The EPs felt particular deficits in the fields of cardiopulmonary resuscitation (n=18) and trauma management (n=8). The preferred educational strategies included simulator-based training (n=24) as well as more exposure to pediatric intensive care and pediatric anesthesia (n=12). Despite their own limited experience EPs can realistically assess the incidence and severity of pediatric emergencies. They felt the greatest deficits were in the care of infrequent but life-threatening emergencies. Three educational groups can be differentiated: knowledge and skills to be gained with children in hospital, clinical experience from adult care also applicable in children and rare diagnoses and interventions to be trained with manikins or simulators.Der Anaesthesist 08/2009; 58(9):876-83. · 0.99 Impact Factor -
Article: [Foudroyant meningococcal sepsis in emergency medicine. Medical treatment and post-exposure prophylaxis].
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ABSTRACT: A paediatric emergency case with a rescue helicopter, which was reported as unexpected cardiac arrest of a 4-year-old child will be described. Based on this case, the symptoms and therapy of meningococcal sepsis and Waterhouse-Friderichsen-Syndrome under emergency conditions will be discussed as well as aspects of post-exposure prophylaxis.Der Anaesthesist 05/2008; 57(4):369-73. · 0.99 Impact Factor -
Article: Leitlinien zur Reanimation 2005 – Was haben sie bewirkt, was gibt es Neues?
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ABSTRACT: Unter Koordination des International Liason Committee on Resuscitation (ILCOR) haben weltweit Experten über mehrere Jahre daran gearbeitet, die Maßnahmen, die zu einem verbesserten Überleben nach einem Kreislaufstillstand führen können, mit einer möglichst hohen wissenschaftlichen Evidenz zu belegen. Auf dem resultierenden „Consensus of Science“ aufbauend hat der European Resuscitation Council (ERC) die überarbeiteten Leitlinien zur kardiopulmonalen Reanimation2005 veröffentlicht. Die Änderungen der Leitlinien haben v.a. dazu geführt, dass die Herzdruckmassage für längere Zeit ununterbrochen durchgeführt wird. Dies war möglich, da Maßnahmen, für die nicht eindeutig gezeigt werden konnte, dass sie zu einem verbesserten Überleben führen, nunmehr seltener durchgeführt werden. Beides scheint bewirkt zu haben, dass kardiopulmonale Reanimationen effizienter und strukturierter durchgeführt werden können. Es ist aber auch festzustellen, dass manche Änderungen, wie z.B. die unmittelbare Fortsetzung einer Herzdruckmassage nach einer Defibrillation, schwerer zu vermitteln sind. Neue Erkenntnisse weisen schon jetzt darauf hin, dass weitere Änderungen der Leitlinien zu erwarten sind. Under coordination of the International Liason Committee on Resuscitation (ILCOR) for several years experts all over the world allocated resuscitation measures by their level of evidence, that would lead to improved survival after cardiac arrest. Derived from the “Consensus of Science” in 2005 the European Resuscitation Council (ERC) published the reedited guidelines for cardiopulmonary resuscitation. The most important effect of the guideline changes is that external cardiac compressions can be performed for longer periods without interruptions. This has been possible since resuscitation measures that have not shown to improve survival now have to be done less frequently. Hereby it seems to be easier to perform cardiopulmonary resuscitation more efficiently and structured. But it also had to be noticed that some changes, e.g. immediate continuation of external cardiac compressions following defibrillation, are more difficult to teach. New conclusions indicate that further guideline changes can be expected.Notfall 02/2008; 11(2):84-90. · 0.54 Impact Factor -
Article: [Medical emergency teams: current situation and perspectives of preventive in-hospital intensive care medicine].
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ABSTRACT: Severe clinical incidents occur in up to 10% of all non-intensive care unit (ICU) patients, which have an estimated mortality of 5-8%. As in the prehospital setting, early clinical warning signs can be identified in the majority of cases. Studies suggest that introduction of an in-hospital medical emergency team (MET) which responds to objective criteria of physiological deterioration, may effectively reduce the incidence of in-hospital cardiac arrests as well as unanticipated or readmissions to the ICU. According to this concept, METs would evaluate and treat non-ICU patients at risk at an early stage before a potentially fatal deterioration of cardiorespiratory parameters occurs. This article reviews available data on preventive in-hospital intensive care medicine and reflects on the circumstances for an implementation of METs in Germany, Austria and Switzerland.Der Anaesthesist 02/2008; 57(1):70-80. · 0.99 Impact Factor -
Article: Umsetzung der Reanimationsleitlinien 2005 in der studentischen Lehre
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ABSTRACT: Am 28.11.2005 hat der European Resuscitation Council (ERC) die überarbeiteten Leitlinien zur kardiopulmonalen Reanimation veröffentlicht. In der Folge mussten die Änderungen und Neuerungen nicht nur an medizinische Laien und professionelle Helfer weitergegeben, sondern sollten auch so schnell wie möglich in der studentischen Lehre vermittelt werden. Da mit Inkrafttreten der neuen Approbationsordnung für Ärzte (ÄAppO) am 01.10.2003 die Notfallmedizin als eigenständiger Querschnittsbereich seit dem Sommersemester 2004 im Medizinstudium gelehrt wird, waren die strukturellen Voraussetzungen bereits geschaffen, auch die kardiopulmonale Reanimation entsprechend der Leitlinien zu vermitteln. Die Anpassung der Lehrinhalte an die aktualisierten Leitlinien konnte daher bereits mit dem Sommersemester 2006 realisiert werden. Wie die kardiopulmonale Reanimation entsprechend der ERC-Leitlinien 2005 in der studentischen Lehre vermittelt sowie überprüft werden können und welcher Aufwand dafür erforderlich ist, wird in diesem Beitrag beschrieben. November 28th 2005 the revised guidelines for resuscitation have been published by the European Resuscitation Council (ERC). Subsequently the modifications and innovations not only had to be passed on to lay persons and professionals but also as soon as possible to medical students. With commencement of the new regulations for the license to practice medicine (Approbationsordnung für Ärzte) on October 1st 2003, Emergency Medicine is an independent cross-section subject within the curriculum for a medical degree since summer-semester 2004. With this the structural prerequisites for teaching cardiopulmonary resuscitation according to the guidelines already had been established. Thereby it already has been possible to adapt the content of teaching with the summer-semester 2006. This article describes what methods are feasible to teach cardiopulmonary resuscitation according to the ERC guidelines 2005, how they can be examined and what efforts are necessary for realization.Notfall 01/2008; 11(2):105-112. · 0.54 Impact Factor -
Article: Intubating laryngeal mask airway for difficult out-of-hospital airway management: a prospective evaluation.
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ABSTRACT: Out-of-hospital airway management is a critical skill, demanding expert knowledge and experience. The intubating laryngeal mask airway (ILMA) is a ventilatory and intubating device which may be of value in this arena. We evaluated the ILMA for out-of-hospital management of the difficult airway. Twenty-one anaesthesia-trained emergency physicians (EPs) completed a training programme and used the ILMA in patients with difficult-to-manage airways. Indications for use of the ILMA included patients with difficult laryngoscopy, multiple intubation attempts, limited access to the patient's head, presence of pharyngo-laryngeal trauma, and gastric fluids or bleeding obscuring the view of the vocal cords. During the study period, 146 of 2513 patients underwent tracheal intubation or alternate rescue airway insertion. In 135 patients, laryngoscopy was performed and Cormack-Lehane view was recorded as grade I in 72 (53.3%), II in 45 (33.3%), III in 10 (7.4%), and IV in 8 (5.9%). EPs encountered 11 patients (7.5%) with difficult-to-manage airways. ILMA insertion and ventilation was possible in 10 patients in the first and one patient in the second attempt. ILMA-guided tracheal intubation was successful in all patients, in 10 after the first and in 1 after two attempts. In this study, ventilation and intubation with ILMA was successful in all patients with difficult-to-manage airways. Our data support the use of the ILMA as rescue device for out-of-hospital airway management by staff who have appropriate airway skills and have received appropriate training.BJA British Journal of Anaesthesia 09/2007; 99(2):286-91. · 4.24 Impact Factor -
Article: [The supra-acetabular pelvic clamp. Emergency treatment for unstable pelvic ring fractures].
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ABSTRACT: The anatomic region on the lateral cortex of the ileum, where a palpable groove is formed by angulations of the lateral cortex of the iliac wing, is recommended as the insertion point for the pelvic emergency clamp by many authors. In our opinion this technique often leads to an incomplete closure of the anterior pelvic ring as well as to bacterial contamination of the access for the sacroiliac joint screw fixation and is accompanied by a risk for nerve and vessel injuries. To reduce these risks the pelvic clamp was placed at a supra-acetabular location. The goal of our study was to report on our experiences with the supra-acetabular position of the pelvic emergency clamp and to compare our results with the current literature. From September 1998 to February 2006 the pelvic emergency clamp was applied in 15 polytraumatized patients (9 male, 6 female), with a mean age of 46 years (19-93) and a mean injury severity score (ISS) of 40 points (25-66) with mechanically and hemodynamically unstable pelvic ring fractures. According to the AO classification the injury pattern was type B2 in four cases, type B3 in one case, type C1 in seven cases, type C2 in two cases and type C3 in one case. The pelvic clamp was percutaneously applied 2-3 cm cranial to the acetabular roof. The duration from hospital admission until the pelvic emergency clamp was applied amounted to an average of 54 min (15-150); the procedure itself was performed in all cases in less than 15 min. The mean Hb at arrival in the emergency department was 7.4 (2.4-13.8) mg/dl and the mean systolic blood pressure 69 (0-130) mmHg. In 14 patients a complete closure of the anterior and posterior pelvic ring could be achieved; in 1 patient an overcompression of the anterior pelvic ring was observed. Four patients died due to massive bleeding. Three patients with isolated pelvic ring fractures became hemodynamically stable within 20 min after treatment with the supra-acetabular pelvic clamp. Nine patients needed additional emergency surgery because of intracerebral, intrathoracic or intra-abdominal injuries. On average in the first 6 h, 36.7 (9-175) units of erythrocyte concentrates and 34.5 (4-200) units of fresh frozen plasma were transfused. The supra-acetabular pelvic clamp leads to a homogeneous force distribution to the pelvic ring and enables complete closure of the anterior and posterior pelvic ring in unstable pelvic fractures. Reduction of the intrapelvic volume and compression of the posterior pelvic ring can thus be achieved. Risks for intrapelvic perforation or injuries of vessels and nerves are low. No bacterial contamination of the access for the sacroiliac screw fixation occurs. To avoid overcompression of the unstable pelvic ring, manual or radiological control of the closure of the ventral pelvic ring is necessary.Der Unfallchirurg 07/2007; 110(6):521-7. · 0.61 Impact Factor -
Article: EMS systems in Germany.
Resuscitation 02/2006; 68(1):45-9. · 3.60 Impact Factor -
Article: [New pathways in undergraduate medical education - first experiences with the cross section speciality emergency and intensive care medicine].
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ABSTRACT: On October 1 (st) 2003 Emergency Medicine was recognised for the first time as an independent cross section speciality in the new German "Approbationsordnung fuer Aerzte" (Medical Licensing Regulations). These amendments were made not only to increase the amount of small group teaching sessions but also to encourage a multidisciplinary and rather practical approach to the related topics. This article portrays the realisation of these objectives in form of a multidisciplinary module, as it has been established at University of Göttingen Medical School since the summer semester of 2004. We present the new curriculum, calculate the associated personnel resources and demonstrate the results of the structured evaluation given by the participating students. We linked the fields of emergency and intensive care medicine by splitting them up into submodules which the students had to run through according to a set rota. 162 students were allocated to 27 small groups. Every student received a total of 38.5 hours of teaching, with the workshops coming to 46.8 %. The workshops comprised of nine sessions, three in Emergency Medicine, four in Intensive Care Medicine and two at human patient simulators. In addition we scheduled a seminar and an accompanying lecture. The final examination was performed as an Objective Structured Clinical Evaluation (OSCE). The realisation of the new module required a total of 1290 working hours for medical staff and 130 for our student aids. Compared to all other modules of Goettingen University Medical School the module here presented obtained the highest overall evaluation score by the medical students. Lessons with a high amount of practical involvement (i. e. Emergency Medicine and simulator-based workshops) were significantly better evaluated than rather formal teaching techniques, such as the lectures and the seminar. According to the students' self-assessment the simulator-based workshops were seen particularly valuable for the facilitation of knowledge transfer into clinical practice. The determined realisation of the new German Medical Licensing Regulations requires considerable time resources. However, its evaluation by the medical students is strikingly positive.ains · Anästhesiologie · Intensivmedizin 10/2005; 40(9):536-43. · 0.41 Impact Factor -
Article: [Blunt chest trauma with total rupture of the right main stem bronchus--a case report].
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ABSTRACT: Tracheo-bronchial lesions in blunt chest trauma are rare--the incidence is about 1%--but potentially life-threatening events. Indirect signs such as pneumothorax, pneumomediastinum, subcutaneous emphysema or an insufficient expansion of the lungs after drainage of a pneumothorax are ominous. The fastest and most reliable method to assess the definite diagnosis of tracheo-bronchial lesion is fibre-optic tracheobronchoscopy. Early surgical treatment is mandatory to prevent major pulmonary resection. This case shows that computer tomography might fail to provide the right diagnosis. Independent lung ventilation is an option to protect the bronchial anastomosis during the early postoperative period. Reported here is the case of a young man who sustained a total traumatic rupture of the right main stem bronchus after being thrown from the passenger seat through the windshield of a motor vehicle. When the emergency doctor arrived on the scene, he found the patient with dyspnoea and massive thoracic subcutaneous emphysema. Reduced breath sounds on the left and no breath sounds on the right side led to an immediate placement of two chest tubes and controlled mechanical ventilation. After primary care in a district hospital, the patient was transferred to our university hospital for further treatment of his head injury. On admission, the patient was making breath sounds on both sides and a CT scan showed no clear sign of a tracheo-bronchial lesion. After neurosurgical intervention, the diagnosis of a rupture of the right main stem bronchus was made with delay by fibre-optic bronchoscopy. The patient was intubated with a left-sided double lumen endotracheal tube followed by surgical end-to-end anastomosis of the lesion. The initial postoperative ventilator support consisted of BIPAP-mode ventilation of the left lung, while the right lung was kept open with positive airway pressure. Forty-eight hours later, synchronised independent lung ventilation with two ventilators was established to protect the surgical result. The ventilation was switched to conventional mode a further 48 hours later. Extubation and the remaining ICU stay were uneventful.Anaesthesiologie und Reanimation 02/2004; 29(1):12-5.
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Institutions
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2008–2012
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Universitätsmedizin Göttingen
Göttingen, Lower Saxony, Germany
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2006–2012
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Georg-August-Universität Göttingen
- Center for Anesthesiology, Emergency and Intensive Care Medicine
Göttingen, Lower Saxony, Germany
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