Christian Hohenstein

Universitätsklinikum Jena, Jena, Thuringia, Germany

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Publications (9)4.77 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Accidental injection of benzodiazepines can cause severe limb ischemia, often resulting in limb amputation. We report on a young drug addict who presented to the emergency department with severe pain and limb ischemia after accidental diazepam injection in the femoral artery. Although angiography revealed markedly reduced blood flow in the distant arteries of the lower limb and myoglobin was highly elevated, the limb was rescued with full recovery. Treatment consisted of ischiadic and femoral nerve block with continuous ropivacain application, intravenous alpostradil and heparin infusion as well as intraarterial nitroglycerin infusion. This therapeutic approach seems reasonable and was effective in preventing limb amputation in this case.
    The American journal of emergency medicine 01/2014; · 1.54 Impact Factor
  • The Journal of Emergency Medicine. 01/2014; 46(2):278.
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    ABSTRACT: Many patients are victims of disastrous incidents during medical interventions. One of the obligations of physicians is to identify these incidents and to subsequently develop preventive strategies in order to prevent future events. Airway management and prehospital emergency medicine are of particular interest as both categories frequently show very dynamic developments. Incidents in this particular area can lead to serious injury but at the same time it has never been analyzed what kind of incidents might harm patients during prehospital airway management. The German website http://www.cirs-notfallmedizin.de (CIRS critical incident reporting systems) offers anonymous reporting of critical incidents in prehospital emergency medicine. All incidents reported between 2005 and 2012 were screened to identify those which were concerned with airway management and four experts in this field analyzed the incidents and performed a root cause analysis. The database contained 845 reports. The authors considered 144 reports to be airway management related and identified 10 root causes: indications for intubation but no intubation performed (n = 8), no indications for intubation but intubation attempt performed (n = 7), wrong medication (n = 25), insufficient practical skills (n = 46), no use of alternative airway management (n = 7), insufficient handling before or after intubation (n = 27), defect equipment (n=28), lack of equipment (n = 31), others (n = 18) and factors that cannot be influenced (n = 12). The incidents that were reported via the website http://www.cirs-notfallmedizin.de and that occurred during airway management in prehospital emergency medicine are described. To improve practical airway management skills of emergency physicians are one of the most important tasks in order to prevent critical incidents and are discussed in the article.
    Der Anaesthesist 08/2013; · 0.85 Impact Factor
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    ABSTRACT: BACKGROUND: Medical errors frequently contribute to morbidity and mortality. Prehospital emergency medicine is prone to incidents that can lead to immediate deadly consequences. Critical incident reporting can identify typical problems and be the basis for structured risk management in order to reduce and mitigate these incidents. METHODS: We set up a free access internet website for German-speaking countries, with an anonymous reporting system for emergency medical services personnel. After a 7-year study period, an expert team analysed and classified the incidents into staff related, equipment related, organisation and tactics, or other. RESULTS: 845 reports were entered in the study period. Physicians reported 44% of incidents, paramedics 42%. Most patients were in a life-threatening or potentially life-threatening situation (82%), and only 53% of all incidents had no influence on the outcome of the patient. Staff-related problems were responsible for 56% of the incidents, when it came to harm, 78% of these incidents were staff related. CONCLUSIONS: Incident reporting in prehospital emergency medicine can identify system weaknesses. Most of the incidents were reported during care of patients in life-threatening conditions with a high impact on patient outcome. Staff-related problems contributed to the most frequent and most severe incidents.
    Emergency Medicine Journal 01/2013; · 1.65 Impact Factor
  • Christian Hohenstein, Peter Rupp, Thomas Fleischmann
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    ABSTRACT: We wanted to identify incidents that led or could have led to patient harm during prehospital cardiopulmonary resuscitation. A nationwide anonymous and Internet-based critical incident reporting system gave the data. During a 4-year period we received 548 reports of which 74 occurred during cardiopulmonary resuscitation. Human error was responsible for 85% of the incidents, whereas equipment failure contributed to 15% of the reports. Equipment failure was considered to be preventable in 61% of all the cases, whereas incidents because of human error could have been prevented in almost all the cases. In most cases, prevention can be accomplished by simple strategies with the Poka-Yoke technique. Insufficient training of emergency medical service physicians in Germany requires special attention. The critical incident reports raise concerns regarding the level of expertize provided by emergency medical service doctors.
    European Journal of Emergency Medicine 05/2010; · 0.73 Impact Factor
  • T. Fleischmann, C. Hohenstein
    Notarzt. 01/2010; 26(02):73-84.
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    Christian Hohenstein, Steffen Herdtle
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    ABSTRACT: Colloid cysts are usually benign brain tumors, which rarely cause acute neurological deterioration with sudden death due to an acute increase of intracranial pressure. So far, the final pathophysiology and clinical signs of impending death are unclear in this context. We present a case of an adolescent who presented with symptoms similar to gastroenteritis. He unexpectedly developed a generalized seizure, acute pulmonary edema and life-threatening cardiac dysrhythmia. Subtle distinctions between symptoms due to intracranial hypertension, which typically cause headache and vomiting, and true gastroenteritis are discussed as well as the pathophysiology of neurogenic pulmonary edema and the origin of cerebral-triggered cardiac dysrhythmias.
    International Journal of Emergency Medicine 01/2010; 3(1):65-6.
  • C. Hohenstein, T. Fleischmann
    Notarzt. 01/2007; 23(1):1-6.
  • Christian Hohenstein, Thomas Fleischmann, Dorothea Hempel