[Impact of the COVID-19 crisis in Spring 2020 on trauma case numbers of an academic teaching hospital in Stuttgart : Trauma during a pandemic]. / Einfluss der COVID-19-Krise im Frühjahr 2020 auf traumatologische Fallzahlen eines akademischen Lehrkrankenhauses in Stuttgart : Trauma während einer Pandemie.

BACKGROUND: To cope with the COVID-19 outbreak in Germany, the government imposed a lockdown, which led to restrictions and lifestyle changes for the population. PURPOSE: This study aimed to evaluate the impact of the lockdown on activities causing trauma and the consultation in emergency rooms. MATERIAL AND METHODS: All consecutive trauma patients consulting the Emergency Department of the Marienhospital Stuttgart (MHS), Germany, during the 6 weeks preceding the lockdown, during and after the lockdown were included. The time and type of consultation, treatment received, Manchester triage score, type of trauma, the anatomical region of the injury as well as demographic data were reported and compared. RESULTS: The study included 551 cases during lockdown, 943 cases before and 783 cases after the lockdown. We observed a reduced caseload during the lockdown of 41.6% compared to before and of 29.7% compared to after (p < 0.001). Patients were on average older in the observation group than in both control groups (before : 51.5 years, lockdown: 56.1 years, after: 51.6 years) (p < 0.001). Injuries to the head and neck were constant (25.0%, 25.4%, 25.5%). We noticed lower limb injuries decreasing (26.1%, 22.3%, 22.7%) and upper limb injuries increasing (25.5%, 31.8%, 30.1%). A decrease in sports injuries (11.1%, 5.1%, 9.1%) and work accidents (16.1%, 10.7%, 12.8%) resulted in more domestic accidents (30.4%, 52.5%, 31.8%). Self-referral decreased (67.7%, 53.2%, 60.3%) while referral via paramedics increased (28.3%, 38.7%, 35.6). Blunt trauma was the most common cause of injury (55.6%, 61.0%, 55.3%). Indications for surgery were higher (16.8%, 21.6%, 14.0%). CONCLUSION: The lockdown and restrictions in personal life and daily routine had an impact on the frequency, etiology and management of trauma patients in Stuttgart.

Comparison of SARS-CoV-2 antigen testing to RT-PCR in a real-world setting-an observational cohort study.

A total of 2978 patients with validated paired results (SARS-CoV2-antigen and PCR) were identified. Our results show that only 45 antigen tests from 90 patients with positive validated PCR were correctly identified by antigen testing (sensitivity 50%). Roughly 50% of these patients had ongoing respiratory symptoms.

Automated mechanical cardiopulmonary resuscitation devices versus manual chest compressions in the treatment of cardiac arrest: protocol of a systematic review and meta-analysis comparing machine to human.

INTRODUCTION: Cardiac arrest is a leading cause of death in industrialised countries. Cardiopulmonary resuscitation (CPR) guidelines follow the principles of closed chest compression as described for the first time in 1960. Mechanical CPR devices are designed to improve chest compression quality, thus considering the improvement of resuscitation outcomes. This protocol outlines a systematic review and meta-analysis methodology to assess trials investigating the therapeutic effect of automated mechanical CPR devices at the rate of return of spontaneous circulation, neurological state and secondary endpoints (including short-term and long-term survival, injuries and surrogate parameters for CPR quality) in comparison with manual chest compressions in adults with cardiac arrest. METHODS AND ANALYSIS: A sensitive search strategy will be employed in established bibliographic databases from inception until the date of search, followed by forward and backward reference searching. We will include randomised and quasi-randomised trials in qualitative analysis thus comparing mechanical to manual CPR. Studies reporting survival outcomes will be included in quantitative analysis. Two reviewers will assess independently publications using a predefined data collection form. Standardised tools will be used for data extraction, risks of bias and quality of evidence. If enough studies are identified for meta-analysis, the measures of association will be calculated by dint of bivariate random-effects models. Statistical heterogeneity will be evaluated by I2-statistics and explored through sensitivity analysis. By comprehensive subgroup analysis we intend to identify subpopulations who may benefit from mechanical or manual CPR techniques. The reporting follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. ETHICS AND DISSEMINATION: No ethical approval will be needed because data from previous studies will be retrieved and analysed. Most resuscitation studies are conducted under an emergency exception for informed consent. This publication contains data deriving from a dissertation project. We will disseminate the results through publication in a peer-reviewed journal and at scientific conferences. PROSPERO REGISTRATION NUMBER: CRD42017051633.

[Assessment of the risk of infection from SARS-CoV-2 for healthcare workers-findings from practice]. / Beurteilung des Infektionsrisikos durch SARS-CoV-2 für medizinisches Personal ­ Erkenntnisse aus der Praxis.

SARS-CoV­2 has rapidly spread over the world in a pandemic manner causing an infection of predominantly pulmonary manifestation named the COVID-19 disease. Currently, there is neither an effective vaccination nor a specific therapy available. At least two vaccines will be available at the time of publication. In the international press, the risk for medical personnel of SARS-CoV­2 is rated as high. The Robert Koch Institute, Germany's leading epidemiological authority, regards the risk of infection for the general population to be high. The aim of this article is to discuss and reassess the risk of infection and disease for healthcare workers based on practical experience, national regulations and guidelines, and the number of infections. Both unprotected healthcare workers and healthcare workers equipped with personal protective equipment (PPE) are considered. A corresponding risk matrix is created.The risk of infection with SAR-CoV­2 for healthcare workers is comparable to the general population and rated as high. Proper use of PPE reduces this risk to medium. PPE consists of liquid-proof gowns, gloves, and filtering face pieces (FFP; FFP 2 as a standard, FFP 3 for aerosol-releasing interventions), a hair cover, and protective goggles. Improper use of PPE, inadequate hygienic measures, and long working shifts increase the risk of infection.

Association between the dynamics of the COVID-19 epidemic and ABO blood type distribution.

The coronavirus disease 2019 (COVID-19) pandemic is currently the most critical challenge in public health. An understanding of the factors that affect severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection will help fight the COVID-19 pandemic. This study sought to investigate the association between SARS-CoV-2 infection and blood type distribution. The big data provided by the World Health Organization (WHO) and Johns Hopkins University were used to assess the dynamics of the COVID-19 epidemic. The infection data in the early phase of the pandemic from six countries in each of six geographic zones divided according to the WHO were used, representing approximately 5.4 billion people around the globe. We calculated the infection growth factor, doubling times of infection and death cases, reproductive number and infection and death cases in relation to the blood type distribution. The growth factor of infection and death cases significantly and positively correlated with the proportion of the population with blood type A and negatively correlated with the proportion of the population with blood type B. Compared with the lower blood type A population (<30%), the higher blood type A population (⩾30%) showed more infection and death cases, higher growth factors and shorter case doubling times for infections and deaths and thus higher epidemic dynamics. Thus, an association exists between SARS-CoV-2 and the ABO blood group distribution, which might be useful for fighting the COVID-19 pandemic.

[German recommendations on lung and thoracic ultrasonography in patients with COVID-19]. / Empfehlungen zur Lungen- und Thoraxsonographie bei Patienten mit COVID-19-Erkrankung.

Lung and chest ultrasound are further examination modalities in addition to computed tomography and laboratory diagnostics in patients with COVID-19. It extends the clinical-physical examination because it can examine lung surface sensitively. Lung surface pattern changes have been found in sonograms of patients with COVID-19 pneumonia and during the course of the disease. German specialist societies of clinical acute, emergency and intensive care medicine as well as imaging, which are concerned with the care of patients with SARS-CoV­2 infection and COVID-19, have coordinated recommendations for lung and thorax sonography. This document has been created within a transparent process, led by the German Society of Interdisciplinary Emergency and Acute Medicine e. V. (DGINA), and worked out by an expert panel and delegates from the societies. Sources of the first 200 cases were summarized. Typical thorax sonographic findings are presented. International sources or standards that were available in PubMed until May 24, 2020 were included. Using case studies and multimedia content, the document is intended to not only support users but also demonstrate quality features and the potential of chest and lung sonography. The German Society for Ultrasound in Medicine (DEGUM) is carrying out a multicenter study (study coordination at the TU Munich).

Effects of a media campaign on resuscitation performance of bystanders: a manikin study.

OBJECTIVE: Cardiac arrest is associated with a poor outcome if cardiopulmonary resuscitation (CPR) is delayed. Nevertheless, CPR performance by laypersons in witnessed cardiac arrest is frequently poor. The present study evaluated the effect of a media campaign on CPR performance. PARTICIPANTS AND METHODS: CPR performance of 1000 individuals who did not have any medical background was evaluated using a resuscitation manikin. The media campaign consisted of flyers, posters, and electronic advertisement. Five hundred individuals were evaluated before the media campaign and 500 individuals after the media campaign. Age and male/female ratio were comparable within each of the groups. Premedia campaign performance was compared with postmedia campaign performance with respect to chest compressions and ventilation metrics. RESULTS: Chest compression depth and total compression work were significantly higher after the media campaign: median depth 51 mm postcampaign versus 45 mm precampaign (P<0.001), median cumulative compression work postcampaign 4176 versus 2462 mm precampaign (P<0.001). Tidal volumes and ventilation work were significantly lower following the media campaign, but did not differ between participants who had acknowledged exposure to the campaign and those who did not. Ventilation performance was generally poor across the two groups both before and after the media campaign. CONCLUSION: A simple and cost-efficient media campaign appears to enhance the performance of chest compressions. Ventilation performance and the rate of CPR performance were not increased by the campaign.

Suicidality in emergency medicine: Results from a retrospective analysis of emergency documentation forms.

BACKGROUND: To analyze suicidal care episodes in emergency medical responses in Germany. METHOD: Anonymized data from emergency care episodes in Ulm from 2004 to 2013 were analyzed retrospectively. RESULTS: 158 of 933 psychiatric emergencies (16 %) were suicide related, including 14 completed suicides, 25 care episodes with suicidal ideation, and 119 suicide attempts. Significantly more men than women completed suicide (χ²(2,N = 934) = 12.70, p = 0.02). 93 % of the total psychiatric emergencies received any medication at all, and only about 33 % were transported to a psychiatric hospital. CONCLUSION: Psychiatric treatment for suicidality in emergency medicine requires improvement to ensure that patients receive adequate therapy.

[Case report: Snake bite - an odd case]. / Kasuistik: Notarzteinsatz abseits des Alltags - Biss einer Klapperschlange.

Emergency medical service is called by a 54-year-old man bitten by his rattlesnake. Upon initial survey we find the patient in a cardiopulmonary stable condition. He has bite marks and pain on his rapidly swelling middle finger of his right hand. Our initial treatment is immobilization of the patient. The snake raiser has already called the poison control center in Munich. By the help of this institution we bring him to a hospital having the right antivenom on hand.