ABSTRACT
In the situation of a shortage of ventilation beds, ethically justifiable, transparent and comprehensible decisions must be made. This concept proposes that all patients are first intubated depending on necessity and then assessed by a triage team afterwards. In this situation newly admitted COVID patients compete with newly admitted Non-COVID patients as well as patients already treated in intensive care units for a ventilator. The combination of short-term and long-term prognoses should enable the interprofessional triage team to make comprehensible decisions. The aim of the prioritization concept is to save as many human lives as possible and to relieve the treatment team of the difficult decision on prioritization.
Subject(s)
COVID-19 , Hospitalization , Humans , Intensive Care Units , SARS-CoV-2 , TriageSubject(s)
Anisocoria/diagnosis , Anisocoria/etiology , Consciousness Disorders/diagnosis , Consciousness Disorders/etiology , Drainage , Hematoma, Subdural, Chronic/surgery , Postoperative Complications/diagnosis , Status Epilepticus/diagnosis , Trephining , Aged , Diagnosis, Differential , Electroencephalography , Humans , Male , Perfusion Imaging , Signal Processing, Computer-Assisted , Tomography, X-Ray ComputedABSTRACT
The case of a female patient with a suprasellar optic glioma is reported, who was admitted to the intensive care unit due to decompensated diabetes insipidus with hypernatremia of 194 mmol/l. The sodium concentration was reduced slowly over 4 days and the patient recovered without sequelae. Based on this case the article deals with the pathophysiology and therapy of hypernatremia. An increase in extracellular osmolarity leads to augmented production of intracellular osmolytes in order to maintain the cell volume constant. Due to this counterregulation correction of the sodium concentration must be done with caution.
Subject(s)
Hypernatremia/therapy , Algorithms , Critical Care , Diagnosis, Differential , Female , Fluid Therapy , Glioma/complications , Humans , Hypernatremia/diagnosis , Hypernatremia/etiology , Magnetic Resonance Imaging , Osmolar Concentration , Pituitary Neoplasms/complications , Sodium/blood , Young AdultABSTRACT
INTRODUCTION: It has been shown that long-term treatment with opioids does not necessarily impair driving ability in patients suffering from chronic pain. However, few studies are so far available on how increases in daily opioid dosage affect driving ability. METHODS: A prospective trial was conducted in patients suffering from chronic noncancer pain, to examine the effects of the daily dose of opioids on psychomotor and cognitive functions. A computerized test system was administered to patients before and 7 days after alteration of their opioid therapy, to determine performance affecting driving ability at each time point. The test design was based on both international and national recommendations for the examination of driving safety. RESULTS: Raising the daily dose of opioids and/or changing to an opioid at a higher WHO level had no effect on the functions relevant to driving ability in the group context. Pain intensity and serum concentrations of morphine influenced only few items in the test battery. CONCLUSION: Seven days after an increase in the daily dose of an opioid or after the initiation of opioid therapy there was no general deterioration in patients' driving ability at group level.
