Good neurological outcome after accidental hyopthermia presenting with asytole.

A 43-year-old woman became exhausted and fainted on descent at 1127 MAMSL altitude and snowfall. A rescue team diagnosed asystole. With manual cardiopulmonary resuscitation (CPR) she was transported to the next extracorporeal life support (ECLS) center. Admission temperature was 20.7 °C. CPR continued until ECLS was initiated. Two days later she was awake, orientated, and with no neurological deficits. With hypothermic cardiac arrest, a favorable outcome depends on early continuous CPR, triage, and ECLS rewarming. It holds true that "nobody is dead until they are warmed and dead" if one cools first and arrests thereafter.

[Life-saving air supported avalanche mission at night in high alpine terrain]. / Lebensrettender luftgestützter lawineneinsatz bei nacht im hochalpinen gelände.

This is a case report about a helicopter emergency medical service (HEMS) operation during the night in response to an avalanche accident with two completely buried victims. One of the victims was rescued alive after 9.2 h presenting with a patent airway and an air pocket and was successfully rewarmed with forced air from 23°C core temperature without any neurological deficits. After the rescue the patient developed lung edema which resolved spontaneously within 2 days. The second victim was found dead presenting with an air pocket but solid frozen thorax. The special circumstances of the rescue operation and treatment are presented and discussed. The impact of a frozen chest on resuscitation decisions is presented and discussed with an emphasis on the triage of multiple victims.

[Patient safety - definition and epidemiology of adverse events, errors and incidents]. / Patientensicherheit - Definition und Epidemiologie von unerwünschten Ereignissen, Fehlern und Schäden.

Multiple studies in the last years on patient safety brought this issue into focus for healthcare workers, but also politics and public. It is evident, that patient safety in health care is not longer a "nice to have", but an absolutely "must", analog others high risk industries. This article presents the most important basis principles of patient safety. The development from the error- to the safety culture is described. The terms adverse event, error and incident are defined as well other important terms and possible human pitfalls. At the end epidemiology correlations are presented, to underline the importance of patient safety in medicine. This article should help to understand the terminology of patient safety, to be able to understand the real important ideas and context of patient safety.

[72-year-old man with syncope and left hemiparesis]. / 72-jähriger Patient mit Synkope und linksseitiger Hemisymptomatik.

A 72-year-old man was admitted with left hemiparesis after a painless syncope with suspected ischemic stroke. So far he was a healthy man without any cardiovascular risk factors. A computed tomography scan of the head did not show any abnormal findings. In the clinical evaluation we revealed pulse deficits in the left-sided extremities and the blood pressure of the left arm was not measurable. The final diagnosis was an acute aortic dissection, beginning in the proximal portion of the ascending aorta, leading to the iliacal arteries. The patient was transferred and surgery was performed immediately with success. Painless acute aortic dissection presenting only with neurologic symptoms made the correct diagnosis extremely difficult. Correct diagnosis, however, is essential, otherwise thrombolytic therapy - indicated for acute-stage cerebral infarction - would have been performed, probably with a fatal outcome.

[Application of the current resuscitation guidelines 2005. Case report of successful cardiopulmonary resuscitation]. / Anwendung der aktuellen Reanimationsrichtlinien 2005. Fallbericht einer erfolgreichen kardiopulmonalen Reanimation.

The international guidelines for cardiopulmonary resuscitation are subject to continuous modification and were revised in November 2005. This report describes a case of an out-of-hospital cardiopulmonary resuscitation where the patient survived a cardiac arrest without neurological sequelae after chest compression (30:2), bag-mask ventilation and multiple biphasic defibrillation (single shocks). This article gives a practical review of the most important new recommendations in the current resuscitation guidelines. The accomplished measures are discussed on the background of the new recommendations.

[High precision of the emergency call]. / Treffgenauigkeit des Notrufes.

INTRODUCTION: In the emergency office, as the central contact place for somebody seeking medical aid the emergency call is distributed to the on-call practitioners or to the ambulance service. Prerequisite is a high precision of the emergency call. RESULTS: In 63% of direct emergency caller information is classified as useful. 98.4% of the call receiving staff reacted calm, straight forward and experienced. In 74.9% the content was complete, not considering more detailed circumstances. 84.7% of the direct calling persons but only 50% of the indirect calling persons gave complete information. In 70.3% of emergency calls no medical diagnosis could be determined. More frequently, symptoms were mentioned indicating a specific disease (28.6%). Due to insufficient specificity the decision to send an emergency doctor was made if life threatening could not be excluded (34.9%). In 31.4% of cases the order of emergency doctors from the emergency office were not justified retrospectively according to the doctors impression at the place of emergency. The justified use of the emergency doctors was highest in patients with internal diseases (58.9%). The necessity of sending an emergency doctor according to direct and indirect reporting was 70.5% and 57.9%, respectively. CONCLUSION: The analysis shows, that the person reporting the emergency is often not able to meet the requirements of medical aid and that he is not able to estimate the necessary level of medical aid. In addition, an improved qualification of the staff in the emergency office is needed to improve the correct distribution of emergency calls. Through further qualification of this staff a potential cost saving in the area of emergency service could be achieved.

The natural history of gastroschisis during fetal life: development of the fibrous coating on the bowel loops.

Patients with gastroschisis have a paraumbilical defect of the anterior abdominal wall through which bowel loops protrude. These bowel loops are edematous and covered by a fibrous coating. The moment of occurrence of gastroschisis as well as the development of the fibrous coating are unknown. This prompted an investigation of 26 human embryos and fetuses with gastroschisis at various developmental stages (crown-rump length 25-240 mm) and two stillborn fetuses (gestational age 30 weeks) with gastroschisis, as well as resected material from ten newborns (gestational age 33-40 weeks) operated for gastroschisis. Progressive changes of the serosa were only noted after the 30th week of gestation and consisted of an amniotic fluid peritonitis and progressive fibrosis. The changes are in agreement with experimental data and correlate with changes in the composition of amniotic fluid. The findings prove that gastroschisis is a very early occurrence, while the fibrous coating is a late development.