[Mortui vivos docent : The dead teach the living]. / Mortui vivos docent : Die Toten lehren die Lebenden.

There are considerable similarities and intersections between forensic medicine and emergency medicine. This applies especially to frustraneously resuscitated patients or other lethal clinical courses of traumatized patients who are subject to latter forensic autopsy. Cooperation between departments of emergency and forensic medicine not only has emergency medical training potential, but also the possibility of retrospective evaluation of medical emergency measures - both in individual cases and with regard to epidemiological aspects. In particular, the widespread registration of autopsied pre-hospital trauma deaths that occurred despite on-scene resuscitation attempts is useful. The pre-hospital situation represents a hotspot, but also a blind spot in the overall trauma mortality. In recent clinical registers, preclinical deaths go mostly unrecorded, despite the undisputed benefits of clinical registers.

[Medical Emergency Preparedness in offshore wind farms : New challenges in the german north and baltic seas]. / Notfallmedizinische Versorgung in Offshore-Windparks : Neue Herausforderungen in der deutschen Nord- und Ostsee.

BACKGROUND: Offshore windfarms are constructed in the German North and Baltic Seas. The off-coast remoteness of the windfarms, particular environmental conditions, limitations in offshore structure access, working in heights and depths, and the vast extent of the offshore windfarms cause significant challenges for offshore rescue. Emergency response systems comparable to onshore procedures are not fully established yet. Further, rescue from offshore windfarms is not part of the duty of the German Maritime Search and Rescue Organization or SAR-Services due to statute and mandate reasons. Scientific recommendations or guidelines for rescue from offshore windfarms are not available yet. The present article reflects the current state of medical care and rescue from German offshore windfarms and related questions. The extended therapy-free interval until arrival of the rescue helicopter requires advanced first-aid measures as well as improved first-aider qualification. Rescue helicopters need to be equipped with a winch system in order to dispose rescue personnel on the wind turbines, and to hoist-up patients. For redundancy reasons and for conducting rendezvous procedures, adequate sea-bound rescue units need to be provided. In the light of experiences from the offshore oil and gas industry and first offshore wind analyses, the availability of professional medical personnel in offshore windfarms seems advisible. Operational air medical rescue services and specific offshore emergency reaction teams have established a powerful rescue chain. Besides the present development of medical standards, more studies are necessary in order to place the rescue chain on a long-term, evidence-based groundwork. A central medical offshore registry may help to make a significant contribution at this point.

Oral bioavailability of digoxin is enhanced by talinolol: evidence for involvement of intestinal P-glycoprotein.

OBJECTIVE: Recent data indicated that disposition of oral digoxin is modulated by intestinal P-glycoprotein. The cardioselective beta-blocker talinolol has been described to be secreted by way of P-glycoprotein into the lumen of the gastrointestinal tract after oral and intravenous administration. We therefore hypothesized that coadministration of digoxin and talinolol may lead to a drug-drug interaction based on a competition for intestinal P-glycoprotein. METHODS: Pharmacokinetics of digoxin (0.5 mg orally), talinolol (30 mg intravenously and 100 mg orally), and digoxin plus talinolol orally, as well as digoxin plus talinolol intravenously, were assessed in five male and five female healthy volunteers (age range, 23 to 30 years; body weight, 60 to 95 kg) in a changeover study with at least a 7-day washout period. Digoxin and talinolol were analyzed by fluorescence polarization immunoassay and HPLC, respectively. RESULTS: Oral coadministration of 100 mg talinolol increased the area under the concentration-time curve (AUC) from 0 to 6 hours and the AUC from 0 to 72 hours of digoxin significantly by 18% and 23%, respectively (5.85+/-1.49 versus 7.22+/-1.29 ng x h/mL and 23.0+/-3.3 versus 27.1+/-3.7 ng x h/mL, for both P<.05) and the maximum serum levels by 45%. Renal clearance and half-life of digoxin remained unchanged. Coinfusion of 30 mg talinolol with oral digoxin had no significant effects on digoxin pharmacokinetics. Digoxin did not affect the disposition of talinolol after both oral and intravenous administration. CONCLUSION: We observed a significantly increased bioavailability of digoxin with oral coadministration of talinolol, which is most likely caused by competition for intestinal P-glycoprotein.