[Decompression sickness as differential diagnosis in internal medicine emergency admissions]. / Dekompressionskrankheit als Differentialdiagnose in der internistischen Notaufnahme.

Two men (aged 37 years--patient 1, and 26 years--patient 2), both in good health, had dived as a sport to a depth of 40 and 45 m, respectively, reportedly keeping to the prescribed decompression times on their ascent. Patient 1 immediately developed shortness of breath and pain in the chest, later neurological deficits in both legs, as well as faecal and urinary incontinence. Examination 60 h later revealed paraparesis, increased leg proprioceptor reflexes and paraesthesia below the 10th thoracic vertebra, with abnormal posterior column function. After recompression (hyperbaric oxygenation, 6 treatment sessions of 4 h each over 8 days, as prescribed in US Navy Table No. 6) the signs improved and two months later there were no deficits. Patient 2 developed 30 min after a similar dive painful, doughy swellings and redness over the upper ventral half of the thorax and both upper arms. All signs and symptoms disappeared after recompression treatment (hyperbaric oxygenation for 3 h), begun 28 h after the dive. Previously elevated levels for haemoglobin (18.5 g/dl), haematocrit (0.56) and red blood corpuscles (5.98 x 10(6)/microliters) returned to normal. The described neurological abnormalities are typical for type II, redness and joint pains for type I decompression sickness.

[Propofol for sedation during postoperative mechanical ventilation. A comparative study with Lytic Mixture]. / Propofol zur Sedierung während postoperativer Beatmung. Vergleichende Untersuchung mit Lytischer Mischung.

Propofol infusion was found to provide excellent sedation and rapid recovery in intensive care. The present study compared Propofol with lytic solution (lytic solution = mixture of 100 mg Pethidine, 50 mg Promethazine and 0.6 mg Dihydroergotamine) during 6 hours of postoperative artificial ventilation. 60 patients after major abdominal surgical procedures were studied with ethical committee approval and informed consent. Patients were randomly allocated to receive either Propofol or lytic solution. We aimed at a sedation level of stage 5 according to the Ramsey score. The mean drug dosages were 3.9 mg/kg/h of Propofol and 4.2 ml/h of lytic solution. Hemodynamic values, blood gases as well as various biochemical measures did not show any difference between the groups. At the end of the sedation period triglyceride concentrations were significantly higher in patients receiving Propofol (166 + 79 mg/dl) compared to the control group (97 + 60 mg/dl). Significant and relevant differences were found for the times of recovery after discontinuation of the sedative. These times were very short in the Propofol group. Furthermore, in view of a longer recovery time after lytic solution in this group the respiratory rate was significantly slower up to the end of the observation period. We conclude that a major advantage of Propofol in the present study was the rapid recovery after 6 hour sedation. Patients gain vigilance rapidly and sufficient spontaneous respiration within minutes. Not at least thanks to these facts patient's safety can be improved in the recovery period.

Physician and nursing (personnel) requirements for ICUs. Therapeutic Intervention Scoring System (TISS) versus time requirements for patient care--a comparative study in an interdisciplinary surgical intensive care unit.

OBJECTIVE: To measure total physician manoeuvres and total nursing manoeuvres in intensive care patients and to compare the results with calculated personnel requirements on the basis of TISS scores. DESIGN: Open prospective study. SETTING: Sixty-three ICU patients on two consecutive days. MEASUREMENT: 1. Total physician activities (TPM) in minutes/patient-day; total nursing manoeuvres (TNM) in min/patient-day. 2. TISS Calculation of personnel requirements on the basis of both parameters. RESULTS: TPM averaged at 3.9 hours. No fixed correlation was established between TISS and TPM. TNM averaged 1,073 minutes/patient-day and demonstrated a good correlation with TISS. CONCLUSIONS: Physician activities on a surgical ICU averaged 3.9 hours/patient-day. Nursing manoeuvres average 17.9 hours/patient-day. Individual measurements must be made before calculating personnel requirements on the basis of TISS scores.

[Monitoring critically ill patients during transport by helicopter using a patient with abdomen apertum as an example]. / Die Uberwachung Schwerstkranker während des Hubschraubertransportes am Beispiel einer Patientin mit Abdomen apertum.

Noninvasive continuous monitoring systems are newly emerging as an important means of monitoring during transports in emergency care, e.g. transportation by helicopter. While automatic oscillometric blood pressure monitors have been used in the perioperative area for some time, a similar development can be observed in the field of emergency care and transportation with the availability of light, portable and battery operated systems. For monitoring adequate oxygenation, pulse oximeters have recently been brought into discussion for both the perioperative period and the transport of critically ill patients. In contrast to well-established monitoring techniques during helicopter transports (ECG, inspection, manually measured blood pressure (BP), pulse oximetry reveals an oxygen deficiency due to respiratory and cardiocirculatory problems, enabling precious time to be saved. This concept is illustrated during the helicopter transport of a critically ill patient with abdomen apertum caused by Clostridium perfringens infection. Even with a critical look at the already described mishaps of this method--e.g. overestimation of true O2 saturation (sO2) and additional overestimation caused by Hb-derivatives--pulse oximetry was found to be superior to the established monitoring techniques. Furthermore, oscillometric blood pressure detection was very satisfactory during the 30-min helicopter transport. Based on our results, we believe pulse oximetry and automatic oscillometric BP-measurement to be useful for monitoring during transports in helicopters, thus improving patient safety.

[Computerized tomography of the thorax in intensive care patients]. / Die thorakale Computertomographie bei Intensivpatienten.

Thoracic CT for patients in intensive care is cumbersome but provides important additional information in the presence of complicated lung changes. Total opacification of a lung field visualised on conventional portable films may be due to infiltration and/or fluid and/or collapse by using the clinical information in conjunction with densitometric measurements. CT may help in the differentiation of pulmonary oedema, particularly in the presence of ARDS and its complications. It is also possible to accurately localise abscesses and empyemas in the presence of extensive consolidation. This makes it possible to drain abscesses or empyemas, or pleural fluid in unusual situations, which has become loculated, or to aspirate a pneumothorax.

[A new CPAP system]. / Ein neues CPAP-System.

The "AMBU-CPAP system" is a new, simple and reliable circuit for administering positive airway pressure in spontaneous-breathing therapy. Some disadvantages of other CPAP devices are avoided, and the use of the system with low gas flow is possible. The change of airway pressure during respiration was measured and was found to be less than 5 millibars.

[Artificial respiration technics]. / Beatmungstechniken.

In general there are two distinguishable methods of artificial ventilation: assisted spontaneous ventilation and controlled ventilation. Spontaneous ventilation can be supported by CPAP or PEEP, in order to improve oxygenation, and by IMV to improve CO2 elimination. Furthermore, high frequency low pressure ventilation may be used versus low frequency high pressure ventilation. Conventional IPPV may be supported by continuous endexspiratory pressure. In special cases IRV may be applied. High frequency low pressure ventilation methods may be used intra- and postoperatively as well as post-traumatically.