[Emergency Cricothyrotomy - step by step]. / Notfallkoniotomie ­ Schritt für Schritt.

Emergency cricothyrotomy is a live saving intervention to rapidly gain access to the airways in patients who cannot be intubated nor ventilated. Considering complications such as bleeding, thyroid and cricoid cartilage injury and creation of a false tract emergency cricothyrotomy should not be performed until non-invasive attempts including video laryngoscopy and the use of supraglottic airway devices have been exploited within a fixed difficult airway management algorithm. Methods of emergency cricothyrotomy can be differentiated in a catheter-over-needle, Seldinger-wire and surgical technique. However, success is less dependent from the choice of method but from individual experience and training. Despite a lack of evidence due to its infrequent use cricothyrotomy generally results in an acceptable success rate. In this review a selection of commercially available cricothyrotomy sets is presented, indications for their use are outlined and their handling is described.

[Qualified post-mortem examination-experiences from Bremen]. / Qualifizierte Leichenschau ­ Erfahrungen aus Bremen.

On 1 August 2017, the qualified post-mortem examination was introduced in Bremen by changing the relevant law. A substantial change is the separation of the pure death determination, which can be done by any physician, and the subsequent execution of the post-mortem examination by a suitably qualified physician. For the city of Bremen, the Institute for Legal Medicine (IRM) was charged with this task (in Bremerhaven, the health department).In this article, practical implementation, problems, and advantages and disadvantages of the new law are presented. For the year 2018 we did a statistical evaluation of the qualified post-mortem examination.After notification of a case of death to the IRM, the post-mortem examination will be carried out on the same or the following working day by an IRM doctor. In 2018, 7585 post-mortem examinations took place. In nearly 300 cases (4%) the type of death had to be changed (natural/not natural).Problems arise if external undertakers are involved. Further challenges arise in the collection of the anamnesis and implementation after extended weekends as well as due to the lack of knowledge about the death scene and generally the difficulty to conclude on the cause of death within the scope of an external post-mortem examination. One advantage to mention is that every deceased person is relatively promptly subjected to a post-mortem examination by a qualified doctor and overall the quality of the examination has improved. A disadvantage is the increased cost.