[Analysis of response reports of an in-hospital emergency team : Three years experience at a maximum medical care hospital]. / Analyse der Einsatzdaten eines innerklinischen Notfallteams : Dreijährige Erfahrung an einem Krankenhaus der Maximalversorgung.

BACKGROUND: In-hospital emergencies can lead to unexpected admission to the ICU, cardiac arrest or even death. Therefore, hospitals have to implement an adequate in-hospital emergency management. The results of the deployment of the in-hospital emergency team of a hospital providing maximum medical care will be presented. PATIENTS AND METHODS: In 2003 the Westpfalz-Klinikum, Kaiserslautern introduced a central emergency team. The data of the emergency teams on alarm calls and the patient records from 2004 to 2007 were evaluated. RESULTS: There were 241 alarm calls (9 alarm calls/100 beds and year). The mean age of the patients was 67 years and 56% were male. In 79% of all alarm calls the vital functions were compromised and in 37% cardiac arrest had occurred. When the emergency team arrived all cardiac arrest patients had received basic life support, however, no early defibrillation had been applied. On arrival of the emergency team 41% of the patients could be left on-site after emergency treatment, 40% had to be admitted to an intensive care or intermediate care unit and 21% died or were already dead (5 patients). In 27% of all cardiac arrests ventricular fibrillation/pulseless ventricular tachycardia was the first detected sign. Restoration of spontaneous circulation could be established in 53% and 20% of all resuscitated patients could be discharged. Respiratory emergencies (21%) and altered states of consciousness (20%) were other leading causes for calling the emergency team. CONCLUSIONS: The high proportion of patients in a life-threatening condition and cardiac arrests indicates the necessity for closer patient monitoring, more intensive emergency training including early defibrillation and continuing education of hospital staff in the prevention and early detection of emergencies, in addition to the provision of an emergency team.

Does the efficacy of supplemental oxygen for the prevention of postoperative nausea and vomiting depend on the measured outcome, observational period or site of surgery?

High intra-operative oxygen concentration reportedly reduces postoperative nausea and vomiting (PONV), but recent data are conflicting. Therefore, we tested whether the effectiveness of supplemental oxygen depends on the endpoint (nausea vs. vomiting), observation interval (early vs. late) or surgical field (abdominal vs. non-abdominal). We randomly assigned 560 adult patients undergoing various elective procedures with a PONV risk of at least 40% to intra-operative 80% (supplemental) or 30% oxygen (control). Potential confounding factors were similar between groups. Incidences of nausea were similar in the groups during early (12% (supplemental) vs. 10% (control), p = 0.43) and late intervals, 26%vs. 20%, p = 0.09, as were the incidences of vomiting (early: 2%vs. 3%, p = 0.40; late: 8%vs. 9%, p = 0.75). Supplemental oxygen was no more effective at reducing PONV in abdominal (40%vs. 31%, p = 0.37) than in non-abdominal surgery (25%vs. 21%, p = 0.368). Thus, supplemental oxygen was unable to reduce PONV independent of the endpoint, observational period or site of surgery.

[Management of cardiac arrest in a German soccer stadium. Structural, process and outcome quality]. / Management des Kreislaufstillstands in einer Fussballarena. Struktur-, Prozess- und Ergebnisqualität.

BACKGROUND: In Germany there is a lack of data about the quality of emergency medical care in mass gatherings. The following report reflects our experience with management of cardiac arrest events as an example for the most critical medical emergency in a soccer stadium. METHODS: The Fritz-Walter Stadium is a well-known soccer arena with a crowd capacity of 46,600. Emergency medical care is provided by a 2-tiered system consisting of 3 emergency physicians and 65 ambulance personnel and paramedics. Resuscitation was conducted according to the guidelines of the European Resuscitation Council and American Heart Association. RESULTS: Within 80 months, 13 witnessed cardiac arrests occurred, all in males. In each case the initial rhythm was ventricular fibrillation, 6 patients collapsed before or after the match. Basic life support was usually provided within 2 min, defibrillation and advanced life support within 4 min, 77% regained spontaneous circulation, and 62% survived without neurologic deficits. CONCLUSION: Cardiac arrest is a relatively frequent event in a soccer stadium. Due to a well organised response system, the survival rate exceeded by far the corresponding figures reported by public health systems.