Björn Jüttner

Alteration of anion gap and strong ion difference caused by hydroxyethyl starch 6% (130/0.42) and gelatin 4% in children.

Background:  Synthetic colloid administration is a common practice for preventing perioperative hypovolemia and consecutive circulatory failure in children. This prospective, randomized study was conducted to investigate the effects of two different unbalanced synthetic colloid solutions on acid–base equilibrium in children.

Paediatric airway management in mucopolysaccharidosis 1: a retrospective case review.

Context Airway management in children suffering from mucopolysaccharidosis 1 (Hurler syndrome) remains challenging despite advances in both treatment and airway management techniques. Objectives Forty-one anaesthetic charts following ten children over a 6-year period (2004–2010) were reviewed with emphasis on airway problems. Results All children had early stem cell transplantation at the age of 2 years or earlier. Mean (SD) age was 5 (4.3) years. Mask ventilation was difficult in five of 41 (12%) anaesthetics or in three of ten children. There were 29 intubations. Direct laryngoscopy was described as difficult (Cormack and Lehane ≥3) on 11 occasions in five of ten children. There were three of 26 (12%) failed intubations with direct laryngoscopy. These situations were resolved by a fibre-optic procedure, by laryngeal mask airway (LMA) insertion or by use of a videolaryngoscope. A laryngeal mask airway was used 11 times to avoid invasive airway management and once when direct laryngoscopy was impossible. Conclusion The airway management of children with mucopolysaccharidosis 1 remains critical, despite advances in both treatment and airway management techniques. Problems did not seem to increase as children grew older. We assume that technical improvements such as standardised use of the laryngeal mask airway or attached tube channel videolaryngoscopes as well as a stem cell transplantation treatment of the disease helped the management of older children with mucopolysaccharidosis 1.

Tumor lysis associated with dexamethasone use in a child with leukemia

Postoperative nausea and vomiting (PONV) occurs in every third patient undergoing general anesthesia without PONV prophylaxis. Antiemetic prophylaxis with dexamethasone is commonly used in patients at moderate risk. We present a case in which PONV prophylaxis with a single dose of dexamethasone led to tumor lysis in a patient with acute leukemia. In case of a cancer patient at moderate risk for PONV, the anesthesiologist should contact the oncologist first, or use other antiemetic drugs such as antiserotoninergic agents for PONV prophylaxis.

Hyperbare Therapie und Tauchmedizin – Hyperbare Therapie Teil 1: evidenzbasierte Akutversorgung

Hyperbaric oxygen therapy (HBOT), i. e. breathing pure oxygen at elevated ambient pressure, remains the gold standard of care in treating air or gas embolism and decompression illness. Guidelines are less clear on the value of HBOT in acute management of carbon monoxide (CO) poisoning or clostridial necrosis. To evaluate the evidence of clinical efficacy of HBOT we performed a systematic literature review. Part 1 assesses acute indications such as air or gas embolism, decompression sickness, CO-poisoning, clostridialmyonecrosis, necrotizing problem wounds, acute traumatic wounds and arterial retinal occlusion. Part 2 discusses further uses of HBOT as adjuvant treatment and highlights problems in assessing the value of HBOT using evidence-based medicine criteria.

Diagnostik und Behandlung von Tauchunfällen

In 2015 the German Society for Diving and Hyperbaric Medicine (GTÜM) and the Swiss Underwater and Hyperbaric Medical Society (SUHMS) published the updated guidelines on diving accidents 2014-2017. These multidisciplinary guidelines were developed within a structured consensus process by members of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), the Sports Divers Association (VDST), the Naval Medical Institute (SchiffMedInst), the Social Accident Insurance Institution for the Building Trade (BG BAU), the Association of Hyperbaric Treatment Centers (VDD) and the Society of Occupational and Environmental Medicine (DGAUM). This consensus-based guidelines project (development grade S2k) with a representative group of developers was conducted by the Association of Scientific Medical Societies in Germany. It provides information and instructions according to up to date evidence to all divers and other lay persons for first aid recommendations to physician first responders and emergency physicians as well as paramedics and all physicians at therapeutic hyperbaric chambers for the diagnostics and treatment of diving accidents. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose and the following key action statements: on-site 100% oxygen first aid treatment, still patient positioning and fluid administration are recommended. Hyperbaric oxygen (HBO) recompression remains unchanged the established treatment in severe cases with no therapeutic alternatives. The basic treatment scheme recommended for diving accidents is hyperbaric oxygenation at 280 kPa. For quality management purposes there is a need in the future for a nationwide register of hyperbaric therapy.

Case report: fatal diving-accident : Or: accident while diving?

This example of a fatal diving accident shows how challenging such cases can be in pre-hospital and clinical care. There is no common mechanism in diving fatalities and more than one group of disorders coming along with decompression sickness. Diving medicine is not an element of medical education, which results in insecurity and hampers adequate therapy of diving incidents. This is aggravated by an insufficient availability of hyperbaric chambers in Germany.ZusammenfassungDer vorgestellte Tauchunfall belegt dessen Herausforderung in der präklinischen und klinischen Versorgung. Häufig gibt es keinen klaren Unfallmechanismus und oft mehr als eine Erkrankungsentität. Die Tauchmedizin ist so gut wie kein Bestandteil der regelhaften ärztlichen Aus- und Weiterbildung, sodass häufig Unsicherheiten bezüglich der Behandlung vorherrschen, die die optimale Therapie behindern. Hinzu kommt die desolate Versorgung Deutschlands mit rufbereiten Druckkammern an Zentren der Maximalversorgung.AbstractThis example of a fatal diving accident shows how challenging such cases can be in pre-hospital and clinical care. There is no common mechanism in diving fatalities and more than one group of disorders coming along with decompression sickness. Diving medicine is not an element of medical education, which results in insecurity and hampers adequate therapy of diving incidents. This is aggravated by an insufficient availability of hyperbaric chambers in Germany.

Carbon monoxide poisoning from waterpipe smoking: a retrospective cohort study

Abstract Objective: Waterpipe smoking may increasingly account for unintentional carbon monoxide poisoning, a serious health hazard with high morbidity and mortality. We aimed at identifying waterpipe smoking as a cause for carbon monoxide poisoning in a large critical care database of a specialty care referral center. Methods: This retrospective cohort study included patients with a history of exposure to waterpipe smoking and carbon monoxide blood gas levels >10% or presence of clinical symptoms compatible with CO poisoning admitted between January 2013 and December 2016. Patients’ initial symptoms and carbon monoxide blood levels were retrieved from records and neurologic status was assessed before and after hyperbaric oxygen treatment. Results: Sixty-one subjects with carbon monoxide poisoning were included [41 males, 20 females; mean age 23 (SD ± 6) years; range 13–45] with an initial mean carboxyhemoglobin of 26.93% (SD ± 9.72). Most common symptoms included syncope, dizziness, headache, and nausea; 75% had temporary syncope. Symptoms were not closely associated with blood COHb levels. Conclusion: CO poisoning after waterpipe smoking may present in young adults with a wide variability of symptoms from none to unconsciousness. Therefore diagnosis should be suspected even in the absence of symptoms.

Kohlenmonoxidvergiftung: Hyperbare Sauerstoffbehandlung (HBOT) empfehlenswert

Drinhaus et al. [1] geben einen sehr guten Überblick über feuerwehrtechnische Grundlagen und medizinische Besonderheiten der notärztlichen Tätigkeit im Brandeinsatz. DieDarstellung imAbschnitt „Rauchgasintoxikation“ sollte allerdings diskutiert und ergänzt werden. Ausdrücklich sind die klinischen Symptome der systemischen zellulären Hypoxie bei Rauchgasintoxikation unspezifisch. In einer Auswertung [2] von 1323 Patienten mit Kohlenmonoxidvergiftung waren die häufigsten Symptome dennoch Kopfschmerz, Schwindel, Übelkeit, Verwirrtheit, Müdigkeit, Brustschmerz, Kurzatmigkeit und Verlust des Bewusstseins. Die Verdachtsdiagnose einer Kohlenmonoxidvergiftung kann im Rettungsdienst nur klinisch gestellt werden: auf der Grundlage einer Exposition mit Kohlenmonoxid [3]. Die von der FDA (Food and Drug Administration) empfohlene nichtinvasive Mehrwellenpulsoximetrie ist kontrovers in ihrer Anwendungssicherheit und hinsichtlich falsch-positiver Ergebnisse

Diagnosis and treatment of diving accidents : new German guidelines for diving accidents 2014-2017

In 2015 the German Society for Diving and Hyperbaric Medicine (GTÜM) and the Swiss Underwater and Hyperbaric Medical Society (SUHMS) published the updated guidelines on diving accidents 2014-2017. These multidisciplinary guidelines were developed within a structured consensus process by members of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), the Sports Divers Association (VDST), the Naval Medical Institute (SchiffMedInst), the Social Accident Insurance Institution for the Building Trade (BG BAU), the Association of Hyperbaric Treatment Centers (VDD) and the Society of Occupational and Environmental Medicine (DGAUM). This consensus-based guidelines project (development grade S2k) with a representative group of developers was conducted by the Association of Scientific Medical Societies in Germany. It provides information and instructions according to up to date evidence to all divers and other lay persons for first aid recommendations to physician first responders and emergency physicians as well as paramedics and all physicians at therapeutic hyperbaric chambers for the diagnostics and treatment of diving accidents. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose and the following key action statements: on-site 100% oxygen first aid treatment, still patient positioning and fluid administration are recommended. Hyperbaric oxygen (HBO) recompression remains unchanged the established treatment in severe cases with no therapeutic alternatives. The basic treatment scheme recommended for diving accidents is hyperbaric oxygenation at 280 kPa. For quality management purposes there is a need in the future for a nationwide register of hyperbaric therapy.

Diagnostik und Therapie der Kohlenmonoxidvergiftung

Knörr et al. präsentieren eine bisher nichtalltägliche Kasuistik aus der kinderärztlichen Notaufnahme. Die Darstellung der Diagnose und insbesondere der Therapie und des Verlaufs sollte allerdings diskutiert und ergänzt werden. Im Abschn. „Anamnese und Befund“ wird eine schwere Kohlenmonoxidintoxikation mit initialer Bewusstlosigkeit und fortgesetzt eingeschränkter Orientierung zur Situation sowie nachgewiesener Exposition mit Kohlenmonoxid beschrieben. InderBlutgasanalysewurde die Diagnose bestätigt. Folgerichtig ist die Behandlung mit einer Sauerstoffatmung über eine Reservoirmaske begonnen worden. Nach Absetzen der Sauerstoffgabe bestand allerdings weiterhin eine Bewusstseinsstörung. In dem beschriebenen Fall war nach 16h eine Elimination des Carboxyhämoglobins (CO-Hb) bei 100%iger Sauerstoffatmung zu erwarten und nachweisbar (. Abb. 1). Dennoch ist ausdrücklich zu betonen, dass CO-Hb nur als Surrogatparameter aufgrund seiner einfachen Messbarkeit zu bewerten ist. Die pleiotropen Effekte des CO bewirken u. a. eine Einschränkung der mitochondrialen Atmungskette, zellulären Energiegewinnung, Inflammation und Radikalbildung, insbesondere zerebral und kardial mit einem von demCOHbunabhängigenEliminationsverhalten [1]. Die klinischen Symptome der systemischen zellulären Hypoxie bei Kohlenmonoxidintoxikationen sind unspezifisch. Die häufigsten Symptome in