Kreislaufstillstand unter besonderen Umständen: Elektrolytstörungen, Vergiftungen, Ertrinken, Unterkühlung, Hitzekrankheit, Asthma, Anaphylaxie, Herzchirurgie, Trauma, Schwangerschaft, Stromunfall

Cardiac monitoring always required after electrical injuries?

BACKGROUND

Controversy still exists regarding inpatient monitoring of patients exposed to electrical injuries.

MATERIALS AND METHODS

In a monocentric retrospective study, we evaluated the medical records of 169 patients admitted to the University Hospital of Cologne from January 2000 to January 2014 because of electrical trauma. The electrocardiogram (ECG) data of 40 patients were missing.

RESULTS

Patients in our collective were predominantly young men (60 %) with an average age of 17.5 ± 17 years (1 year to 73 years). The electrical trauma occurred occupational (20 %), domestic (65 %), and during leisure time (15 %). In the high-voltage (≥ 1000 V) group (n = 7; 71 % male; 40.0 ± 19.4 years) one death was reported, related to an open intracranial injury and cardiac arrest. Of the six surviving patients five showed normal ECGs and one a sinus tachycardia. In the low-voltage (< 1000 V) group (n = 162, 56 % male; 5.0 ± 4.3 years) the ECG findings were as follows: 104 normal, 5 sinus tachycardia, 3 sinus arrhythmia, 6 ST segment changes, 3 premature atrial contraction, 1 premature ventricular contraction, 1 atrio-ventricular (AV)-Block and 1 delta wave. In all, one patient showed a self-limiting supraventricular tachycardia.

CONCLUSION

Asymptomatic and stable patients without any risk factors and with a normal initial ECG need no inpatient cardiac monitoring after an electrical injury.

Automatic chest compression devices--when do they make sense?

The current resuscitation guidelines of the European Resuscitation Council do not include automatic chest compression devices (ACDs) as standard equipment to support cardiopulmonary resuscitation attempts. One possible reason could be the lack of a list of indications and contraindications for the use of ACD systems. This review should give a summary of current studies and developments according to ACD systems and deliver a list of possible applications. Furthermore, we discuss some ethical problems with cardiopulmonary resuscitation attempts and, in particular, with ACD systems. The use of ACDs occurs instead of manual chest compression. Because of this, there is no reason for changing the current guidelines, especially termination recommendations while using ACD systems. From our point of view, ACDs are a very good supplement to the current standard of resuscitation according to the European Resuscitation Council guidelines.

[When the resting membrane potential becomes restless. Acute hyperkalemia in the perioperative phase]

Acute hyperkalemia is a life-threatening event and often occurs abruptly and without warning in the perioperative field. Risk factors are found on multiple levels as they can derive from a patients pre-existing condition or result from the surgical intervention or management of anesthesia. The therapy of hyperkalemia depends on the dimensions of electrolyte disturbance and a distinction can be made between therapeutic measures with a rapid and those with a long-term effect.