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Busch HJ, Wolfrum S, Michels G, Baumgärtel M, Bodmann KF, Buerke M, Burst V, Enghard P, Ertl G, Fach WA, Hanses F, Heppner HJ, Hermes C, Janssens U, John S, Jung C, Karagiannidis C, Kiehl M, Kluge S, Koch A, Kochanek M, Korsten P, Lepper PM, Merkel M, Müller-Werdan U, Neukirchen M, Pfeil A, Riessen R, Rottbauer W, Schellong S, Scherg A, Sedding D, Singler K, Thieme M, Trautwein C, Willam C, Werdan K. [Clinical acute and emergency medicine curriculum-focus on internal medicine : Recommendations for advanced training in internal medicine in the emergency department]. Med Klin Intensivmed Notfmed 2024:10.1007/s00063-024-01113-3. [PMID: 38625382 DOI: 10.1007/s00063-024-01113-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 04/17/2024]
Abstract
In Germany, physicians qualify for emergency medicine by combining a specialty medical training-e.g. internal medicine-with advanced training in emergency medicine according to the statutes of the State Chambers of Physicians largely based upon the Guideline Regulations on Specialty Training of the German Medical Association. Internal medicine and their associated subspecialities represent an important column of emergency medicine. For the internal medicine aspects of emergency medicine, this curriculum presents an overview of knowledge, skills (competence levels I-III) as well as behaviours and attitudes allowing for the best treatment of patients. These include general aspects (structure and process quality, primary diagnostics and therapy as well as indication for subsequent treatment; resuscitation room management; diagnostics and monitoring; general therapeutic measures; hygiene measures; and pharmacotherapy) and also specific aspects concerning angiology, endocrinology, diabetology and metabolism, gastroenterology, geriatric medicine, hematology and oncology, infectiology, cardiology, nephrology, palliative care, pneumology, rheumatology and toxicology. Publications focussing on contents of advanced training are quoted in order to support this concept. The curriculum has primarily been written for internists for their advanced emergency training, but it may generally show practising emergency physicians the broad spectrum of internal medicine diseases or comorbidities presented by patients attending the emergency department.
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Affiliation(s)
- Hans-Jörg Busch
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum Freiburg, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Sebastian Wolfrum
- Interdisziplinäre Notaufnahme Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - Guido Michels
- Notfallzentrum, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus der Universitätsmedizin Mainz, Trier, Deutschland
| | - Matthias Baumgärtel
- Klinikum Nürnberg, Universitätsklinik für Innere Medizin 3 der Paracelsus Medizinischen Privatuniversität, Nürnberg, Deutschland
| | | | - Michael Buerke
- Medizinische Klinik II, St. Marien-Krankenhaus Siegen, Siegen, Deutschland
| | - Volker Burst
- Schwerpunkt Klinische Akut- und Notfallmedizin und Klinik II für Innere Medizin, Uniklinik Köln, Köln, Deutschland
| | - Philipp Enghard
- Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité Universitätsmedizin, Berlin, Deutschland
| | - Georg Ertl
- Deutsches Zentrum für Herzinsuffizienz, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Wolf Andreas Fach
- MVZ CCB am AGAPLESION Bethanien Krankenhaus, Frankfurt (Main), Deutschland
| | - Frank Hanses
- Interdisziplinäre Notaufnahme, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Hans Jürgen Heppner
- Klinik für Geriatrie und Geriatrische Tagesklinik, Klinikum Bayreuth - Medizincampus Oberfranken und Friedrich-Alexander-Universität Erlangen-Nürnberg, Bayreuth, Deutschland
| | | | - Uwe Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Stefan John
- Medizinische Klinik 8, Abteilung für Internistische Intensivmedizin, Klinikum Nürnberg-Süd, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - Christian Jung
- Klinik für Kardiologie, Pneumologie und Angiologie des Universitätsklinikums Düsseldorf, Heinrich-Heine Universität Düsseldorf, Düsseldorf, Deutschland
| | - Christian Karagiannidis
- ARDS und ECMO Zentrum Köln-Merheim, Kliniken Köln und Universität Witten/Herdecke, Köln, Deutschland
| | - Michael Kiehl
- Medizinische Klinik I, Klinikum Frankfurt (Oder), Frankfurt (Oder), Deutschland
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Alexander Koch
- Medizinische Klinik III, Universitätsklinikum Aachen, Aachen, Deutschland
| | | | - Peter Korsten
- Klinik für Rheumatologie und Klinische Immunologie, St. Josef-Stift Sendenhorst, Sendenhorst, Deutschland
| | - Philipp M Lepper
- Klinik für Akut- und Notfallmedizin, Universität und Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | | | - Ursula Müller-Werdan
- Medizinische Klinik für Geriatrie und Altersmedizin, der Charité - Universitätsmedizin Berlin und EGZB, Berlin, Deutschland
| | - Martin Neukirchen
- Interdisziplinäres Zentrum für Palliativmedizin und Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Alexander Pfeil
- Klinik für Innere Medizin III, Universitätsklinikum Jena, Jena, Deutschland
| | - Reimer Riessen
- Internistische Intensivstation 93, Dept. f. Innere Medizin, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Wolfgang Rottbauer
- Klinik für Innere Medizin II (Kardiologie, Angiologie, Pneumologie, Intensivmedizin, Sport- und Rehabilitationsmedizin), Universitätsklinikum Ulm, Ulm, Deutschland
| | | | | | - Daniel Sedding
- Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Ernst-Grube-Straße 40, 06097, Halle (Saale), Deutschland
| | - Katrin Singler
- Universitätsklinik für Innere Medizin - Geriatrie & Institut für Biomedizin des Alterns, Klinikum Nürnberg Paracelsus Medizinische Privatuniversität & Friedrich-Alexander Universität Erlangen-Nürnberg, Nürnberg & Erlangen, Deutschland
| | - Marcus Thieme
- Abteilung Innere Medizin und REGIOMED Gefäßzentrum, REGIOMED Klinikum Sonneberg, Sonneberg und Klinik für Innere Medizin I, Universitätsklinikum Jena, Jena, Deutschland
| | | | - Carsten Willam
- Medizinische Klinik 4, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Karl Werdan
- Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Ernst-Grube-Straße 40, 06097, Halle (Saale), Deutschland.
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Michels G, Greim CA, Krohn A, Ott M, Feuerstein D, Möckel M, Fuchs N, Friemert B, Wolfrum S, Kiefl D, Bernhard M, Reifferscheid F, Bathe J, Walcher F, Dietrich CF, Lechleuthner A, Busch HJ, Sauer D. [Recommendations for Education in Sonography in Prehospital Emergency Medicine (pPOCUS): Consensus paper of DGINA, DGAI, BAND, BV-ÄLRD, DGU, DIVI and DGIIN]. Med Klin Intensivmed Notfmed 2023; 118:39-46. [PMID: 37548658 DOI: 10.1007/s00063-023-01054-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Point-of-care sonography is a precondition in acute and emergency medicine for the diagnosis and initiation of therapy for critically ill and injured patients. While emergency sonography is a mandatory part of the training for clinical acute and emergency medicine, it is not everywhere required for prehospital emergency medicine. Although some medical societies in Germany have already established their own learning concepts for emergency ultrasound, a uniform national training concept for the use of emergency sonography in the out-of-hospital setting is still lacking. Experts of several professional medical societies have therefore joined forces and developed a structured training concept for emergency sonography in the prehospital setting. The consensus paper serves as quality assurance in prehospital emergency sonography.
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Affiliation(s)
- Guido Michels
- Notfallzentrum, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus der Universitätsmedizin Mainz, Nordallee 1, 54292, Trier, Deutschland.
| | - Clemens-Alexander Greim
- Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, Klinikum Fulda, Fulda, Deutschland
| | - Alexander Krohn
- Department für interdisziplinäre Akut‑, Notfall- und Intensivmedizin (DIANI), Klinikum Stuttgart, Stuttgart, Deutschland
| | - Matthias Ott
- Department für interdisziplinäre Akut‑, Notfall- und Intensivmedizin (DIANI), Klinikum Stuttgart, Stuttgart, Deutschland
| | - Doreen Feuerstein
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Martin Möckel
- Notfall- und Akutmedizin, Zentrale Notaufnahmen und Chest Pain Units, Campus Virchow-Klinikum/Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Nikola Fuchs
- St.-Antonius-Hospital gGmbH, Klinik für Akut- und Notfallmedizin, Eschweiler, Deutschland
| | - Benedikt Friemert
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - Sebastian Wolfrum
- Interdisziplinäre Notaufnahme, Universitätsklinikums Schleswig-Holstein, Kiel, Deutschland
| | | | - Michael Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Heinrich-Heine Universität, Düsseldorf, Deutschland
| | - Florian Reifferscheid
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Janina Bathe
- Institut für Rettungs- und Notfallmedizin, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Felix Walcher
- Klinik für Unfallchirurgie, Universitätsmedizin Magdeburg, Magdeburg, Deutschland
| | - Christoph F Dietrich
- Department für Allgemeine Innere Medizin DAIM, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Schweiz
| | | | - Hans-Jörg Busch
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Dorothea Sauer
- Zentrale Notaufnahme, Asklepios Klinik Wandsbek, Hamburg, Deutschland
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Michels G, Greim CA, Krohn A, Ott M, Feuerstein D, Möckel M, Fuchs N, Friemert B, Wolfrum S, Kiefl D, Bernhard M, Reifferscheid F, Bathe J, Walcher F, Dietrich CF, Lechleuthner A, Busch HJ, Sauer D. [Recommendations for Education in Sonography in Prehospital Emergency Medicine (pPOCUS): Consensus paper of DGINA, DGAI, BAND, BV-ÄLRD, DGU, DIVI and DGIIN]. Anaesthesiologie 2023; 72:654-661. [PMID: 37544933 DOI: 10.1007/s00101-023-01327-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Point-of-care sonography is a precondition in acute and emergency medicine for the diagnosis and initiation of therapy for critically ill and injured patients. While emergency sonography is a mandatory part of the training for clinical acute and emergency medicine, it is not everywhere required for prehospital emergency medicine. Although some medical societies in Germany have already established their own learning concepts for emergency ultrasound, a uniform national training concept for the use of emergency sonography in the out-of-hospital setting is still lacking. Experts of several professional medical societies have therefore joined forces and developed a structured training concept for emergency sonography in the prehospital setting. The consensus paper serves as quality assurance in prehospital emergency sonography.
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Affiliation(s)
- Guido Michels
- Notfallzentrum, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus der Universitätsmedizin Mainz, Nordallee 1, 54292, Trier, Deutschland.
| | - Clemens-Alexander Greim
- Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, Klinikum Fulda, Fulda, Deutschland
| | - Alexander Krohn
- Department für interdisziplinäre Akut‑, Notfall- und Intensivmedizin (DIANI), Klinikum Stuttgart, Stuttgart, Deutschland
| | - Matthias Ott
- Department für interdisziplinäre Akut‑, Notfall- und Intensivmedizin (DIANI), Klinikum Stuttgart, Stuttgart, Deutschland
| | - Doreen Feuerstein
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Martin Möckel
- Notfall- und Akutmedizin, Zentrale Notaufnahmen und Chest Pain Units, Campus Virchow-Klinikum/Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Nikola Fuchs
- St.-Antonius-Hospital gGmbH, Klinik für Akut- und Notfallmedizin, Eschweiler, Deutschland
| | - Benedikt Friemert
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - Sebastian Wolfrum
- Interdisziplinäre Notaufnahme, Universitätsklinikums Schleswig-Holstein, Kiel, Deutschland
| | | | - Michael Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Heinrich-Heine Universität, Düsseldorf, Deutschland
| | - Florian Reifferscheid
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Janina Bathe
- Institut für Rettungs- und Notfallmedizin, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Felix Walcher
- Klinik für Unfallchirurgie, Universitätsmedizin Magdeburg, Magdeburg, Deutschland
| | - Christoph F Dietrich
- Department für Allgemeine Innere Medizin DAIM, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Schweiz
| | | | - Hans-Jörg Busch
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum (UNZ), Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Dorothea Sauer
- Zentrale Notaufnahme, Asklepios Klinik Wandsbek, Hamburg, Deutschland
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Anheuser P, Michels G, Gakis G, Neisius A, Steffens J, Kranz J. [Position paper of the working group Urological Acute Medicine]. Urologie 2023; 62:936-940. [PMID: 37115300 DOI: 10.1007/s00120-023-02090-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 04/29/2023]
Abstract
Emergency patients with acute genitourinary system diseases are frequently encountered in both outpatient and clinical emergency structures. It is estimated that one-third of all inpatients in a urology clinic initially present as an emergency. In addition to general emergency medicine knowledge, specialized urologic expertise is a prerequisite for the care of these patients, which is needed early and specifically for optimal treatment outcomes. It must be taken into account that, on the one hand, the current structures of emergency care still lead to delays in patient care despite positive developments in recent years. On the other hand, most hospital emergency facilities need urologic expertise on site. In addition, politically intended changes in our health care system, which drive an increasing ambulantization of medicine and condition a further centralization of emergency clinics, become effective. The aim of the newly established working group "Urological Acute Medicine" is to ensure and further improve the quality of care for emergency patients with acute genitourinary system diseases and, in consensus with the German Society of Interdisciplinary Emergency and Acute Medicine, to define precise task distributions and interfaces of both specialities.
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Affiliation(s)
- Petra Anheuser
- Klinik für Urologie, Asklepios Klinik Wandsbek, Alphonsstr. 14, 22403, Hamburg, Deutschland.
- Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland.
| | - Guido Michels
- Klinik für Akut- und Notfallmedizin, St. Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Georgios Gakis
- Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - Andreas Neisius
- Abteilung für Urologie und Kinderurologie, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus der Universitätsmedizin Mainz, Trier, Deutschland
| | - Joachim Steffens
- Klinik für Urologie und Kinderurologie, St. Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Jennifer Kranz
- Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
- Klinik für Urologie und Kinderurologie, Uniklinik RWTH Aachen, Aachen, Deutschland
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Michels G, Greim CA, Krohn A, Ott M, Feuerstein D, Möckel M, Fuchs N, Friemert B, Wolfrum S, Kiefl D, Bernhard M, Reifferscheid F, Bathe J, Walcher F, Dietrich CF, Lechleuthner A, Busch HJ, Sauer D. Empfehlungen zur Sonografieausbildung in der prähospitalen Notfallmedizin (pPOCUS): Konsensuspapier von DGINA, DGAI, BAND, BV-ÄLRD, DGU, DIVI und DGIIN. Notf Rett Med 2023. [DOI: 10.1007/s10049-023-01196-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
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Kaiser U, Dropco I, Reuthner K, Ertl M, Schlitt HJ, Herr W, Stroszczynski C, Jung EM. Wireless handheld focused ultrasound in student teaching during the COVID-19 pandemic: Initial results of a pilot study1. Clin Hemorheol Microcirc 2023; 85:297-305. [PMID: 36502312 DOI: 10.3233/ch-229104] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The study aim was to investigate the use of a novel device, the Vscan Air™, for rapidly and effectively performing ultrasound in student teaching during the COVID-19 pandemic. MATERIAL AND METHODS As part of the ultrasound practical course with integrated hands-on activity required by the regular medical curriculum, 100 medical students were instructed in the use of the Vscan Air™, including duplex mode. They then evaluated the quality of the ultrasound images obtained by the Vscan Air™ from previously selected organs. RESULTS 100 students were interviewed (female n = 68, male n = 32; age >18 years n = 100). The rated image quality never fell below a mean of 3 for the examined organs and portal vein flow (liver 4,58; spleen 3,99; kidneys 4,29; aorta 4,16; Douglas/rectovesical space 4,14; portal vein 4,43; pancreas 3,53; Focused Assessment with Sonography for Trauma 4,38). Scores below 3 were found sporadically in ultrasounds of the spleen (n = 4), kidneys (n = 3), Douglas/rectovesical space (n = 2), and pancreas (n = 15). The liver was rated the lowest for 59 ratings. The portal vein was evaluated in 68 cases. The hepatic artery and hepatic veins could be also visualized in all 68 examinations. The aorta was evaluated in 62 cases. CONCLUSION The Vscan Air™ technology offered adequate image quality and provided a new, fast and patient-oriented technique to support continuous ultrasound examinations and education of students, especially during a pandemic. Particularly noteworthy is the uncomplicated compliance with the required high level of hygiene.
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Affiliation(s)
- Ulrich Kaiser
- Medical Clinic and Polyclinic III, University Hospital Regensburg, Regensburg, Germany
| | - Ivor Dropco
- Clinic and Polyclinic for Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Kathrin Reuthner
- Medical Clinic and Polyclinic III, University Hospital Regensburg, Regensburg, Germany
| | - Michael Ertl
- Department of Medical Technology, University Hospital Regensburg, Regensburg, Germany
| | - Hans Jürgen Schlitt
- Clinic and Polyclinic for Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Wolfgang Herr
- Medical Clinic and Polyclinic III, University Hospital Regensburg, Regensburg, Germany
| | - Christian Stroszczynski
- Institute for Diagnostic Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
| | - Ernst Michael Jung
- Institute for Diagnostic Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
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Dietrich CF, Bulla P, Dudwiesus H, Lo H, Hocke M, Hoffmann B, Horn R, Lehmann B, Morf S, Nuernberg D, Prosch H, Serra A, Spengler J, Blaskova A, Jenssen C. [Perspectives and Challenges of hand-held Ultrasound]. Z Gastroenterol 2022. [PMID: 36170860 DOI: 10.1055/a-1901-9394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The use of handheld ultrasound devices from a technical and data protection point of view, device properties, functionality, documentation, indications, delegation of performance, applications by doctors, students and non-medical staff is examined and discussed.
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Affiliation(s)
- Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Peter Bulla
- Medizinische Klinik I, Klinik für Gastroenterologie, Gastrointestinale Onkologie, Hepatologie, Infektiologie und Geriatrie, Universitätsklinikum Tübingen, Deutschland, Tübingen, Germany
| | | | - Hendra Lo
- Brandenburgisches Institut für Klinischen Ultraschall, Medizinische Hochschule Brandenburg, Neuruppin, Germany
| | - Michael Hocke
- Klinik für Innere Medizin II, HELIOS Klinikum Meiningen, Meiningen, Germany
| | - Beatrice Hoffmann
- Beth Israel Deaconess Medical Center, Boston MA, Boston, United States
| | - Rudolf Horn
- Center da sandà Val Müstair, Sta. Maria, Switzerland
| | - Beat Lehmann
- Universitäres Notfallzentrum, Inselspital Universitätsspital Bern, Bern, Switzerland
| | - Susanne Morf
- Center da sandà Val Müstair, Sta. Maria, Val Müstair, Switzerland
| | - Dieter Nuernberg
- Brandenburgisches Institut für Klinischen Ultraschall und Fakultät Gesundheitswissenschaften, Medizinische Hochschule Brandenburg, Neuruppin, Germany
| | - Helmut Prosch
- Univ. Klinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Wien, Austria
| | | | | | - Andrea Blaskova
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Christian Jenssen
- Brandenburgisches Institut für Klinischen Ultraschall, Medizinische Hochschule Brandenburg, Neuruppin, Germany
- Innere Medizin, Krankenhaus Märkisch Oderland GmbH, Strausberg, Germany
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Michels G, Wolfrum S, Dodt C, Busch HJ. [Treatment algorithm: Focused ultrasound and echocardiography]. Med Klin Intensivmed Notfmed 2022. [PMID: 35579702 DOI: 10.1007/s00063-022-00928-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
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Michels G, Horn R, Helfen A, Hagendorff A, Jung C, Hoffmann B, Jaspers N, Kinkel H, Greim CA, Knebel F, Bauersachs J, Busch HJ, Kiefl D, Spiel AO, Marx G, Dietrich CF. Standardisierte Kontrastmittelsonographie (CEUS) in der klinischen Akut- und Notfallmedizin sowie Intensivmedizin (CEUS-Akut). Kardiologe 2022; 16:160-163. [DOI: 10.1007/s12181-022-00531-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 11/27/2023]
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Michels G, Horn R, Helfen A, Hagendorff A, Jung C, Hoffmann B, Jaspers N, Kinkel H, Greim CA, Knebel F, Bauersachs J, Busch HJ, Kiefl D, Spiel AO, Marx G, Dietrich CF. [Standardized contrast-enhanced ultrasound (CEUS) in clinical acute and emergency medicine as well as critical care (CEUS Acute) : Consensus statement of the DGIIN, DIVI, DGINA, DGAI, DGK, ÖGUM, SGUM und DEGUM]. Anaesthesist 2022; 71:307-310. [PMID: 35142877 DOI: 10.1007/s00101-021-01080-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Guido Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Str. 8, 52249, Eschweiler, Deutschland.
| | - Rudolf Horn
- Notfallmedizin, Center da sandà Val Müstair, Sta. Maria, Schweiz
| | - Andreas Helfen
- Medizinische Klinik I, Katholisches Klinikum Lünen Werne GmbH, St.-Marien-Hospital Lünen, Lünen, Deutschland
| | - Andreas Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Christian Jung
- Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Beatrice Hoffmann
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Natalie Jaspers
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Köln, Köln, Deutschland
| | - Horst Kinkel
- Praxis für Gastroenterologie, Düren, Deutschland
| | - Clemens-Alexander Greim
- Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, Klinikum Fulda, Pacelliallee 4, 36043, Fulda, Deutschland
| | - Fabian Knebel
- Klinik für Innere Medizin II: Schwerpunkt Kardiologie, Sana Klinikum Lichtenberg, Berlin, Deutschland
| | - Johann Bauersachs
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Hans-Jörg Busch
- Universitätsklinikum, Universitäts-Notfallzentrum, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Daniel Kiefl
- Klinik für Interdisziplinäre Notfallmedizin, Sana Klinikum Offenbach, Offenbach am Main, Deutschland
| | - Alexander O Spiel
- Klinik Ottakring, Zentrale Notaufnahme, Wiener Gesundheitsverbund, Wien, Österreich
| | - Gernot Marx
- Klinik für operative Intensivmedizin, Universitätsklinikum Aachen, Aachen, Deutschland
| | - Christoph F Dietrich
- Department für Allgemeine Innere Medizin DAIM, Kliniken Hirslanden Beau Site, Salem und Permanence, Schänzlihalde 11, 3013, Bern, Schweiz.
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12
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Michels G. [Resuscitation room management : Today and tomorrow]. Med Klin Intensivmed Notfmed 2021; 116:375-6. [PMID: 34043034 DOI: 10.1007/s00063-021-00809-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
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13
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Trauzeddel RF, Nordine M, Groesdonk HV, Michels G, Pfister R, Reuter DA, Scheeren TWL, Berger C, Treskatsch S. [Perioperative optimization using hemodynamically focused echocardiography in high-risk patients-A practice guide]. Anaesthesist 2021; 70:772-784. [PMID: 33660043 DOI: 10.1007/s00101-021-00934-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND The number of high-risk patients undergoing surgery is steadily increasing. In order to maintain and, if necessary, optimize perioperative hemodynamics as well as the oxygen supply to the organs (DO2) in this patient population, a timely assessment of cardiac function and the underlying pathophysiological causes of hemodynamic instability is essential for the anesthesiologist. A variety of hemodynamic monitoring procedures are available for this purpose; however, due to method-immanent limitations they are often not able to directly identify the underlying cause of cardiovascular impairment. OBJECTIVE To present a stepwise algorithm for a perioperative echocardiography-based hemodynamic optimization in noncardiac surgery high-risk patients. In this context, echocardiography on demand according to international guidelines can be performed under certain conditions (hemodynamic instability, nonresponse to hemodynamic treatment) as well as in the context of a planned intraoperative procedure, mostly as a transesophageal echocardiography. METHODS AND RESULTS Hemodynamically focused echocardiography as a rapidly available bedside method, enables the timely diagnosis and assessment of cardiac filling obstructions, volume status and volume response, right and left heart function, and the function of the heart valves. CONCLUSION Integrating all echocardiographic findings in a differentiated assessment of the patient's cardiovascular function enables a (patho)physiologically oriented and individualized hemodynamic treatment.
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Affiliation(s)
- R F Trauzeddel
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - M Nordine
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - H V Groesdonk
- Klinik für Interdisziplinäre Intensivmedizin und Intermediate Care, Helios Klinikum Erfurt, Erfurt, Deutschland
| | - G Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - R Pfister
- Klinik III für Innere Medizin, Herzzentrum, Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - D A Reuter
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - T W L Scheeren
- Klinik für Anästhesiologie, Universitätsmedizin Groningen, Groningen, Niederlande
| | - C Berger
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - S Treskatsch
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland.
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14
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John S, Riessen R, Karagiannidis C, Janssens U, Busch HJ, Kochanek M, Michels G, Hermes C, Buerke M, Kluge S, Baumgärtel M, Braune S, Erbguth F, Fuhrmann V, Lebiedz P, Mayer K, Müller-Werdan U, Oppert M, Sayk F, Sedding D, Willam C, Werdan K. [Core curriculum Medical intensive care medicine of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN)]. Med Klin Intensivmed Notfmed 2021; 116:1-45. [PMID: 33427907 PMCID: PMC7799161 DOI: 10.1007/s00063-020-00765-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 11/25/2022]
Abstract
Medical intensive care medicine treats patients with severe, potentially life-threatening diseases covering the complete spectrum of internal medicine. The qualification in medical intensive care medicine requires a broad spectrum of knowledge and skills in medical intensive care medicine, but also in the general field of internal medicine. Both sides of the coin must be taken into account, the treatment with life-sustaining strategies of the acute illness of the patient and also the treatment of patient's underlying chronic diseases. The indispensable foundation of medical intensive care medicine as described in this curriculum includes basic knowledge and skills (level of competence I-III) as well as of behavior and attitudes. This curriculum is primarily dedicated to the internist in advanced training in medical intensive care medicine. However, this curriculum also intends to reach trainers in intensive care medicine and also the German physician chambers with their examiners, showing them which knowledge, skills as well as behavior and attitudes should be taught to trainees according to the education criteria of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN).
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Affiliation(s)
- S John
- Klinikum Nürnberg-Süd, Medizinische Klinik 8, Abteilung für Internistische Intensivmedizin, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - R Riessen
- Dept. für Innere Medizin, Internistische Intensivstation, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - C Karagiannidis
- ARDS und ECMO Zentrum Köln-Merheim, Professur für extrakorporale Lungenersatzverfahren der Universität Witten-Herdecke, Abteilung Pneumologie, Intensiv- und Beatmungsmedizin, Kliniken der Stadt Köln gGmbH, Köln, Deutschland
| | - U Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital gGmbH, Akademisches Lehrkrankenhaus der RWTH Aachen, Eschweiler, Deutschland
| | - H-J Busch
- Universitäts-Notfallzentrum Freiburg, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - M Kochanek
- Klinik I für Innere Medizin (Hämatologie und Onkologie), Schwerpunkt Internistische Intensivmedizin, Universitätsklinikum Köln, Köln, Deutschland
| | - G Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Akademisches Lehrkrankenhaus der RWTH Aachen, Eschweiler, Deutschland
| | | | - M Buerke
- Medizinische Klinik II, St. Marien-Krankenhaus Siegen, Siegen, Deutschland
| | - S Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - M Baumgärtel
- Klinikum Nürnberg-Nord, Intensivstation 10/II, Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - S Braune
- IV. Med. Klinik - Internistische Intensivmedizin und Notaufnahme, Franziskus-Hospital Münster, Münster, Deutschland
| | - F Erbguth
- Klinikum Nürnberg, Universitätsklinik für Neurologie, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - V Fuhrmann
- Klinik für Innere Medizin I, Evangelisches Klinikum Niederrhein, Duisburg, Deutschland
| | - P Lebiedz
- Klinik für Innere Medizin und Internistische Intensivmedizin, Ev. Krankenhaus Oldenburg, Steinweg 13-17, Oldenburg, Deutschland
| | - K Mayer
- Medizinische Klinik 4, Pneumologie und Schlafmedizin, ViDia Kliniken, Karlsruhe, Deutschland
| | - U Müller-Werdan
- Klinik für Geriatrie und Altersmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
- Evangelisches Geriatriezentrum Berlin (EGZB), Berlin, Deutschland
| | - M Oppert
- Klinik für Notfall- und Intensivmedizin, Klinikum Ernst von Bergmann, Potsdam, Deutschland
| | - F Sayk
- Campus Lübeck, Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - D Sedding
- Universitätsklinikum Halle (Saale), Klinik und Poliklinik für Innere Medizin III, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland
| | - C Willam
- Universitätsklinikum Erlangen, Medizinische Klinik 4, Nephrologie und Hypertensiologie, Friedrich-Alexander-Universität Erlangen, Erlangen, Deutschland
| | - K Werdan
- Universitätsklinikum Halle (Saale), Klinik und Poliklinik für Innere Medizin III, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland.
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15
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Hempel D, Casu S, Michels G. [Focused ultrasound in the emergency room]. Med Klin Intensivmed Notfmed 2021; 116:390-9. [PMID: 33420555 DOI: 10.1007/s00063-020-00768-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/09/2020] [Accepted: 12/09/2020] [Indexed: 01/16/2023]
Abstract
Ultrasound is an important tool in diagnosis and treatment of critically ill patients. For trauma patients the eFAST (extended focused assessment with sonography for trauma) algorithm is already implemented in the diagnostic pathway. However, critically ill patients without trauma also need a structured approach including an early focused ultrasonographic exam. National and international guidelines regarding critical illnesses such as acute coronary syndrome, cardiogenic shock complicating myocardial infarction, pulmonary embolism or acute aortic syndromes recommend the use of ultrasound. We present pathways how ultrasound can be used in the diagnostic approach of common symptoms such as dyspnea, shock and abdominal pain. Using the ABCDE approach this article shows how ultrasound can be incorporated into the diagnostic pathway.
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16
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Hempel D, Michels G. [Sonography in intensive care and emergency medicine : A new training concept]. Med Klin Intensivmed Notfmed 2020; 116:301-306. [PMID: 32318820 DOI: 10.1007/s00063-020-00688-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/02/2020] [Accepted: 03/26/2020] [Indexed: 01/20/2023]
Abstract
Structured sonography training in internal medicine intensive care and emergency medicine (SIN) comprises two levels and was proposed by three national societies in Germany (DGIIN, DGK and DEGUM). The curriculum consists of a basic level (SIN-I) and an expert level (SIN-II) which are consecutive levels teaching both theoretical and hands-on skills using a symptom-based approach. Competency is assessed using written, oral and practical structured assessments at the end of each level. The goal is to implement national and international recommendations regarding the use of point-of-care ultrasound into clinical practice.
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Affiliation(s)
- D Hempel
- Zentrale Notaufnahme und Aufnahmestation, Universitätsklinik Magdeburg, Magdeburg, Deutschland
| | - G Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital Eschweiler, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland.
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17
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Michels G, Wengenmayer T, Hagl C, Dohmen C, Böttiger BW, Bauersachs J, Markewitz A, Bauer A, Gräsner JT, Pfister R, Ghanem A, Busch HJ, Kreimeier U, Beckmann A, Fischer M, Kill C, Janssens U, Kluge S, Born F, Hoffmeister HM, Preusch M, Boeken U, Riessen R, Thiele H. [Recommendations for extracorporeal cardiopulmonary resuscitation (eCPR) : Consensus statement of DGIIN, DGK, DGTHG, DGfK, DGNI, DGAI, DIVI and GRC]. Anaesthesist 2019; 67:607-616. [PMID: 30014276 DOI: 10.1007/s00101-018-0473-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Extracorporeal cardiopulmonary resuscitation (eCPR) may be considered as a rescue attempt for highly selected patients with refractory cardiac arrest and potentially reversible etiology. Currently there are no randomized, controlled studies on eCPR, and valid predictors of benefit and outcome which might guide the indication for eCPR are lacking. Currently selection criteria and procedures differ across hospitals and standardized algorithms are lacking. Based on expert opinion, the present consensus statement provides a proposal for a standardized treatment algorithm for eCPR.
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Affiliation(s)
- G Michels
- Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - T Wengenmayer
- Klinik für Kardiologie und Angiologie I, Universitäts-Herzzentrum Freiburg - Bad Krozingen, Medizinische Fakultät der Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - C Hagl
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Ludwig-Maximilians-Universität, München, Deutschland
| | - C Dohmen
- LVR-Klinik Bonn, Bonn, Deutschland
| | - B W Böttiger
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universität zu Köln, Köln, Deutschland
| | - J Bauersachs
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | | | - A Bauer
- MediClin Herzzentrum Coswig, Coswig, Deutschland
| | - J-T Gräsner
- Institut für Rettungs- und Notfallmedizin, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - R Pfister
- Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - A Ghanem
- Abteilung Kardiologie, II. Medizinische Klinik, Asklepios Klinik St. Georg, Hamburg, Deutschland
| | - H-J Busch
- Universitäts-Notfallzentrum, Universitätsklinikum Freiburg, Medizinische Fakultät der Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - U Kreimeier
- Klinik für Anästhesiologie, Klinikum der Universität München, Ludwig-Maximilians-Universität, München, Deutschland
| | - A Beckmann
- Herzzentrum Duisburg, Klinik für Herz- und Gefäßchirurgie, Evangelisches Krankenhaus Niederrhein, Duisburg, Deutschland
| | - M Fischer
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, ALB FILS KLINIKEN GmbH, Klinik am Eichert, Göppingen, Deutschland
| | - C Kill
- Zentrum für Notfallmedizin, Universitätsmedizin Essen, Essen, Deutschland
| | - U Janssens
- Klinik für Innere Medizin und Intensivmedizin, St.-Antonius-Hospital, Eschweiler, Deutschland
| | - S Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - F Born
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Ludwig-Maximilians-Universität, München, Deutschland
| | - H M Hoffmeister
- Klinik für Kardiologie und Allgemeine Innere Medizin, Städtisches Klinikum Solingen gGmbH, Solingen, Deutschland
| | - M Preusch
- Zentrum für Innere Medizin, Klinik für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - U Boeken
- Klinik für Kardiovaskuläre Chirurgie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - R Riessen
- Department für Innere Medizin, Internistische Intensivstation, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - H Thiele
- Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universitätsklinik, Leipzig, Deutschland
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18
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Michels G. [Bedside imaging in emergency and critical care medicine : Integration of ultrasound in a clinical context]. Med Klin Intensivmed Notfmed 2019; 114:488-489. [PMID: 31506811 DOI: 10.1007/s00063-019-0557-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- G Michels
- Klinik III für Innere Medizin, Herzzentrum, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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Kumle B, Merz S, Mittmann A, Pin M, Brokmann JC, Gröning I, Biermann H, Michael M, Böhm L, Wolters S, Bernhard M. Nichttraumatologisches Schockraummanagement. Notf Rett Med 2019. [DOI: 10.1007/s10049-019-0613-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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20
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Michels G, Wengenmayer T, Hagl C, Dohmen C, Böttiger BW, Bauersachs J, Markewitz A, Bauer A, Gräsner JT, Pfister R, Ghanem A, Busch HJ, Kreimeier U, Beckmann A, Fischer M, Kill C, Janssens U, Kluge S, Born F, Hoffmeister HM, Preusch M, Boeken U, Riessen R, Thiele H. Empfehlungen zur extrakorporalen kardiopulmonalen Reanimation (eCPR). Z Herz- Thorax- Gefäßchir 2019. [DOI: 10.1007/s00398-018-0262-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
A "biomarker" is measures something quantitatively or qualitatively, and this improves clinical decision-making. Echocardiography is therefore also a "biomarker". It provides information on anatomy, function and haemodynamics. Echocardiography can provide important information for almost all cardiovascular diseases in emergency and intensive care medicine: acute coronary syndrome, myocardial infarction, heart failure, pulmonary embolism, sepsis, endocarditis, stroke, etc. All patients with dyspnea, chest pain, respiratory insufficiency, sepsis and after resuscitation must receive echocardiography. Conventional biomarkers complete the picture here-to enable optimal diagnosis and therapy.
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Affiliation(s)
- F Knebel
- Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Charité Universitätsmedizin Berlin, Campus Mitte, 10098, Berlin, Deutschland.
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22
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Jaspers N, Holzapfel B, Kasper P. [Abdominal ultrasound in emergency and critical care medicine]. Med Klin Intensivmed Notfmed 2019; 114:509-518. [PMID: 30840096 DOI: 10.1007/s00063-019-0551-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/02/2019] [Accepted: 02/02/2019] [Indexed: 12/29/2022]
Abstract
Abdominal ultrasound is established as an important and low-risk diagnostic procedure in emergency and intensive care medicine that allows rapid and precise diagnosis in symptomatic patients and helps to evaluate which further diagnostic steps are needed. Abdominal ultrasound should be performed as the initial imaging modality in all symptomatic patients in an emergency or intensive care unit and can be used with great accuracy to detect the presence of various abdominal pathologies, such as abdominal aortic aneurysm, abscess, ureterolithiasis or free fluid. Furthermore ultrasound represents the imaging modality of choice for guiding many diagnostic and interventional percutaneous procedures in emergency and intensive care medicine and can be used e. g. to drain pleural fluid or abdominal abscesses. Contrast-enhanced ultrasound (CEUS) can additionally be performed to provide a more reliable assessment of solid organ injuries and has the potential to detect parenchymal lesions or active bleeding from a variety of traumatic origins. Abdominal ultrasound is aimed to integrate rapidly detectable sonographic findings into the clinical context. To ensure required standards, regular training is necessary and it is important to understand methodological limitations.
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Affiliation(s)
- N Jaspers
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - B Holzapfel
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - P Kasper
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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23
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Stöbe S, Metze M, Spies C, Hagendorff A. [Transesophageal echocardiography in emergency and intensive care medicine : Indication and implementation]. Med Klin Intensivmed Notfmed 2019; 114:490-498. [PMID: 30830290 DOI: 10.1007/s00063-019-0549-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/02/2019] [Accepted: 02/02/2019] [Indexed: 10/27/2022]
Abstract
Transesophageal echocardiography (TEE) in emergency and intensive care medicine represents an additional semi-invasive method to confirm or rebut suspected diagnoses in critically ill patients. Three-dimensional (3D)-TEE investigations are established in the clinical workflow of emergency and intensive care units because 3D-TEE investigations permit a differentiation of artifacts due to oblique views by simultaneous documentation of sectional planes and en face views of characteristic cardiac structures. Thus, the level of diagnostic validity can be significantly increased by 3D-TEE investigation. The main indications of TEE investigation in emergency medicine are hemodynamic instability due to myocardial, pericardial or valvular heart diseases as well as suspected endocarditis and aortic dissection.
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Affiliation(s)
- S Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - M Metze
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - C Spies
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - A Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
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Hempel D, Schröper T, Pfister R, Michels G. [Ultrasound training in emergency and intensive care medicine : Integration already in medical school?]. Med Klin Intensivmed Notfmed 2019; 114:519-524. [PMID: 30830291 DOI: 10.1007/s00063-019-0550-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 02/02/2019] [Indexed: 12/21/2022]
Abstract
Ultrasound is an important diagnostic tool especially in emergency and intensive care medicine. It is always available at the bedside and shortens time to diagnosis. Many specialties have integrated ultrasound into diagnostic algorithms as part of the extended physical exam. Numerous differential diagnoses can be easily excluded using point-of-care ultrasound and therefore adequate treatment is initiated faster. Emergency or focused ultrasound is therefore of outstanding relevance to any emergency or critical care physician. Integration into medical school curricula is becoming more common tough no nationwide standards are in place yet.
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Affiliation(s)
- D Hempel
- Zentrale Notaufnahme und Aufnahmestation, Universitätsklinik Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland.
| | - T Schröper
- Klinik III für Innere Medizin, Herzzentrum, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - R Pfister
- Klinik III für Innere Medizin, Herzzentrum, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - G Michels
- Klinik III für Innere Medizin, Herzzentrum, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
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Wong A, Galarza L, Duska F. Critical Care Ultrasound: A Systematic Review of International Training Competencies and Program. Crit Care Med 2019; 47:e256-62. [DOI: 10.1097/ccm.0000000000003626] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lesage B, Martinez M, Lefebvre T, Cavalli P, Cailasson L, Léger M, d’Arras A, Boyer A, Redjaline A, Viallon A. Pratique de l’échographie clinique au sein d’un réseau territorial d’urgence. Ann Fr Med Urgence 2019. [DOI: 10.3166/afmu-2018-0086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectif : L’échographie clinique en médecine d’urgence (ECMU) est un outil essentiel de notre pratique. L’objectif principal de notre étude était d’évaluer les caractéristiques des médecins pratiquant l’ECMU au sein de notre territoire. L’objectif secondaire était d’analyser les facteurs influençant une pratique régulière.
Matériel et méthodes : Étude descriptive multicentrique et déclarative, réalisée auprès de médecins urgentistes travaillant au sein d’un réseau territorial de médecine d’urgence à l’aide d’un questionnaire en ligne.
Résultats : Cent onze questionnaires sur 120 envoyés ont été renseignés (92 %). Onze services (92 %) étaient dotés en échographe dont neuf (82 %) en dotation propre. Soixantesix médecins (59 %) déclaraient pratiquer l’échographie régulièrement. La FAST (focused assessment with sonography for traumas) était la plus pratiquée (80 médecins, 72 %), suivie de l’exploration hémodynamique (50 médecins, 45 %) et pleurale (44 médecins, 40 %). Dans le groupe des médecins ne pratiquant pas l’ECMU, 17 médecins sur 22 (77 %) l’expliquaient par un manque de formation. Dans le même temps, l’intérêt porté à l’ECMU par les urgentistes était coté à 7 ± 2 sur une échelle de 0 à 9. Les facteurs associés à la fréquence de la pratique de l’ECMU étaient le sexe (p < 0,001), le type d’activité (p = 0,005), le type de formation à l’échographie (p < 0,001) et l’ancienneté d’équipement de son service en échographe (p < 0,001).
Conclusion : Cette enquête a montré que la pratique régulière était majoritaire avec un intérêt porté par les praticiens à l’ECMU élevé. Cependant, le frein principal à son développement était un niveau de formation jugé insuffisant par certains praticiens.
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Abstract
Focused echocardiography has become increasingly important for bedside diagnostics in acute medicine. Focused echocardiography can detect various cardiac pathologies, such as pericardial effusion, left ventricular dysfunction, right heart strain, relevant heart valve defects and dissection of the ascending aorta. Echocardiographic findings should be interpreted in the clinical context.
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Affiliation(s)
- G Michels
- Klinik III für Innere Medizin, Herzzentrum der Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - R Pfister
- Klinik III für Innere Medizin, Herzzentrum der Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - D Hempel
- Zentrale Notaufnahme, Medizinische Fakultät, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Magdeburg, Deutschland
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Milkau M, Noll T, Sayk F. [Point-of-care ultrasonography of the abdomen in emergency and intensive care medicine]. Med Klin Intensivmed Notfmed 2018; 113:638-48. [PMID: 30302528 DOI: 10.1007/s00063-018-0491-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/21/2018] [Accepted: 09/12/2018] [Indexed: 10/28/2022]
Abstract
Point-of-care ultrasound is a fundamental part of diagnostic and therapeutic management in emergency and intensive care medicine. The availability of high-resolution mobile ultrasound systems allows high-quality imaging at the bedside of the patient. Point-of-care ultrasound is not a comprehensive differential diagnostic abdominal ultrasound examination. Rather, the aim of the method is to integrate easily detectable sonographic findings into the clinical context. From this, the necessary diagnostic or therapeutic procedures are derived. This article shows opportunities and limitations of this method. The structure of the article is given by the leading clinical symptoms. The focus is on the ultrasound examination and the characteristic sonographic findings with illustrative ultrasound images. This is followed by a short differential diagnostic interpretation. Further diagnostic or therapeutic management is also briefly addressed.
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Michels G, Wengenmayer T, Hagl C, Dohmen C, Böttiger BW, Bauersachs J, Markewitz A, Bauer A, Gräsner J, Pfister R, Ghanem A, Busch H, Kreimeier U, Beckmann A, Fischer M, Kill C, Janssens U, Kluge S, Born F, Hoffmeister HM, Preusch M, Boeken U, Riessen R, Thiele H. Recommendations for extracorporeal cardiopulmonary resuscitation (eCPR): consensus statement of DGIIN, DGK, DGTHG, DGfK, DGNI, DGAI, DIVI and GRC. Clin Res Cardiol 2019; 108:455-64. [DOI: 10.1007/s00392-018-1366-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/30/2018] [Indexed: 11/27/2022]
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Michels G, Wengenmayer T, Hagl C, Dohmen C, Böttiger BW, Bauersachs J, Markewitz A, Bauer A, Gräsner J, Pfister R, Ghanem A, Busch H, Kreimeier U, Beckmann A, Fischer M, Kill C, Janssens U, Kluge S, Born F, Hoffmeister HM, Preusch M, Boeken U, Riessen R, Thiele H. Empfehlungen zur extrakorporalen kardiopulmonalen Reanimation (eCPR): Konsensuspapier der DGIIN, DGK, DGTHG, DGfK, DGNI, DGAI, DIVI und GRC. Kardiologe 2018; 12:332-41. [DOI: 10.1007/s12181-018-0268-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Michels G, Wengenmayer T, Hagl C, Dohmen C, Böttiger BW, Bauersachs J, Markewitz A, Bauer A, Gräsner JT, Pfister R, Ghanem A, Busch HJ, Kreimeier U, Beckmann A, Fischer M, Kill C, Janssens U, Kluge S, Born F, Hoffmeister HM, Preusch M, Boeken U, Riessen R, Thiele H. Empfehlungen zur extrakorporalen kardiopulmonalen Reanimation (eCPR). Med Klin Intensivmed Notfmed 2018; 113:478-486. [DOI: 10.1007/s00063-018-0452-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Balzer F, Trauzeddel RF, Ertmer M, Erb J, Heringlake M, Groesdonk HV, Goepfert M, Reuter DA, Sander M, Treskatsch S. Utilization of echocardiography in Intensive Care Units: results of an online survey in Germany. Minerva Anestesiol 2018; 85:263-270. [PMID: 29945434 DOI: 10.23736/s0375-9393.18.12657-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND In patients with hemodynamic instability echocardiography has been recommended as the preferred modality to evaluate the underlying pathophysiology. However, due to the fact that recent scientific data on the utilization of echocardiography in German Intensive Care Units (ICU) are scarce, we sought to investigate current practice. METHODS A structured, web-based, anonymized survey was performed from May until July 2015 among members of the German Interdisciplinary Association of Critical Care and Emergency Medicine (DIVI) consisting of 14 questions. Descriptive data analysis was performed. RESULTS One hundred four intensivists participated in the survey. Two-thirds of participants (66%) used echocardiography regularly for hemodynamic monitoring and stated that it changed the therapy in 26-50% of the cases irrespective of the time performed after ordering the examination. Transthoracic (TTE) were more frequently used than transesophageal (TEE) examinations. Twenty-six percent of the participants held an echocardiography certificate with a formal examination, 27% completed a structured training without an examination and almost half of the questioned ICU personnel (47%) did not complete a comprehensive training. CONCLUSIONS The results of this survey demonstrate a widespread utilization of echocardiography as part of routine diagnostic on frequent number of operative ICUs. However, there might be a lack of structured echocardiographic training especially for anesthesiologists.
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Affiliation(s)
- Felix Balzer
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum Charité, University Medicine Berlin, Berlin, Germany
| | - Ralf F Trauzeddel
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum Charité, University Medicine Berlin, Berlin, Germany
| | - Martin Ertmer
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum Charité, University Medicine Berlin, Berlin, Germany
| | - Joachim Erb
- Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital of Basel, Basel, Switzerland
| | - Matthias Heringlake
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - Heinrich V Groesdonk
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Faculty of Medicine, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Matthias Goepfert
- Department of Anesthesiology and Intensive Care Medicine, Klinikum Passau, Passau, Germany
| | - Daniel A Reuter
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rostock, Rostock, Germany
| | - Michael Sander
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, Gießen, Germany
| | - Sascha Treskatsch
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum Charité, University Medicine Berlin, Berlin, Germany -
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Michels G, Hempel D, Pfister R, Janssens U. Emergency ultrasound and echocardiography in patients with infarct-related cardiogenic shock : A survey among members of the German Society of Medical Intensive Care and Emergency Medicine. Med Klin Intensivmed Notfmed 2018; 114:434-438. [PMID: 29632969 DOI: 10.1007/s00063-018-0431-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/13/2018] [Accepted: 03/07/2018] [Indexed: 02/07/2023]
Abstract
Current international and national guidelines promote the use of emergency echocardiography in patients with cardiogenic shock. We assessed whether these recommendations are followed in clinical practice of infarct-related cardiogenic shock patients. For this purpose we conducted a web-based survey among all members of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN); 40% of the DGIIN members completed the survey. Participants reported that in their department emergency echocardiography/ultrasound is performed on most patients in infarct-related cardiogenic shock presenting to the emergency department/chest pain unit or intensive care unit (58.6% versus 81.4%). Only 33% stated that on patients admitted directly to the catheterization laboratory emergency ultrasound/echocardiography is applied in their institution. Local availability of a standardized algorithm was lacking in the majority of departments (77.2%). A great proportion (38.3%) of participants stated that they personally had no formal training in emergency ultrasound. In order to meet the demands of the current guidelines, in addition to integration of ultrasound examinations into diagnostic algorithms, a structured training of all emergency and intensive care physicians is necessary.
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Affiliation(s)
- G Michels
- Department III of Internal Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - D Hempel
- Department of Emergency Medicine, University Hospital Jena, Jena, Germany
| | - R Pfister
- Department III of Internal Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - U Janssens
- Department of Cardiology, St Antonius Hospital, Eschweiler, Germany
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Hempel D, Pfister R, Michels G. Strukturierte bettseitige Sonographie in der Intensivmedizin. Z Herz- Thorax- Gefäßchir 2018. [DOI: 10.1007/s00398-017-0201-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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35
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Hempel D, Pfister R, Michels G. [Structured bedside-ultrasound in intensive care medicine]. Med Klin Intensivmed Notfmed 2017; 112:741-58. [PMID: 29063125 DOI: 10.1007/s00063-017-0366-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/17/2017] [Accepted: 09/18/2017] [Indexed: 12/27/2022]
Abstract
The so-called point-of-care ultrasound (POCUS) is of increasing importance for diagnostics and therapy control in intensive care medicine. Based on focused thorax sonography, echocardiography, and abdominal sonography, the most important working and differential diagnoses can be demonstrated or excluded depending on the leading symptom. Sonographic-based algorithms allow a structured evaluation especially of patients with the common leading symptoms dyspnea and thoracic pain.
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