An endocrine crisis is a hormonal disorder that leads to death if left untreated. The fundamental importance of endocrine regulatory circuits for homeostasis is also evident in critical illnesses-as a consequence of another disease or as a cause. In fact, the clinical presentation of a crisis is often nonspecific and therefore differs from the classical presentation of endocrine disorders. This review summarizes intensive care aspects of crises due to glucocorticoid deficiency (adrenal crisis) or excess (Cushing's crisis), excess thyroid hormone (thyroid storm), and hypercalcemic crisis (parathyroid crisis). The focus is on differential diagnostic classification, stabilization as a primary intensive care task, and differentiation from detailed endocrinological differential diagnostics.

Hitzeerkrankungen stellen ein zunehmendes Gesundheitsrisiko dar, bedingt durch die fortschreitende Urbanisierung, das Ausmaß der Hitzewellen infolge des Klimawandels sowie den demografischen Wandel mit einem wachsenden Anteil vulnerabler älterer Bevölkerungsgruppen. Im Rahmen der aktuellen Hitzewellen werden aus allen Teilen Deutschlands zahlreiche Hitzetote gemeldet (laut RKI im ersten Halbjahr 2026 mindestens 9800 hitzebedingte Sterbefälle) [1]. Länder wie Deutschland, die bisher nur wenig Kontakt mit schweren Hitzeerkrankungen hatten, sind zumeist für die Behandlung der schweren hitzebedingten Erkrankungen unzureichend vorbereitet. Bei den Hitzeerkrankungen unterscheidet man hitzeassoziierte von hitzebedingten Erkrankungen. Hitzeassoziierte Erkrankungen umfassen eine temperaturbedingte Verschlechterung bereits bestehender Erkrankungen (z. B. kardiale oder pulmonale Erkrankungen, Infektionen und Dehydrierung) und treten deutlich häufiger auf als klassische hitzebedingte Erkrankungen. Hitzebedingte Erkrankungen sind Syndrome, die direkt durch Hitze und/oder Sonneneinstrahlung entstehen, z. B. Sonnenstich, Hitzesynkope, Hitzekrämpfe, Hitzeerschöpfung und Hitzschlag, fließende Übergänge zwischen den Entitäten sind möglich. Diese Gesundheitsstörungen entstehen, wenn der Körper durch hohe Außentemperaturen, direkte Sonneneinstrahlung, körperliche Anstrengung und/oder fehlende Luftzirkulation die Wärme nicht mehr ausreichend an die Umgebung abgeben kann und es konsekutiv zu einer Thermoregulationsstörung kommt. Hitzebedingte Erkrankungen können unterschiedliche Schweregrade erreichen und reichen von leichtgradigen Hitzeerkrankungen mit Ödemen, Muskelkrämpfen oder Kollaps über die Hitzeerschöpfung bis hin zum schwergradigen Hitzschlag („heat stroke“) mit schweren neurologischen Symptomen und potenziell letalem Ausgang. Im Fokus dieses Konsensuspapiers stehen daher die Differenzialdiagnostik der hitzebedingten Erkrankungen, deren Prophylaxe und die therapeutischen Maßnahmen.

An endocrine crisis is a hormonal disorder that leads to death if left untreated. The fundamental importance of endocrine regulatory circuits for homeostasis is also evident in critical illnesses-as a consequence of another disease or as a cause. In fact, the clinical presentation of a crisis is often nonspecific and therefore differs from the classical presentation of endocrine disorders. This review summarizes intensive care aspects of crises due to glucocorticoid deficiency (adrenal crisis) or excess (Cushing's crisis), excess thyroid hormone (thyroid storm), and hypercalcemic crisis (parathyroid crisis). The focus is on differential diagnostic classification, stabilization as a primary intensive care task, and differentiation from detailed endocrinological differential diagnostics.

Unter einer endokrinen Krise wird eine hormonelle Störung verstanden, die unbehandelt zum Tod führt. Darüber hinaus zeigt sich die fundamentale Bedeutung endokriner Regelkreise für die Homöostase auch bei kritischen Erkrankungen – als Folge einer anderen Krankheit oder ursächlich. Tatsächlich ist die klinische Präsentation einer endokrinen Krise häufig unspezifisch und unterscheidet sich daher von der gelehrten Präsentation endokriner Erkrankungen. In dieser Übersichtsarbeit werden intensivmedizinische Aspekte von Krisen durch einen Glukokortikoidmangel (Nebennierenkrise) oder -exzess (Cushing-Krise), einen Exzess an Schilddrüsenhormon (thyreotoxische Krise) und der hyperkalzämischen Krise zusammengefasst. Der Schwerpunkt liegt in der differenzialdiagnostischen Einordnung, der Stabilisierung als primär intensivmedizinische Aufgabe und der Abgrenzung zu einer detaillierten endokrinologischen Differenzialdiagnostik.

According to long-term studies, patients with adrenal insufficiency (AI) exhibit a reduced quality of life and increased mortality. In addition to cardiovascular and malignant diseases, the risk of mortality is particularly increased by adrenal crises. Fatal adrenal crises could be completely prevented by timely intravenous or subcutaneous administration of glucocorticoids. In the case of an established diagnosis of AI, a deterioration in the general condition, gastroenteritis symptoms, exsiccosis and a clinical picture of sepsis must lead to the suspicion of an adrenal crisis. However, the diagnosis is only confirmed by the response to glucocorticoids. So-called check-point inhibitors are becoming increasingly important as a cause of AI. Therefore, AI and adrenal crises continue to pose a challenge for patients, their relatives and the treating physicians.

Gewalt gegen medizinisches Personal in Notaufnahmen und auf Intensivstationen hat in den letzten Jahren deutlich zugenommen und stellt eine erhebliche Gefährdung für Mitarbeitende dar. 97

According to long-term studies, patients with adrenal insufficiency (AI) exhibit a reduced quality of life and increased mortality. In addition to cardiovascular and malignant diseases, the risk of mortality is particularly increased by adrenal crises. Fatal adrenal crises could be completely prevented by timely intravenous or subcutaneous administration of glucocorticoids. In the case of an established diagnosis of AI, a deterioration in the general condition, gastroenteritis symptoms, exsiccosis and a clinical picture of sepsis must lead to the suspicion of an adrenal crisis. However, the diagnosis is only confirmed by the response to glucocorticoids. So-called check-point inhibitors are becoming increasingly important as a cause of AI. Therefore, AI and adrenal crises continue to pose a challenge for patients, their relatives and the treating physicians.

Die chronisch-habituelle Fremdkörperingestion (chFI) bei Erwachsenen stellt eine seltene, aber klinisch relevante Herausforderung in der Notfallmedizin dar. Wiederholte Vorstellungen, hoher Ressourcenverbrauch und ein interdisziplinärer Behandlungsbedarf erschweren die Versorgung. Systematische Daten zur aktuellen Versorgungsrealität in deutschen Notaufnahmen fehlen bislang. Erfassung von Häufigkeit, Ressourceneinsatz und Versorgungsdefiziten im Umgang mit der chFI aus Sicht ärztlicher Notaufnahmeleitungen. Bundesweite anonyme Online-Befragung ärztlicher Leitungen deutscher Notaufnahmen mit standardisiertem Fragebogen. Erfasst wurden strukturelle, klinische und organisatorische Aspekte der Versorgung. Die Auswertung erfolgte deskriptiv. Freitextantworten wurden mittels induktiver Kategorienbildung analysiert. Von 1081 versendeten E‑Mail-Einladungen konnten 831 (77

BACKGROUND AND OBJECTIVE:Violence against healthcare workers in emergency departments and intensive care units has increased significantly in recent years, posing a substantial threat to staff safety. In German emergency departments, 97% of staff report verbal violence and 76% report physical violence. The German Society for Medical Intensive Care and Emergency Medicine (DGIIN) presents the first comprehensive position paper on violence prevention and protective measures. METHODS:The position paper was developed by an interprofessional author group of the DGIIN based on current research data, international literature, and clinical practice experience. It analyzes forms, frequency, causes, and consequences of violence in the hospital setting and develops concrete recommendations for action. RESULTS:Violence manifests as verbal, physical, sexual, and racist assaults, with patient-related violence (type II) being most common. Main causes are intoxication (45%), long waiting times, staff shortages, and existential fears. Consequences include work disability to posttraumatic stress disorder (PTSD, 15.8%). The position paper defines eight action areas: standard operating procedures (SOPs), leadership responsibility, systematic incident reporting, mandatory training and de-escalation programs with emphasis on verbal and nonverbal communication techniques (active listening, body language), structured psychosocial support (acute care and peer support), staffing, security measures (services, structural modifications, alarm systems, video surveillance), legal protection. CONCLUSION:Violence prevention and staff protection are essential to patient safety. Professional communication competencies are central de-escalation instruments. The DGIIN demands systematic implementation of all measures in hospitals and their integration into financing. A zero-tolerance culture toward violence, combined with preventive, intervening, and follow-up structures, secures workforce capacity and qualified personnel retention.

Biochemically, hypercalcemia can be classified as mild (< 3 mmol/L), moderate (3-5 mmol/L), or severe (> 3.5 mmol/L). Mild hypercalcemia is usually asymptomatic. Severe hypercalcemia can also be oligo- or asymptomatic if it has developed slowly. Symptomatic hypercalcemia is therefore usually at least moderate biochemically. Pronounced acute symptoms are accompanied by nausea, vomiting, exsiccosis, and a corresponding disturbance of vigilance. In chronic forms, fatigue, nephrolithiasis, and gastrointestinal complaints play a greater role. In > 90% of cases, hypercalcemia is caused by primary hyperparathyroidism (pHPT) or malignant hypercalcemia (humoral hypercalcemia of malignancy: HHM). Elevated PTH and hypercalciuria are diagnostic for pHPT. In the case of HHM, the tumor disease is very often either known or obvious. If the PTH is then suppressed, further clarification is usually unnecessary. Calcitriol-dependent hypercalcemia, on the other hand, is already rare. In the case of calcium-induced exsiccosis, volume compensation is of decisive therapeutic importance. Inhibition of bone resorption by bisphosphonates or denosumab is then the most important pharmacological intervention. As a rule, the calcium can be normalized or at least reduced sufficiently well within 2-4 days. Patients requiring intensive care can also be stabilized well with these measures and therapy escalation is typically not necessary.

In 28 patients supported by an Impella pump (Impella CP, Abiomed Inc.®, Danvers, MA), hemodynamic measurements by PiCCO (PULSION Medical Systems SE®, Feldkirchen, Germany) and pulmonary artery catheter (PAC or Swan-Ganz Catheter; Edwards Lifescience®, Unterschleissheim, Germany) were compared. There was a significant positive correlation of cardiac output (CO; r 2 = 0.917, p < 0.001), systemic vascular resistance index (SVRI; r 2 = 0.904, p < 0.001), stroke volume index (SI; r 2 = 0.909, p < 0.001) and left ventricular work index (LCWI; r 2 = 0.689, p < 0.001) in PiCCO and PAC measurements under Impella CP support. We conclude, that in patients with left-ventricular Impella support, hemodynamics may be assessentd by PiCCO or PAC.

Biochemisch wird die Hyperkalzämie häufig in mild (< 3 mmol/L), moderat (3–5 mmol/L) oder schwer (> 3,5 mmol/L) eingeteilt. Eine milde Hyperkalzämie ist in der Regel asymptomatisch. Auch eine schwere Hyperkalzämie kann oligo- oder asymptomatisch sein, wenn sie sich langsam entwickelt hat. Eine symptomatische Hyperkalzämie ist daher in der Regel mindestens biochemisch moderat. Eine ausgeprägte akute Symptomatik geht mit Übelkeit, Erbrechen, Exsikkose und einer entsprechenden Vigilanzstörung einher. Bei chronischen Verlaufsformen spielen Müdigkeit, Nephrolithiasis und gastrointestinale Beschwerden eine größere Rolle. Mit > 90

Die Krankenhausalarm- und -einsatzplanung (KAEP) stellt für Krankenhäuser ein wichtiges Werkzeug zur Bewältigung eines Massenanfalls von Verletzten (MANV) dar. Krankenhäuser sind vom Gesetzgeber dazu verpflichtet, eine KAEP zu etablieren und zu schulen. MANV-Übungen eigenen sich als Trainingsinstrument für Mitarbeiter und zur Evaluierung der bestehenden Strukturen. Die KAEP des Universitätsklinikums Würzburg (UKW) wurde im Rahmen einer MANV-Übung anhand zuvor definierter Übungsziele evaluiert. Im Rahmen einer groß angelegten MANV-Übung wurden die Abläufe gemäß MANV-Plan des UKW geübt. Dabei wurden als Übungsziele die Überprüfung von Führungsstruktur, Personaleinsatz, Raumordnung, Sichtung, Patientenfluss und Kommunikation festgelegt. Es wurden vorab mehrere Übungsziele definiert. Das Erreichen der Übungsziele wurde anhand eines anonymisierten Fragebogens ausgewertet. Die KAEP des UKW ist grundsätzlich gut geeignet, einen MANV zu bewältigen, wenn adäquat geschult und trainiert wurde. Optimierungsbedarf zeigte sich v. a. bei der Kommunikationsstruktur, den Zuständigkeiten in den Behandlungsbereichen sowie der Kenntnis der Mitarbeiter über die vorhandenen Alarm- und Einsatzpläne und der vorgehaltenen Materialien. MANV-Übungen sind gut geeignet, die KAEP zu evaluieren. Das Vorhandensein einer klaren Führungs- und Kommunikationsstruktur stellt ein kritisches und erfolgsentscheidendes Element dar. Gute Kenntnisse über die vorgehaltenen Materialien, die Inhalte der KAEP und eine konsequente Anwendung der im MANV-Plan festgelegten Prozesse sind essenziell für einen koordinierten Ablauf des Einsatzgeschehens. Dies kann durch regelmäßige und verpflichtende Schulungen und Trainings erreicht werden.

ABSTRACTIntroductionDuring the COVID-19 pandemic, SARS-CoV-2 antigen rapid detection tests (RDTs) emerged as point-of-care diagnostics in addition to the RT-qPCR as the gold standard for SARS-CoV-2 diagnostics. Facing the course of the COVID-19 pandemic to an endemic characterised by several SARS-CoV-2 virus variants of concern (VOC) and an increasing public COVID-19 vaccination rate the aim of the study was to investigate the long-term test performance of SARS-CoV-2 RDT in large-scale, clinical screening use during and its influencing factors, above all SARS-CoV-2 VOC and COVID-19 vaccination.MethodsIn a prospective performance assessment conducted at a single centre tertiary care hospital, RDTs from three manufacturers (NADAL®, Panbio™, MEDsan®) were compared to RT-qPCR among individuals aged ≥ 6 month. The evaluation involved the determination of standardised viral load from oropharyngeal swabs as well as the evaluation of their influencing factors, especially the COVID-19 vaccination, for detecting SARS-CoV-2 in a clinical point-of-care environment spanning from 12 November 2020 to 30 June 2023 among patients, staff, and visitors of the hospital.ResultsAmong the 78,798 RDT/RT-qPCR tandems analysed, 2,016 (2.6%) tandems tested positive for SARS-CoV-2, with an overall sensitivity of 34.5% (95% CI 32.4-36.6%). A logistic regression revealed that typical COVID-19 symptoms significantly declined over the course of the study and throughout the COVID-19 pandemic, and that among the vaccinated, significantly fewer presented with an infection exhibiting typical symptoms. The employed lasso regression model indicated that only higher viral load and typical COVID-19 symptoms significantly increase the likelihood of a positive RDT result in the case of a SARS-CoV-2 infection directly.ConclusionOur findings indicate that only viral load and COVID-19 symptoms directly influence RDT performance while the obtained effects of COVID-19 vaccination and Omicron VOC both reducing RDT performance were mediated by these two factors. RDTs remain an adequate diagnostic tool for detecting SARS-CoV-2 in individuals showing respiratory symptoms. RDTs show promise beyond SARS-CoV-2, proving adaptable for detecting other pathogens like Influenza and RSV, highlighting their ongoing importance in infection control and prevention efforts.

Background The hospital emergency plan is an important tool for hospitals in the management of a mass casualty incident. It is a legal requirement for hospitals to have such plans in place and to carry out drills. Emergency drills are a useful tool for the training of staff and for the evaluation of existing structures. The emergency plan of the University Hospital W & uuml;rzburg (UKW) was evaluated during a disaster drill based on predefined drill objectives. Methods The procedures according to the emergency plan of the UKW were practiced during a large-scale disaster exercise. The exercise objectives were defined as: testing the management structure, deployment of personnel, physical organization, triage, patient flow and communication. Several exercise objectives were defined in advance. An anonymized questionnaire was used to evaluate the achievement of the exercise objectives. Results When properly trained and practiced the UKW emergency plan is generally well-suited to managing a mass casualty event. Improvements need to be made in the communication structure, responsibilities in the treatment areas and staff knowledge of the existing emergency plans and available material. Discussion Mass casualty drills are a good tool for the evaluation of hospital emergency plans. A critical and decisive element for success is the existence of a clear management and communication structure. A good knowledge of the available material, the contents of the emergency plan and the consistent application of the procedures defined in this plan are essential for a coordinated course of action. This can be achieved by means of regular and mandatory training sessions.

AbstractObjectiveCritical illness is often accompanied by elevated blood glucose, which generally correlates with increased morbidity and mortality. Prehospital blood glucose (PBG) level might be a useful and easy‐to‐perform tool for risk assessment in emergency medicine. This retrospective single‐center cohort study was designed to analyze the association of prehospital glucose measurements with hospitalization rate and in‐hospital mortality.MethodsRecords of 970 patients admitted to a university hospital by an emergency physician were analyzed. Patients with a PBG ≥140 mg/dL (G1, n = 394, equal to 7.8 mmol/L) were compared with patients with a PBG <140 mg/dL (G2, n = 576). Multivariable logistic regression models were used to correct for age, prediagnosed diabetes, and sex.ResultsFive hundred thirty‐four patients (55%) were hospitalized. In comparison to normoglycemic patients, hyperglycemic patients were more likely to be hospitalized with an adjusted odds ratio (OR) of 1.48 (95% confidence interval [CI] 1.11–1.97), more likely to be admitted to the intensive care unit (ICU) with an adjusted OR of 1.74 (95% CI 1.31–2.31) and more likely to die in the hospital with an adjusted OR of 1.84 (95% CI 0.96–3.53). Hospitalized hyperglycemic patients had a median length of stay of 6.0 days (interquartile range [IQR] 8.0) compared to 3.0 days (IQR 6.0) in the normoglycemic group (P < 0.001). In the subgroup analysis of cases without known diabetes, patients with PBG ≥140 mg/dL were more likely to be hospitalized with an adjusted OR of 1.49 (95% CI 1.10–2.03) and more likely to be admitted to ICU/intermediate care with an adjusted OR of 1.80 (95% CI 1.32–2.45), compared to normoglycemic patients.ConclusionElevated PBG ≥140 mg/dL was associated with a higher hospitalization risk, a longer length of stay, and a higher mortality risk and may therefore be included in risk assessment scores.

Eine Perikardpunktion dient einerseits der notfallmäßigen und sofortigen Entlastung einer Herztamponade, andererseits lässt sich das Verfahren zu differenzialdiagnostischen Zwecken einsetzen – jedoch meist nur mit mäßigem Erfolg. Demgegenüber stehen hohe Risiken, wie Verletzungen von Lunge, Leber und dem Herzen selbst. Dieser Schritt-für-Schritt-Beitrag erläutert das sichere Vorgehen einer echokardiografisch gestützten Perikardpunktion.

BACKGROUND:Extracorporeal membrane oxygenation (ECMO) is a lifesaving therapy in patients with acute respiratory distress syndrome (ARDS). Hemostatic complications are frequently observed in patients on ECMO and limit the success of this therapy. Platelets are key mediators of hemostasis enabling activation, aggregation, and thrombus formation by coming in contact with exposed matrix proteins via their surface receptors such as glycoprotein (GP) VI or GPIb/V/IX. Recent research has elucidated a regulatory role of the GPV subunit. The cleaved soluble GPV (sGPV) ectodomain was identified to spatiotemporally control fibrin formation through complex formation with thrombin. OBJECTIVES:We aimed to decipher the impact of ECMO on platelet phenotype and function, including the role of GPV and plasmatic sGPV. METHODS:We recruited 36 patients with ARDS in the wake of COVID-19 pneumonia and performed a longitudinal comparison of platelet phenotype and function in non-ECMO (n = 23) vs ECMO (n = 13) compared with those of healthy controls. Patients were assessed at up to 3 time points (t1 = days 1-3; t2 = days 4-6; and t3 = days 7-14 after cannulation/study inclusion). RESULTS:Agonist-induced platelet activation was assessed by flow cytometry and revealed decreased GPIIb/IIIa activation and α-granule release in all ARDS patients. During ECMO treatment, agonist-induced δ-granule release continuously decreased, which was independently confirmed by electron microscopy and was associated with a prolonged in vitro bleeding time. GPV expression on the platelet surface markedly decreased in ECMO patients compared with that in non-ECMO patients. Plasma sGPV levels were increased in ECMO patients and were associated with poor outcome. CONCLUSION:Our data demonstrate an ECMO-intrinsic platelet δ-granule deficiency and hemostatic dysfunction beyond the underlying ARDS.