Die Inanspruchnahme von Notaufnahmen durch Patienten mit nichtlebensbedrohlichen Beschwerden stellt eine zunehmende Herausforderung dar. Ziel der Studie war es, die Beweggründe zur Notaufnahmevorstellung, die subjektive Dringlichkeit, die vorherige Nutzung vertragsärztlicher Angebote, die Bekanntheit der 116117 sowie eine Bereitschaft zur digitalen Selbsteinschätzung unter Patienten in bayerischen Notaufnahmen zu untersuchen. In einer multizentrischen Querschnittserhebung wurden zwischen September und November 2024 Patienten in 18 bayerischen Notaufnahmen standardisiert mittels Fragebogen befragt. Von 7.527 befragten Patienten waren 49,7

(1) Background: Endotracheal intubation in the prehospital setting is an important skill for emergency physicians, paramedics, and other members of the EMS providing airway management. Its success determines complications and patient mortality. The aim of this study was to find predictors for first-pass intubation success in the prehospital emergency setting. (2) The study was based on a retrospective analysis of a population-based registry of prehospital advanced airway management in Germany. Cases of endotracheal intubation by the emergency medical services in the cities of Tübingen and Jena between 2016 and 2019 were included. The outcome of interest was first-pass intubation success. Univariate and multivariable regression analysis were used to analyse the influence of predefined predictors, including the characteristics of patients, the intubating staff, and the clinical situation. (3) Results: A total of 308 patients were analysed. After adjustment for multiple confounders, the direct vocal cord view, a less favourable Cormack–Lehane classification, the general practitioner as medical specialty, and location and type of EMS were independent predictors for first-pass intubation success. (4) Conclusions: In physician-led emergency medical services, the laryngoscopic view, medical specialty, type of EMS, and career level are associated with FPS. The latter points towards the importance of experience and regular training in endotracheal intubation.

Zusammenfassung Hintergrund und Fragestellung In der prähospitalen Notfallmedizin ist ein erweitertes Atemwegsmanagement eine wichtige Fähigkeit für Notärzte und Notärztinnen . Sein Erfolg bestimmt die Komplikationen und die Sterblichkeit der Patient(inn)en. Ziel der Studie war es, das prähospitale erweiterte Atemwegsmanagement der bodengebundenen Rettungsdienste in zwei vergleichbaren deutschen Städten zu charakterisieren. Material und Methoden Retrospektive Analyse eines prähospitalen Atemwegsmanagementregisters (intubationsregister.de) im Jahr 2018, mit einem Vergleich der Patientenfaktoren, der Intubationssituation, der Charakteristika des Rettungsteams und des Rettungsdiensts in zwei mittelgroßen Städten in Deutschland. Ergebnisse Trotz ähnlicher Demografien und vergleichbarer Strukturen der Rettungsdienste fanden sich relevante Unterschiede in der Intubationssituation, dem Ausbildungsgrad der Notärzte und Notärztinnen, der Art der verwendeten Muskelrelaxanzien, der Verfügbarkeit der Videolaryngoskopie, dem Erfolg des ersten Intubationsversuchs und Komplikationen. Diskussion Eine strukturierte Erhebung des prähospitalen Atemwegsmanagements und ein Vergleich zwischen den Rettungsdiensten unterschiedlicher Städte können relevante Unterschiede aufzeigen und neue Ansatzpunkte für eine verbesserte Patientenversorgung bieten. Weitere Untersuchungen sind notwendig, um die Ergebnisse zu bestätigen und weitere Fragestellungen anschließen zu können.

Background and aim: In the prehospital setting, advanced airway management is an important skill for emergency physicians. Its success determines patient complications and mortality. The aim of the study was to characterize prehospital endotracheal intubation and first-pass intubation success in two comparable German cities. Methods: Retrospective comparison of patient and emergency team factors, the clinical situation, available resources of the emergency medical services (EMS) from a prehospital advanced airway management registry (intubationsregister.de) in two middle sized cities in Germany. Results: Despite comparable emergency medical services operating in cities with similar demographics, there are relevant differences in the perceived difficulty of intubation, the educational level of emergency physicians, the use of neuromuscular blocking agents, the availability of videolaryngoscopy, first-pass intubation success, and complications. Conclusion: Routine documentation of characteristics of prehospital advanced airway management and a city-to-city comparison may help reveal relevant differences and elucidate important factors to improve quality of care. Further investigations are necessary to confirm these results and to elucidate causes and implications.

Background Advanced airway management (AAM) is part of the standard treatment during advanced cardiac life support (ACLS). Current studies underline the importance of a first-pass intubation success (FPS) during in-hospital ACLS. It was shown that a failed initial intubation attempt in out-of-hospital cardiac arrest (OHCA) patients in the emergency department is an independent risk factor for the decreased effectiveness of ACLS measured by the return of spontaneous circulation (ROSC). Objective This study first examines the association between prehospital FPS and ROSC in adults with OHCA and second identifies factors associated with FPS and ROSC. The initial hypothesis was that FPS would increase the probability of ROSC as well as decrease the time to ROSC. Material and methods A retrospective multicenter analysis of 180 adult non-traumatic OHCA patients on whom advanced airway management (AAM) was performed between July 2017 and December 2018 in five different German physician-staffed ambulance stations. For information on FPS the Intubation Registry, and for information on ROSC the German Resuscitation Registry were used. In addition to yes/no questions, multiple answers and free text answers are possible in those questionnaires. The main outcome variables were ‘FPS’, ‘ROSC’ and ‘time to ROSC’. Mann-Whitney tests, χ 2 -tests, Fisher’s exact tests and multivariate binary logistic regressions were used for the statistical evaluation. Demographic factors, characteristics of the performer, selected equipment, laryngoscopy type, intubation method, medications, verification of tube position, respiratory evaluation, complications and time to ROSC were examined with respect to the influence on FPS. Concerning ROSC, the following factors were examined: demographic factors, initial heart rhythm, initial breathing, medications, defibrillation and AAM. Results An FPS was recorded in 150 patients (83.3%), and ROSC was achieved in 82 patients (45.5%) after an average time of 22.16 min. There was a positive association between FPS and ROSC ( p = 0.027). In patients with FPS, a trend for shorter time to ROSC was observed ( p = 0.059; FPS 18 min; no FPS 28 min). The use of capnography (odds ratio, OR = 7.384, 95% confidence interval, CI 1.886–28.917) and complications during AAM (OR = 0.033, 95% CI: 0.007–0.153) were independently associated with FPS. The independent factor associated with ROSC was FPS (OR = 5.281, 95% CI: 1.800–15.494). Conclusion In prehospitally resuscitated adult OHCA patients with AAM, FPS is associated with a higher chance of ROSC.

Over the past year, there has been a significant increase in rapid antigen test (RAT) detection of SARS-CoV‑2 COVID-19. Antigen detection is usually inferior to real-time reverse transcription polymerase chain reaction (RT-PCR) in terms of sensitivity and specificity. The aim of this study was to evaluate a RAT for specificity and sensitivity in an asymptomatic collective. The study was carried out in January 2021 at a hospital located in a district with a 7-day index and an average of more than 100 cases per 100,000 inhabitants. COVID-19 patients are treated at this hospital. All employees with symptoms typical of COVID-19 were not allowed to go to work. We used RAT by Roche® (Roche Diagnostics GmbH, D-68305 Mannheim) and RT-PCR on our employees. The testing was done voluntarily. We performed RT-PCR and RAT using two swab tubes at the same time. We could correlate 919 RAT to 919 RT-PCR tests. 12 people tested positive in RAT. All 12 tests were validated by RT-PCR. There was not one incorrect positive result in RAT. In one person COVID-19 was not detected by RAT, but then positively identified with a RT-PCR. In the group of positive RAT, the mean cycle threshold (CT) value was 19.95. Our results showed a sensitivity of 92.3%, CI (confidence interval) [0.78; 1.00] and a specificity of 100.00% CI [1.0; 1.0]. RAT can be an important tool for screening for SARS-CoV‑2 COVID-19 at the point of care. With low cost and resource needs, high specificity, and high specificity, RAT are performed best during the early stages of SARS-CoV‑2 COVID-19, when the viral loads are high.

Die initiale vitale Gefährdung für Menschen bei Bränden wird nicht durch die thermische Schädigung, sondern durch das Einatmen von Brandrauch verursacht. Neben Kohlenmonoxid (CO) gilt v. a. Blausäure (Zyanwasserstoff, HCN) als Hauptursache. Während man die CO-Vergiftung präklinisch mit einer ausreichenden Sauerstoffzufuhr behandelt, erfordert die HCN-Vergiftung spezielles therapeutisches Wissen.

Die Atemwegssicherung ist eine Kernkompetenz im Rettungsdienst. Sie stellt einen aber immer wieder vor Herausforderungen – insbesondere weil die Rahmenbedingungen am Unfallort meist unvorteilhaft sind. Gut, dass es verschiedene Techniken gibt.

Stromunfälle sind selten, sodass man keine Routine entwickeln kann – gleichzeitig bergen sie Gefahren. Was ist bei der präklinischen Versorgung zu beachten? Und welche Unterschiede gibt es zwischen Nieder- und Hochspannungsunfällen? Antworten darauf und wie Sie sich selber schützen können, lesen Sie im Beitrag.

Accidental injection of benzodiazepines can cause severe limb ischemia, often resulting in limb amputation. We report on a young drug addict who presented to the emergency department with severe pain and limb ischemia after accidental diazepam injection in the femoral artery. Although angiography revealed markedly reduced blood flow in the distant arteries of the lower limb and myoglobin was highly elevated, the limb was rescued with full recovery. Treatment consisted of ischiadic and femoral nerve block with continuous ropivacain application, intravenous alpostradil, and heparin infusion as well as intra-arterial nitroglycerin infusion. This therapeutic approach seems reasonable and was effective in preventing limb amputation in this case.

BACKGROUND:Colloid cysts are usually benign brain tumors, which rarely cause acute neurological deterioration with sudden death due to an acute increase of intracranial pressure. So far, the final pathophysiology and clinical signs of impending death are unclear in this context.AIM:We present a case of an adolescent who presented with symptoms similar to gastroenteritis.RESULTS:He unexpectedly developed a generalized seizure, acute pulmonary edema and life-threatening cardiac dysrhythmia.CONCLUSION:Subtle distinctions between symptoms due to intracranial hypertension, which typically cause headache and vomiting, and true gastroenteritis are discussed as well as the pathophysiology of neurogenic pulmonary edema and the origin of cerebral-triggered cardiac dysrhythmias.