Die Immunthrombozytopenie (ITP) ist eine seltene, erworbene Thrombozytopenie mit einer Inzidenz von 2–4/100.000 Personen und Jahr. Sie wird durch eine Thrombozytenzahl unter 100 G/l definiert und stellt eine Ausschlussdiagnose dar. Schwere Blutungen sind zwar selten, können aber je nach Lokalisation und Ausmaß lebensbedrohlich werden. Therapieoptionen in diesen Fällen beinhalten die Gabe von Thrombozytenkonzentraten (TK), Steroiden und intravenösen Immunglobulinen (IVIG). Bei nichtbeherrschbarer Blutung muss eine notfallmäßige Splenektomie erwogen werden. Es wird der Fall eines Patienten mit therapierefraktärer chronischer ITP geschildert, bei dem es im Verlauf zu einer schweren Blutung und letztlich zum Tode kam.

A 60-year-old woman presented with extensive swelling in the throat and impending airway obstruction. Following a well-established 2-step flexible bronchoscopic intubation procedure, a computed tomography scan identified a large hematoma compromising the airway. Laboratory testing confirmed the diagnosis of acquired hemophilia A (AHA), a rare condition that can potentially be life-threatening, particularly when it results in airway obstruction. The risk of fatal bleeding is substantial when difficult airway management guidelines call for a surgical airway. This case report describes the essentials of hemostatic treatment of AHA and our approach to the management of a difficult airway.

This study investigated the critical care staff's attitude, knowledge and involvement with donation, skills and confidence with donation-related tasks and their association with consent rates at the hospital level. In 2015, we conducted a cross-sectional survey among critical care staff of hospitals involved in organ donation using an anonymous online questionnaire with a response rate of 56.4% (n = 2799). The hospital level consent rate was obtained from the Swiss Monitoring of Potential Donors database (2013-2015). For each hospital, we calculated a mean score for each predictor of interest of the Hospital Attitude Survey and investigated the association with hospital consent rates with generalized linear mixed-effect models. In univariable analysis, one score point increase in doctors' confidence resulted in a 66% (95% CI: 45%-80%) reduction in the odds to consent, and one score point increase in nurses' attitudes resulted in a 223% (95% CI: 84%-472%) increase in the odds to consent. After simultaneously adjusting for all major predictors found in the crude models, only levels of education of medical and nursing staff remained as significant predictors for hospital consent rates. In Switzerland, efforts are needed to increase consent rates for organ donation and should concentrate on continuous support as well as specific training of the hospital staff involved in the donation process.

Various actions have been taken during the last decade to increase the number of organs from deceased donors available for transplantation in Switzerland. This study provides an overview on key figures of the Swiss deceased organ donation and transplant activity between 2008 and 2017. In addition, it puts the evolution of the Swiss donation program’s efficiency in relation to the situation in the neighboring countries.

Ein 79-jähriger Patient wurde wegen einer unklaren Mundbodenschwellung auf die Notfallabteilung zugewiesen. In der Nacht zuvor sei der Patient durch Hustenreiz geplagt worden und bereits einige Wochen zuvor sei eine Schwellung im Bereich der linken Wange aufgetreten.