Evaluierung der NEF-Fehl- und Übergabeeinsätze im Raum Innsbruck

Die Anaesthesiologie - Die Qualität eines Rettungssystems zeichnet sich auch durch den effizienten Einsatz seiner personellen und Fahrzeugressourcen aus. So können im berechtigten Fall...     

The prognostic significance of coma-rating, duration of anoxia and cardiopulmonary resuscitation in out-of-hospital cardiac arrest

Early determination of outcome after successful prehospital cardiopulmonary resuscitation (CPR) is a common problem with great ethical, economic, social, and legal consequences. We prospectively investigated 112 adult patients who had been resuscitated after out-of-hospital cardiac arrest (CA). The aim of our study was to determine whether coma rating by the mobile intensive care unit (MICU) is a useful tool for outcome prediction. For neurological assessment the Innsbruck Coma Scale (ICS) was used initially and after return of spontaneous circulation (ROSC) or 20–30 min after the start of CPR, before any sedating drugs were given. The duration of anoxia and CPR were determined with the automatically recorded emergency call protocol of the dispatch centre and the protocol of the MICU. For estimation of cerebral outcome at the time of discharge from hospital we used the Glasgow-Pittsburgh Cerebral Performance Categories (CPC). Restoration of spontaneous circulation was achieved in 42 patients (37%), and 15 (13%) were discharged from hospital. The first coma rating performed immediately at the time of arrival on scene had no significant prognostic value for prediction of neurological outcome (P = 0.204) and survival (P = 0.103). The second coma rating (performed after ROSC or 20–30 min after the start of CPR), however, demonstrated a significant correlation with neurological outcome (P = 0.0000) and survival (P = 0.0000), a correlation which was comparable to both duration of anoxia and duration of CPR. In patients with out-of-hospital cardiac arrest prognostic information could be obtained with the ICS as early as 20– 30 min after the start of cardiopulmonary resuscitation. Received: 27 November 1996 Received in revised form: 10 July 1997 Accepted: 26 July 1997     

Structural relationships of stemona alkaloids: assessment of species-specific accumulation trends for exploiting their biological activities

On the basis of a comparison of 42 Stemona samples, representing eight different species collected and cultivated in Thailand, species-specific accumulation trends of Stemona alkaloids were analyzed. An overview was achieved by comparative HPLC analyses of methanolic crude extracts of underground parts coupled with diode array or evaporative light scattering detectors. All major compounds were isolated and their structures elucidated by NMR and MS analyses. Protostemonine- and stichoneurine-type derivatives dominated, from which the latter characterize S. tuberosa and S. phyllantha accumulating species-specific isomers of tuberostemonine (3). The widespread S. curtisii and S. collinsiae clearly deviate by protostemonine-type derivatives dominated by stemofoline (10) and/or didehydrostemofoline (11). Further diversification within this structural type results from a mutual accumulation of derivatives with a pyrrolo- or pyridoazepine nucleus, leading to chemical variability in S. curtisii and S. aphylla.     

Einführung eines integrierten Qualit?tsmanagementsystems in der pr?hospitalen Notfallmedizin

Background

The establishment of a Medical Director of Emergency Medical Services (“?rztlicher Leiter Rettungsdienst” – ?LRD) in many German regions, in Switzerland and in Tyrol, Austria, raises the question whether the implementation of an integrated quality management system (QM system) for the entire process of prehospital emergency medicine should be enforced. The authors hypothesize that the current evaluation of the structural, process and outcome quality is not sufficient enough to face future challenges, thus the implementation of an integrated QM system will be necessary.

Objective

The aim is to initiate a broad discussion on the hypothesis in order to specify the tasks of the ?LRD in the context of quality management.

Methods

By using the plan-do-check-act cycle (PDCA cycle) this article highlights and discusses the different steps to establish an integrated QM system. Explanatory examples illustrate the steps of the PDCA cycle.

Results

The implementation of an integrated quality management system in prehospital emergency medicine is described as a model and explained with examples, such as the development of a new organizational structure, a standardized documentation system and comprehensive resource and data management. In the discussion the pros and cons of such a QM system are discussed and its limitations are highlighted.

Conclusions

An integrated QM system puts the entire process of prehospital emergency medicine at the center of attention and institutionalizes the cooperation of all process partners. To promote this approach is seen as a key task of the Medical Director of Emergency Medical Services.     

Unterschätzte Gefahr am Notfallort

Background

Recent studies show that critical incidents in prehospital emergency medicine occur more often than expected. Nevertheless, risk and failure management is not mandatory. The aim of this article is to force the obligatory implementation of risk management in prehospital emergency medicine.

Methods

With the help of a case report, the theoretical basis for risk management, including the four phases of the safety circle (i.e., risk identification, risk assessment, risk accomplishment, risk monitoring), is explained.

Results

Using the example of potential medication errors, specific management measures are presented. The practical implementation of ISO NORM 26825 and the corresponding DIVI-2012 standard for the correct color of syringe labels and the revision of the checklists (vehicle and device checks) are thereby at the center of attention.

Conclusion

The case study confirms the importance of the implementation of risk management in prehospital emergency medicine. Raised safety awareness in rescue teams may increase the safety of patients and staff.     

The results of prehospital cardiopulmonary resuscitation in the initial years of a mobile emergency care system

In this study the outcome of out-of-hospital cardiac arrest (CA) was analyzed during the first 3 years after installation of a mobile intensive care unit (MICU). The unit is staffed by an anesthesiologist as the emergency-care physician and specially trained health-care personnel. The success of cardiopulmonary resuscitation (CPR) was classified into three stages: (1) CPR with temporary cardiac output; (2) CPR primarily successful with spontaneous rhythm and a palpable pulse; (3) CPR, definitely successful resulting in the patient's discharge from the hospital without important neurological sequelae. All patients are grouped according to the disease underlying the CA. The performance of bystander CPR was recorded. The influence the factors sex, age, response time, cardiac rhythm, location of the collapse and period of investigation (1st year, 2nd year, 3rd year) had on the outcome was analyzed. RESULTS. Eighty-nine patients (32.96%) had a temporary cardiac output; 56 patients (20.74%) were primarily successfully resuscitated; and 12 patients (4.44%) survived without important neurological sequelae. Most of the diseases underlying the CA were in the internal disease group. Only 16 cases of bystander CPR performance were recorded. In the group with primarily successful CPR, significantly important factors arose with the increasing CPR success rate due to the period of investigation (1st year: 10.00%, 2nd year: 19.61%, 3rd year: 30.77%) and due to cardiac rhythm "ventricular fibrillation" (34.62%) and "asystole" (11.88%). Furthermore, significantly important factors were found for definite CPR success when comparing males (1.72%) and females (10.64%) and comparing the location of the collapse "in public places" (9.80%) and "at home" (2.00%). CONCLUSION. Our study shows that in spite of installing a MICU, the outcome of CPR is poor without supplementary measures. We consider that systematically teaching the public about basic life support measures and teaching medical students about emergency medicine will lead to a better CPR success rate in combination with continuing education of the MICU personnel.     

Evaluierung der Maßnahmen zur Reduktion von Notarzteinsätzen in Tirol während der COVID-19-Pandemie

Die Anaesthesiologie - Die COVID-19-Hochphase im österreichischem Bundesland Tirol war für den Rettungs- und Notarztdienst sehr herausfordernd. Hauptziel war, unter Aufrechterhaltung der...     

Iridoids as chemical markers of false ipecac (Ronabea emetica), a previously confused medicinal plant

Ethnopharmacological relevance

Several roots or rhizomes of rubiaceous species are reportedly used as the emetic and antiamoebic drug ipecac. True ipecac (Carapichea ipecacuanha) is chemically well characterized, in contrast to striated or false ipecac derived from the rhizomes of Ronabea emetica (syn. Psychotria emetica). Besides its previous use as substitute of ipecac, the latter species is applied in traditional medicine of Panama and fruits of its relative Ronabea latifolia are reported as curare additives from Colombia.

Materials and methods

Compounds of Ronabea emetica were isolated using standard chromatographic techniques, and structurally characterized by NMR spectroscopy and mass spectrometry. Organ specific distribution in Ronabea emetica as well as in Ronabea latifolia was further assessed by comparative HPLC analysis.

Results

Four iridoid-glucosides, asperuloside (1), 6α-hydroxygeniposide (2), deacetylasperulosidic acid (3) and asperulosidic acid (4) were extracted from leaves of Ronabea emetica. Rhizomes, used in traditional medicine, were dominated by 3. HPLC profiles of Ronabea latifolia were largely corresponding. These results contrast to the general tendency of producing emetine-type and indole alkaloids in species of Psychotria and closely related genera and merit chemotaxonomic significance, characterizing the newly delimited genus Ronabea.

Conclusions

The aim of the work was to resolve the historic problem of adulteration of ipecac by establishing the chemical profile of Ronabea emetica, the false ipecac, as one of its less known sources. The paper demonstrates that different sources of ipecac can be distinguished by their phytochemistry, thus contributing to identifying adulterations of true ipecac.