Management of postpartum hemorrhage (PPH): algorithm of the interdisciplinary D-A-CH consensus group PPH (Germany – Austria – Switzerland)

Postpartum hemorrhage (PPH) is one of the main causes of maternal deaths even in industrialized countries. It represents an emergency situation which necessitates a rapid decision and in particular an exact diagnosis and root cause analysis in order to initiate the correct therapeutic measures in an interdisciplinary cooperation. In addition to established guidelines, the benefits of standardized therapy algorithms have been demonstrated. A therapy algorithm for the obstetric emergency of postpartum hemorrhage in the German language is not yet available. The establishment of an international (Germany, Austria and Switzerland D-A-CH) "treatment algorithm for postpartum hemorrhage" was an interdisciplinary project based on the guidelines of the corresponding specialist societies (anesthesia and intensive care medicine and obstetrics) in the three countries as well as comparable international algorithms for therapy of PPH.The obstetrics and anesthesiology personnel must possess sufficient expertise for emergency situations despite lower case numbers. The rarity of occurrence for individual patients and the life-threatening situation necessitate a structured approach according to predetermined treatment algorithms. This can then be carried out according to the established algorithm. Furthermore, this algorithm presents the opportunity to train for emergency situations in an interdisciplinary team.

Hypoglycemia despite hyperglycemia. Is a cerebral glucose deficiency possible even with raised blood sugar levels?

Hypoglycemia represents the most frequent endocrinologic emergency situation in prehospital patient care. As the patients are usually unconscious on arrival of emergency medical personnel, often the only way to establish a diagnosis is by determination of the blood glucose concentration. However, even normoglycemic or hyperglycemic levels cannot definitively exclude the diagnosis of a previous hypoglycemia as the cause of the acute cerebral deficiency. Therefore, and especially in the case of insulin-dependent diabetes mellitus, a differential diagnosis should be considered. We report a case of emergency treatment of a hypoglycemic episode in a female patient with prolonged neuroglycopenia together with cerebrovascular dementia and Alzheimer's disease.

Simulation and analysis of an emergency lowering system for crane applications

An emergency lowering system for use in safety critical crane applications is discussed. The system is used to safely lower the payload of a crane in case of an electric blackout. The system is based on a backup power source, which is used to operate the crane while the regular supply is not available. The system enables both horizontal and vertical movements of the crane. Two different configurations for building the system are described, one with an uninterruptible power source (UPS) or a diesel generator connected in parallel to the crane’s power supply and one with a customized energy storage connected to the intermediate DC-link in the crane. In order to be able to size the backup power source, the power required during emergency lowering needs to be understood. A simulation model is used to study and optimize the power used during emergency lowering. The simulation model and optimizations are verified in a test hoist. Simulation results are presented with non-optimized and optimized controls for two example applications: a paper roll crane and a steel mill ladle crane. The optimizations are found to significantly reduce the required power for the crane movements during emergency lowering.

Menschen mit geistiger Behinderung in Katastrophen- und Notfallsituationen

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