Der allergische Notfall: Adrenalin das Mittel der Wahl bei der Anaphylaxie

Although allergic emergencies do not occur every day, they are as unpredictable as the course of the reaction, and require rapid treatment. Anaphylaxis is a life-threatening general reaction that usually manifests within a few minutes after a known or potential antigen contact. While sole cutaneous symptoms are not sufficient to diagnose anaphylaxis, an episode of acute bronchospasm or hypotension in rare cases may be the only symptom. Almost always two or more organ systems are affected and usually the skin and/or mucous membranes are involved. Epinephrine (adrenaline) is the most important and effective drug in the treatment of anaphylaxis. Since there is no absolute contraindication, epinephrine should be administered intramuscularly at the first signs of anaphylaxis. However, there is a gap between the international treatment guidelines and the daily practice in the treatment of acute allergic, particularly anaphylactic, reactions. This is due not least to the fact that anaphylaxis, the most severe form of allergy, is not sufficiently clear or uniformly defined. After a systemic allergic reaction, all patients should be equipped with emergency medications, appropriately instructed obtain a complete allergy work-up.

Das zyanotische Kind mit kardialer Erkrankung im Notfalldienst

m Gegensatz zu Erwachsenen mit vorwiegend pulmonalen Erkrankungen wie der chronisch obstruktiven Lungenerkrankung, entsteht bei Kindern eine zentrale Zyanose meist durch angeborene Herzfehler. Zyanotische Herzfehler kommen mit einer Häufigkeit von ca. 13 pro 10.000 Lebendgeburten vor. Dadurch, dass heutzutage auch komplexe Herzfehler erfolgreich palliiert werden, steigt die Wahrscheinlichkeit stetig an, im Rettungsdienst Kindern mit einer zentralen Zyanose zu begegnen. Ursachen für das untersättigte Blut in den großen Arterien können eine Minderperfusion der Lungen oder eine vermehrte Durchmischung von arteriellen mit venösem Blut über einen Rechts-Links-Shunt sein. Der beste Indikator einer zentralen Zyanose ist die Zunge, da sie reichlich vaskularisiert und frei von Pigmenten ist. Je nach Altersklasse ist eher eine primäre Volumentherapie oder eine großzügige Sauerstoffapplikation essenziell, oder aber auch keine Notfalltherapie notwendig. Nach der präklinischen Versorgung ist eine stationäre Einweisung unabdingbar, bevorzugt in ein Zentrum mit der Option der kinderintensivmedizinischen oder kinderkardiologischen Betreuung.

Emergency referrals for syncopes - is an ambulatory treatment safe?

Patients after syncopy arrive frequently in an emergency unit. Two scoring systems have been validated for clinical decision making, use of diagnostic methods and need for hospitalisation. Goal of the study was quality control of ambulatory treatment of syncope patients in a University Emergency Department. 200 consecutive patients with syncope were documented, 109 of whom followed by phone-call during two years. The decision for hospitalisation or ambulatory treatment was up to the treating doctor. Age-distribution was biphasic: female sex mainly below the age 25, from 55 to 75 predominantly men. Etiology of syncope remained unclear for the majority of cases, a few neurologic (n=3) or cardiac (n=5) reasons were found with treatment consequences.

Elektive Splenektomie bei Erwachsenen – Vorbereitung, Durchführung und Nachbetreuung

Elective splenectomy in adults is often performed after failure of conservative treatment in patients with hematologic, neoplastic, or autoimmune disorders. The indication to perform a splenectomy should be discussed in an interdisciplinary team and the surgeon should not make the decision on his own. Laparoscopic splenectomy is nowadays established as the gold-standard treatment due to low morbidity and mortality and - compared to open surgery - lower postoperative pain, less intraoperative blood loss and shorter hospital stay. Every patient with planned splenectomy must undergo vaccination against pneumococci and meningococci at least two weeks prior to the operation, which helps reducing the risk of the "overwhelming post-splenectomy infection" (OPSI). Beside re-vaccination against pneumococci and meningococci during follow-up, every patient should be informed about the increased risk of infection, receive a personal post-splenectomy pass and emergency antibiotics in case of infection