Zusammenfassung
Hintergrund
Innerklinische Notfälle können zu unerwarteten Intensivaufnahmen, Kreislaufstillständen oder Todesfällen führen. Kliniken müssen daher die Voraussetzungen für eine adäquate innerklinische Notfallversorgung schaffen. Es wird über die Einsätze des zentralen Notfallteams einer Klinik der Maximalversorgung berichtet.
Patienten und Methoden
Im Jahr 2003 wurde am Westpfalz-Klinikum, Kaiserslautern, ein zentrales Notfallteam eingerichtet. Ausgewertet wurden die Einsatzprotokolle des Notfallteams und die korrespondierenden Patientenakten der Jahre 2004 bis 2007.
Ergebnisse
Es erfolgten 241 Alarme (9 Fälle/100 Betten und Jahr). In 79% der Fälle lag eine Vitalbedrohung vor, in 37% ein Kreislaufstillstand. Es wiesen 27% der reanimierten Patienten einen primär defibrillierbaren Rhythmus auf. Der primäre Reanimationserfolg betrug 53%, die Entlassrate 20%. Daneben waren respiratorische Notfälle und Bewusststeinsstörungen die häufigsten Einsatzindikationen.
Schlussfolgerungen
Der hohe Anteil vital bedrohlicher Notfälle und Kreislaufstillstände deutet darauf hin, dass neben der Vorhaltung eines Notfallteams eine intensivere Aus- und Fortbildung des Klinikpersonals notwendig ist, um Notfälle frühzeitiger zu erkennen und Zwischenfälle konsequenter zu therapieren.
Abstract
Background
In-hospital emergencies can lead to unexpected admission to the ICU, cardiac arrest or even death. Therefore, hospitals have to implement an adequate in-hospital emergency management. The results of the deployment of the in-hospital emergency team of a hospital providing maximum medical care will be presented.
Patients and methods
In 2003 the Westpfalz-Klinikum, Kaiserslautern introduced a central emergency team. The data of the emergency teams on alarm calls and the patient records from 2004 to 2007 were evaluated.
Results
There were 241 alarm calls (9 alarm calls/100 beds and year). The mean age of the patients was 67 years and 56% were male. In 79% of all alarm calls the vital functions were compromised and in 37% cardiac arrest had occurred. When the emergency team arrived all cardiac arrest patients had received basic life support, however, no early defibrillation had been applied. On arrival of the emergency team 41% of the patients could be left on-site after emergency treatment, 40% had to be admitted to an intensive care or intermediate care unit and 21% died or were already dead (5 patients). In 27% of all cardiac arrests ventricular fibrillation/pulseless ventricular tachycardia was the first detected sign. Restoration of spontaneous circulation could be established in 53% and 20% of all resuscitated patients could be discharged. Respiratory emergencies (21%) and altered states of consciousness (20%) were other leading causes for calling the emergency team.
Conclusions
The high proportion of patients in a life-threatening condition and cardiac arrests indicates the necessity for closer patient monitoring, more intensive emergency training including early defibrillation and continuing education of hospital staff in the prevention and early detection of emergencies, in addition to the provision of an emergency team.
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Danksagung
Die Autoren danken dem Pflege- und Ärzteteam der interdisziplinären Intensivstation 6/3 und insbesondere den Oberärzten Dr. T. Huber und Dr. O. Haas für ihr Engagement beim Auf- und Ausbau des zentralen innerklinischen Notfallteams.
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Die Autoren erklären, dass kein Interessenkonflikt besteht.
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Kumpch, M., Luiz, T. & Madler, C. Analyse der Einsatzdaten eines innerklinischen Notfallteams. Anaesthesist 59, 217–224 (2010). https://doi.org/10.1007/s00101-010-1692-z
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DOI: https://doi.org/10.1007/s00101-010-1692-z