Versorgung kritisch kranker Patienten in der zentralen Notaufnahme

 

 Buy Article Permissions and Reprints

Abstract

Resuscitation room management of non-traumatic critically ill patients in the emergency department comprises approximately 1.5% of all emergency department visits. Critically ill patients are usually brought to the hospital by emergency medical services, where they are first examined, given initial treatment, stabilized and then transported for further in-hospital treatment. Resuscitation room management plays a key role at the interface of the out-of-hospital and in-hospital treatment chains. While the structured care of traumatological patients has been established at a very high level for decades, the care of non-traumatic critically ill patients within the framework of resuscitation room care has only come into focus in recent years and is only now being implemented in some places with professional concepts. Emergency departments at all levels of care are equipped to provide structured care for non-traumatologic shock room patients. To professionalize non-traumatic resuscitation room management, the creation of uniform standards from alerting criteria, to equipment and staffing, as well as the establishment of a uniform resuscitation room management algorithm is required. The (PRE_E-)AUD²IT-algorithm provides a structure for the non-traumatic care of critically ill patients in the resuscitation room and includes preparation, resource retrieval, handover, initial care, diagnostics, differential diagnoses and the interpretation of examination findings. This overview focuses on the management of critically ill non-traumatic patients in respect to the resuscitation room care concept.

Publication History

Article published online:
27 July 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• Literatur

• 1 Michael M, Al Agha S, Böhm L. et al. Alters- und geschlechtsbezogene Verteilung von Zuführung, Ersteinschätzung, Entlassart und Verweildauer in der zentralen Notaufnahme. Notfall Rettungsmed 2021; DOI: 10.1007/s10049-021-00895-9.
  CrossrefPubMedGoogle Scholar
• 2 Gräff I, Glien P, von Contzen B. et al. Ersteinschätzung in der Zentralen Notaufnahme. Notfallmedizin up2date 2018; 13: 271-289
  Article in Thieme ConnectPubMedGoogle Scholar
• 3 Bernhard M, Döll S, Kramer A. et al. Elevated admission lactate levels in the emergency department are associated with increased 30-day mortality in non-trauma critically ill patients. Scand J Trauma Emerg Med 2020; 28: 82
  CrossrefPubMedGoogle Scholar
• 4 Kramer A, Urban N, Döll S. et al. Early lactate dynamics in critically ill non-traumatic patients in a resuscitation room of a German emergency department (OBSERvE-Lactate-Study). J Emerg Med 2019; 56: 135-144 DOI: 10.1016/j.jemermed.2018.10.033. (PMID: 30538084)
  CrossrefPubMedGoogle Scholar
• 5 Deutsche Gesellschaft für Unfallchirurgie (federführend). S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung. 2017 https://www.awmf.org/uploads/tx_szleitlinien/012-019l_S3_Polytrauma_Schwerverletzten-Behandlung_2017-08-abgelaufne_01.pdf access-date="2022-04-10"
  PubMedGoogle Scholar
• 6 Michael M, Bax S, Finke M. et al. Aktuelle IST-Analyse zur Situation des nichttraumatologischen Schockraummanagements in Deutschland. Notfall Rettungsmed 2022; 25: 107-115
  CrossrefPubMedGoogle Scholar
• 7 Rovas A, Paracikoglu E, Michael M. et al. Identification and validation of objective triggers for initiation of resuscitation management of acutely ill non-trauma patients: the INITIATE IRON MAN study. Scand J Trauma Resusc Emerg Med 2021; 29: 160 DOI: 10.1186/s13049-021-00973-4. (PMID: 34774074)
  CrossrefPubMedGoogle Scholar
• 8 Piagnerelli M, van Nueffelen M, Maetens Y. et al. A ‘shock room’ for early management of the acutely ill. Anaesth Intens Care 2009; 37: 426-431
  CrossrefPubMedGoogle Scholar
• 9 Bernhard M, Döll S, Hartwig T. et al. Resuscitation room management of critically ill nontraumatic patients in a German emergency department (OBSERvE-study). Eur J Emerg Med 2018; 25: e9-e17 DOI: 10.1097/MEJ.0000000000000543. (PMID: 29406398)
  CrossrefPubMedGoogle Scholar
• 10 Grahl T, Hartwig T, Weidhase L. et al. Early In-hospital Course of Critically Ill Nontraumatic Patients in a Resuscitation Room of a German Emergency Department (OBSERvE2-study). Anaesthesist 2021; DOI: 10.1007/s00101-021-00962-3.
  CrossrefPubMedGoogle Scholar
• 11 Kumle B, Merz S, Mittmann A. et al. Nichttraumatologisches Schockraummanagement. Struktur, Organisation und erste Schritte. Notfall Rettungsmed 2019; 22: 402-414
  CrossrefPubMedGoogle Scholar
• 12 Bernhard M, Hartwig T, Ramshorn-Zimmer A. et al. Schockraummanagement kritisch kranker Patienten in der Zentralen Notaufnahme. Intensiv Notfallbehandlung 2014; 39: 93-108
  CrossrefPubMedGoogle Scholar
• 13 Bernhard M, Ramshorn-Zimmer A, Hartwig T. et al. Schockraummanagement kritisch erkrankter Patienten. Anders als beim Trauma?. Anaesthesist 2014; 63: 144-153
  CrossrefPubMedGoogle Scholar
• 14 Bogner-Flatz V, Hinzmann D, Kanz KG. et al. Der Schockraum als Nahtstelle zwischen Präklinik und Klinik. Notarzt 2020; 36: 283-292
  Article in Thieme ConnectPubMedGoogle Scholar
• 15 Michael M, Kumle B, Pin M. et al. Nichttraumatologisches Schockraummanagement. Med Klin Intensivmed Notfmed 2021; 116: 405-414 DOI: 10.1007/s00063-021-00789-1. (PMID: 33599782)
  CrossrefPubMedGoogle Scholar
• 16 Thelen S, Michael M, Ashmawy H. et al. Schockraummanagement bei traumatologischen Patienten. Anaesthesist 2019; 68: 49-66 DOI: 10.1007/s00101-018-0523-5. (PMID: 30649571)
  CrossrefPubMedGoogle Scholar
• 17 Deutsche Gesellschaft für Unfallchirurgie. Weißbuch Schwerverletztenversorgung. https://www.dgu-online.de/fileadmin/dgu-online/Dokumente/6._Versorgung_und_Wissenschaft/Qualität_und_Sicherheit/2019_DGU-Weissbuch_Schwerverletztenversorgung_3._Auflage_FINAL.PDF access-date="2022-04-10"
  PubMedGoogle Scholar
• 18 Ehlers P, Seidel M, Schacher S. et al. Prospective Observational Multisite Study of Handover in the Emergency Department: Theory versus Practice. West J Emerg Med 2021; 22: 401-409 DOI: 10.5811/westjem.2020.9.47836. (PMID: 33856332)
  CrossrefPubMedGoogle Scholar
• 19 Gröning I, Hoffmann F, Biermann H. et al. Das (PR_E-)AUD2IT-Schema als Rückgrat für eine strukturierte Notfallversorgung und Dokumentation nichttraumatologischer kritisch kranker Schockraumpatienten. Notfall Rettungsmed 2021; DOI: 10.1007/s10049-021-00878-w.
  CrossrefPubMedGoogle Scholar
• 20 Behringer W, Dodt C, Eisenburger P. et al. Intensivmedizinische Aspekte in der Notfallmedizin. Med Klin Intensivmed Notfmed 2020; 115: 625-632 DOI: 10.1007/s00063-020-00741-9. (PMID: 33044657)
  CrossrefPubMedGoogle Scholar
• 21 Michels G, Bernhard M. Nichttraumatologisches Schockraummanagement – ein einheitliches Konzept ist dringend notwendig!. Notfall Rettungsmed 2022; 25: 196-198
  CrossrefPubMedGoogle Scholar