Search PubMed⌕ Search

Biomedical subjects

P Sefrin

Publications and source records attributed to P Sefrin.

At least 19 recordsLinked to original sources
PubMed2006

[The position of the emergency physician in the emergency medical service].

The participation of emergency physicians guarantees the quality of a modern emergency medical service (EMS). Within the scope of cost savings in health-care system, it is questioned whether emergency medical services in the future can be managed without emergency physicians. Deficits of structure and qualitaty of the emergency physician service are raised objections. Recent studies have shown that preclinical care carried out by an emergency physician assure better results. An ongoing improvement in the quality of care should be achieved by the introduction of the new professional training for physicians "emergency medicine". In a direct comparison of two emergency medical services, one with emergency physicians, one only with paramedics it could be demonstrated that the integration of emergency physicians will increase the rate of patients, whose vital status could be improved by more than 20 %. The rate of patients discharged from hospital after cardiopulmonal resuscitation is 3 fold higher than in a rescue service without emergency physicians. However this improvement of quality of care by physicians is linked to higher financial charges. Another aspect supporting the obligatory employment of emergency physicians in Germany is the jurisdiction guaranteeing the right of the patient to receive advanced medical treatment only by (emergency) physicians.

Allied Health Personnel↗
PubMed2004

[Prehospital treatment of the acute coronary syndrome in the emergency medical services in Bavaria].

BACKGROUND AND OBJECTIVE: Regarding patients suffering from cardiovascular diseases, the most common reason for call-outs of German emergency physicians is in 37.2 % of cases, the acute coronary syndrome (ACS). Despite substantial improvements in diagnosis and therapy a reduction of mortality rate has not been documented. METHODS: 200,221 protocols of emergency physicians were analyzed regarding the prehospital treatment of ACS by German emergency physicians. It was a retrospective analysis from available protocols of the emergency medical services in Bavaria. RESULTS: Within 15 minutes after the emergency call the physician reached 92.2 % of the patients. The time to treatment averaged 23.2 (+/- 3.3) minutes. In 37.5 % of the call-outs there was only a slight danger, while in 35.6 % an acute life-threatening event was the reason for hospitalization. Hypertension existed in 52 % of the patients. 25.5 % had a tachycardia, with ECG-changes increased with age and severity of the syndrome. In 93.9 % an emergency-ECG was recorded but only in 8.5 % a 12-channel-ECG. Most frequently (39.1 %) analgetics were administered. Vasodilatators followed in 29.1 %, sedatives in 19.5 %. Antiemetics (18.1 %) were associated with the use of opioids. Typical cardiovascular drugs, such as catecholamines (10.6 %), antihypertensives (10.8 %), antiarrhythmics (9.9 %) or diuretics (7.1 %) were given less frequently. In 68.6 % of the cases the condition improved after medical intervention, in 28.1 % it remained unchanged and in 3.3 % it deteriorated CONCLUSION: Structural and logistic conditions for an early care in Bavaria are provided for prehospital treatment of patients with ACS. However, life support provided by paramedic personnel and medical therapy by the emergency physician still can be improved. The actual protocol of emergency physicians does not provide a complete view of the prehospital medical care.

Acute Disease↗
PubMed2004

[Injuries to car passengers protected by air bags].

OBJECTIVE: The air bag, like the seatbelt, is a further development of the inside protection of motorcar passengers. However, the airbag has also been made responsible for severe internal injuries. METHODS: In a retrospective case control study, 394 accidents in which the air bag was released were analysed. At least medium severe injuries (Maximum Abbreviated Injury Scale: MAIS > or = 2) occurred in 69 cases. Three different patterns of injury were distinguished depending on the level of difficulty of diagnosis by the emergency physician. Damage to the vehicles was scored in five intensities or damage grades. RESULTS: Thoracic injury was most frequently diagnosed in the patients (in 61.5 % of cases), followed by injuries to the lower (50.8 %) and upper extremities (47.7 %). Single injuries with a grade of severity of 2 (MAIS) predominated (59.7 %). In most of the cases the injury was easy to diagnose (64.6 %) because of external signs, in 24.6 % internal injuries were assumed and in only 10.8 % were there no sings of damage to body cavities. Most frequent were occult injuries in the thoracic region (100 %) and in the abdomen (74.4 %). However, occult injuries did not always conform to the grade of deformation to the vehicle, since in 66.7 % the grade of damage was 3. This was not true for the remaining types of injury because external injuries increased with the grade of damage to the vehicle. CONCLUSION: After the release of the air bag, occult injuries of the body cavities have to be expected, even if there are no signs of external injury. Women under 35 years of age are particularly endangered. There exists no minimum velocity for the occurrence of injuries to the body cavities because harm can simply be a result of the release of the air bag.

Accidents, Traffic↗
PubMed2003

[History of the rescue service in Germany--especially in regard to emergency medicine].

Emergency medicine is part of the oldest fields in medicine, however, organized rescue services were at first recognizable in the end of the 19th century or rather in the beginning of the 20th century. In 1908, on the first international congress for rescue services in Frankfurt, the preclinical part was described as a special science, for which a medical instruction would be necessary. In spite of an initially general rejection of an involvement of physicians in the rescue services, it was ascribed to physicians very early to carry out first aid in accidents or sudden illness. In 1958 Kirschner demanded an early medical care at the scene of the accident. After the second world war, the public rescue services were mainly controlled by the occupying powers. The realization of the rescue service was delegated to aid agencies and the fire brigades. In 1956 Bauer was the pioneer of the emergency physician service by dispatching a physician to the scene of the accident with a bus. Out of this resulted the first emergency physician service, which was imitated in many big cities within the Federal Republic of Germany. Since the care for accident casualities stood in the foreground at the beginning, surgeons mainly carried out this service. As the system became more and more established, the characteristics of the patients changed and medical emergency patients increasingly constituted the population of patients. That leaded to a shift in the specialties of the physicians taking part in the emergency physician service. Regarding the qualification specific guidelines were released in 1983 by the federal chamber of physicians in Germany.

Emergency Medicine↗
PubMed2002

[Evaluation of emergency medicine knowledge and procedures after finishing the course "resuscitation specialty"].

Emergency medical services are an indispensable part of out-patient medical care. For this purpose, special qualifications are necessary and these are taught within the framework of a course entitled "Certificate for Emergency Medical Services". These courses are organized either as a block course, that is a one-week course, or as weekend courses in progression. These two types of courses are compared here. Three block courses with 546 participants and five weekend courses with 599 participants were examined. The practical examination took the form of four practice stages, with 95 people from the courses taking the examination. The examination focussed on certain areas such as ECG diagnostics in the case of cardiac arrest, early defibrillation, removing helmets, immobilizing a fractured tibia, respiration with emergency equipment, vein punctures and volume substitution. Of the doctors attending the courses, 59.7% were residents, 35.7% were senior house officers and 4.6% were specialists or general practitioners. Thirty-nine (or 41.1%) of those examined attended a block course and 56 (58.9%) weekend courses. In diagnosing cardiac arrest, those attending a block course were more reliable (92.3% diagnosed correctly, compared with 67.9% in the other group). Fifteen per cent from both groups were not able to correctly diagnose ventricular fibrillation from the ECG. Of the block course participants, 39.1% chose defibrillation with the correct energy, compared with 24.2% of those attending weekend courses. One out of two participants recognized a deliberate fault in the ECG equipment. Thirty-seven per cent of participants of the block course and 35.9% from the weekend courses failed to choose the right size splint for neck immobilization. Regarding respiration, 67.2% of participants of the block course group and 71.4% of the weekend course group carried out manual artificial respiration. When using respirator equipment, 90% from the block course and 72.2% of the other group noticed an increase in respiratory tract pressure. When giving artificial respiration to an infant, 51.9% of the weekend course group and 35.9% of the block course group used an unsuitable emergency respirator. When choosing a central puncture point most participants picked the external jugular vein and gave their own previous experience as the reason (block course 48.2%, others 52.1%). Accuracy regarding the volume requirements in the case of large-scale burns, as well as choosing the quantity (16.7% compared with 7.4%) and the correct solution (47.9% compared with 40.7%) was unsatisfactory. For these reasons, we strongly recommend intensifying training in block courses for the future qualification of doctors in emergency services. It would also be useful to conduct an oral exam at the end of the entire course, which could also entitle candidates to use this professional designation as one of their qualifications.

Certification↗
PubMed2002

[Acute cardiovascular failure and its treatment--value of defibrillation in preclinical management].

Ventricular fibrillation is the most common cause of cardiac arrest. The only scientifically proved therapy that guarantees a long time survival is the early electrical defibrillation. As early as 200 years ago electricity was employed in trying to regain circulation in cases of unexpected death. In the field of emergency medicine almost all rescue services are equipped with defibrillators nowadays and the personnel is trained in using them. Since the application of electricity on the myocardium can lead to damage, there are devices with a varied defibrillation pulse available since recently. The advantage of the biphasic defibrillation is a less harmful impact on the myocardium at lower shock intensity. A further novelty which enables the application by groups other than the rescue services, is the automatic external defibrillator (AED). Extending the availability of defibrillators can contribute to an increase in the presently low success rates of resuscitation.

Algorithms↗
PubMed2001

[The importance of access-to-patient-period in the emergency service].

INTRODUCTION: The "period-to-help" (Hilfsfrist) is defined by the federal states as a measure for further planning and structure the emergency services. This period is composed of distinct time intervals and ends with the arrival of the rescue team at the emergency. From a physician's point of view it is merely the time to the first contact with the patient that is of vital interest. Data on the discrepancy between arrival at the emergency scene and the first contact with the patient are lacking. METHODS: We analysed prospectively 680 emergencies outside the hospital and calculated the so-called "access-to-patient" period (Zugangszeit). 552 emergencies supplied with an ambulance and 128 emergencies supplied with a helicopter ambulance service were analysed. RESULTS: The mean total time period for the ambulance arriving at the patient was 8.17 minutes +/- 30.3 seconds while being 10.52 minutes +/- 73.3 seconds for the helicopter ambulance service. The "access-to-patient" period was 50.9 minutes +/- 8.2 seconds for the ambulance and 75.7 minutes +/- 21.7 seconds for the helicopter ambulance service. For road accidents the "access-to-patient" period was significantly shorter for both the ambulance (12.4 +/- 4.1 seconds) and the helicopter (19,6 +/- 10,8 seconds), while in emergencies taking place inside closed buildings these time intervals were 5 and 6.5 times longer (ambulance 64.2 +/- 10,9 seconds). As outer circumstances counted most to prolonged access-to-patient periods the latter did not correlate with the severity of the injury or the emergency. Appropriate guidance and briefing of the crew of an emergency service at the scene is able to minimize the access-to-patient period (74.5 versus 60.4 seconds for the ambulance and the helicopter, respectively). Delays were caused in 22.6 % of all emergencies, mostly due to imprecise orders, impassable terrain and the inability to identify the building. CONCLUSION: If we consider that road accidents count for merely 10 % of all emergencies it seems appropriate to re-define the so-called "period-to-help" (Hilfsfrist) that takes into account the "access-to-patient" period (Zugangszeit) that is on average 50 seconds. The primary goal of any further planning must be to keep the interval without sufficient therapy as short as possible.

Accidents, Traffic↗
PubMed2000

[The new German resuscitation guidelines in the context of international recommendations].

The German Guidelines for Cardiopulmonary Resuscitation were adapted to match the revised International Guidelines. The revised German edition was based both on the guidelines issued by the American Heart Association (AHA) in 1992 and on those of the European Resuscitation Council (ERC) of 1998, as well as on those released by the International Liaison Committee on Resuscitation (ILCOR) in 1997. Due to the diverging instructions for action the emergency physicians felt considerably unsafe as to what they should really do to achieve maximum results. Only 10.3 per cent of the german emergency physicians followed the recommendations given by the German Federal Chamber of Physicians. Innovations in respect of the basic checkup concern the time for controlling the respiration and circulation (ten seconds). Contrary to the international recommendations the "diagnostic block" is performed in Germany without interspersing basic reanimation. In artificial respiration the tidal volume has been reduced to 600 ml in accordance to the ERC and ILCOR guidelines. The search for the pressure point for cardiac pressure massage has also been adapted to the international recommendations. Also in accordance with the international recommendations defibrillation in case of ventricular fibrillation is now being performed only thrice in series without interspersed basic reanimation. There is some uncertainty with regard to choosing the requisite energy: 16.6% of the emergency physicians opt for less than 200 joule in primary defibrillation whereas 13% are in favour of more than 200 joule. Contrary to the international recommendations which prescribe peripheral venous access as application site for reanimation by drugs, the german guidelines favour the endobronchial path, which is already being practised by 57.4% of the emergency physicians. Hence, emergency medication can be effected in Germany 4 minutes earlier than in other countries. After three unsuccessful applications of 1 mg each of adrenalin the dosage is increased to 5 mg, and in agreement with the AHA guidelines escalating doses are also possible. Sodium bicarbonate is recommended only after more than 20 minutes of reanimation and if so, only in a reduced dose of 0.5 mval/kg body weight. In accordance with the international recommendations there is now a universal algorithm that decides on application only between ventricular fibrillation and nonfibrillation. The new german recommendations have adapted the reanimation procedure in agreement with ERC to national usage without abandoning any principles of the international guidelines.

Cardiopulmonary Resuscitation↗
PubMed2000

[Comparison of hydroxyethyl starch solutions derived from potato and corn starch] .

OBJECTIVE: The study was designed to investigate the effects of hydroxyethyl starch (HES) solutions derived from potato (p) compared to HES derived from corn (c) starch on the colloidosmotic pressure, plasma viscosity, and to measure the plasma and urine concentration. METHODS: After approval by the Ethics Committee, and having obtained informed consent, we recruited 20 patients undergoing lumbar disc surgery who received either 1000 ml of p-HES or c-HES (MW 200,000 DS 0.5) in a randomized, single-blind way. Colloidosmotic pressure, plasma viscosity and the plasma concentration were measured before and 30, 90, 240 min and one day after the infusion. Statistical analysis was performed using chi-square and Mann-Whitney test. There were no differences between the two groups in regard to demographics and anesthesia. RESULTS: Plasma viscosity and colloidosmotic pressure did not change significantly during that time. There were no differences in plasma concentration and excretion of both solutions. The peak plasma concentration was reached after 30 min in both groups (8.57 +/- 3.92 g/l c-group and 7.67 +/- 4.68 g/l p-group) and declined thereafter. Within 6 h 38% (c-group 23.0 +/- 3.2 g HES) and 28% (p-group 16.8 +/- 1.6 g HES) of the infused HES were found in the urine. 12 h later about 50% was excreted. CONCLUSION: The present study demonstrated that there was no clinically apparent effect on hematorheology and pharmacokinetics between these two solutions.

Adult↗
PubMed1998

[Postoperative vomiting. A score for prediction of vomiting risk following inhalation anesthesia].

UNLABELLED: Despite numerous factors are thought to affect postoperative vomiting (PV) recent studies demonstrated that the risk of PV can be predicted by considering just the most important ones. Therefore, the aim of this study was to present the clinically most relevant factors, a risk score based upon those factors and its clinical applicability for other types of surgery. METHODS: In a prospective study 2220 adult inpatients scheduled for elective surgery were monitored for PV after inhalational anaesthesia over 24 hours. None of the patients received prophylactic antiemetic treatment. Multivariate analyses were performed with data of patients who underwent otolaryngological procedures to identify the major risk factors and to derive a risk score. The applicability of the score in surgical and ophthalmological procedures was tested by linear regression analysis of expected and observed incidences. RESULTS: In the multivariate model, clinically most important risk factors for PV were female gender, young age, a positive history of postoperative nausea and vomiting or motion sickness, non-smoking and a long duration of anaesthesia, whereas the relative impact of the "type of operation itself" was small. Expected and observed incidences in patients undergoing other types of surgery were strongly correlated (R2 = 0.99, P < 0.001). CONCLUSION: The risk for PV after inhalational anaesthesia in adults can be predicted using a score which is based on individual risk factors and the duration of anaesthesia only.

Adolescent↗
PubMed1998

[High precision of the emergency call].

INTRODUCTION: In the emergency office, as the central contact place for somebody seeking medical aid the emergency call is distributed to the on-call practitioners or to the ambulance service. Prerequisite is a high precision of the emergency call. RESULTS: In 63% of direct emergency caller information is classified as useful. 98.4% of the call receiving staff reacted calm, straight forward and experienced. In 74.9% the content was complete, not considering more detailed circumstances. 84.7% of the direct calling persons but only 50% of the indirect calling persons gave complete information. In 70.3% of emergency calls no medical diagnosis could be determined. More frequently, symptoms were mentioned indicating a specific disease (28.6%). Due to insufficient specificity the decision to send an emergency doctor was made if life threatening could not be excluded (34.9%). In 31.4% of cases the order of emergency doctors from the emergency office were not justified retrospectively according to the doctors impression at the place of emergency. The justified use of the emergency doctors was highest in patients with internal diseases (58.9%). The necessity of sending an emergency doctor according to direct and indirect reporting was 70.5% and 57.9%, respectively. CONCLUSION: The analysis shows, that the person reporting the emergency is often not able to meet the requirements of medical aid and that he is not able to estimate the necessary level of medical aid. In addition, an improved qualification of the staff in the emergency office is needed to improve the correct distribution of emergency calls. Through further qualification of this staff a potential cost saving in the area of emergency service could be achieved.

Communication↗