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C K Lackner

Publications and source records attributed to C K Lackner.

10 recordsLinked to original sources
PubMed2006

[Pediatric cases in preclinical emergency medicine: critical aspects in the range of missions covered by ground ambulance and air rescue services].

BACKGROUND: The aim of this study was to demonstrate differences in structure and severity of pediatric emergencies treated by aeromedical (air rescue) or ground ambulances services. Conclusions for the training of emergency physicians are discussed. PATIENTS AND METHODS: In a 3-year study period, a total of 9,274 pediatric emergencies covered by the ADAC air rescue service are compared to 4,344 pediatric patients of ground ambulance services in Saarland. RESULTS: In aeromedical services pediatric emergencies are more frequent (12.9% vs. 6.4%), trauma predominates (59.9% vs. 35.6%) and severe injuries or diseases occur more frequently (30.5% vs. 15.0%). In both groups pediatric emergency cases are concentrated into very few diagnostic groups: more than one third of the cases involving pre-school children is due to convulsions. Respiratory diseases and intoxication are the next most frequent causes and are more common in ground ambulance patients. Head trauma is the most common diagnosis in cases of pediatric trauma, followed by musculoskeletal and thoracoabdominal trauma. All types of severe trauma are more frequent in pediatric patients of the aeromedical services. CONCLUSIONS: Training of emergency physicians should include pediatric life support and specific information about frequent pediatric emergency situations. For emergency physicians in aeromedical services, an intensive training in pediatric trauma life support is also necessary.

Air Ambulances↗
PubMed2006

[Trauma centers in Germany. Status report].

BACKGROUND: In Germany, a total of more than 30,000 polytraumatized patients are treated in level I-IV trauma centers. The exact number of hospitals fulfilling the requirements for the treatment of severely injured patients is unknown. We analyzed the number of hospitals in Germany capable of managing polytraumatized patients. We further analyzed the influence of various geographic and infrastructure conditions on the management of severely injured patients in the various Federal States in Germany. METHODS: First we conducted a nationwide research of all hospitals specialized in trauma management. Points of interest were structural and personnel requirements. These data were compared to the data obtained by the Federal Statistical Office. With a special software program we were able to conduct for the first time a geographic visualization of all trauma hospitals. RESULTS: There are 108 level I trauma centers, 209 level II trauma centers, and 431 level III and IV trauma centers in Germany. The geographic concentration of hospitals fulfilling the requirements for the treatment of severely injured patients differs regionally. There is an obvious correlation between trauma deaths and a low hospital concentration and less developed infrastructure. CONCLUSION: Objectively, the number of trauma centers for the treatment of severely injured patients seems to be adequate in Germany. Nevertheless, there are substantial differences between various Federal States in Germany concerning the distribution of hospitals as well as the geographic and infrastructure conditions. To optimize trauma management in Germany we think that the formation of regional trauma networks is mandatory.

Accidents, Traffic↗
PubMed2004

[The importance of Advanced Trauma Life Support (ATLS) in the emergency room].

INTRODUCTION: There is clinical evidence, that a standardized management of trauma patients in the emergency room improves outcome. METHODS: The ATLS training course teaches a systematic approach to the trauma patient in the emergency room. The aim is a rapid and accurate assessment of the patient's physiologic status, the treatment according to priorities and the decision making if transfer to a trauma center is necessary. The German Trauma Society has taken over the course concept from the American College of Surgeons (ACS) and is authorized to organize ATLS courses in Germany. RESULTS: A standardized management in the emergency room helps to prevent secondary injury, to realize timing as a relevant factor in the initial treatment and to assure a high standard of care. The ATLS course provides the participant with knowledge, skills and attitudes and is open to doctors of all specialties involved in the initial management of severely injured patients. CONCLUSION: ATLS teaches a standardized and established approach to the trauma patient in the emergency room. It has been transferred to 46 countries and the content is reviewed regularly to consider new scientific evidence. Germany has the chance to participate in this international standard of care and to introduce own experiences into the review process.

Critical Care↗
PubMed2002

[Permissive hypotension in severe trauma].

Hemodynamic instability in the polytraumatized patient is a predominant feature and most commonly secondary to blood loss accompanying injury. In these patients restoration of intravascular volume attempting to achieve normal systemic pressure faces the risk of increasing blood loss and thereby potentially affecting mortality. Due to the lack of controlled clinical trials in this field, the growing evidence that "hypotensive resuscitation" results in improved long-term survival and improved neurologic outcome, mainly stems from experimental studies in animals. In patient care, several concepts exist for the reduction of blood loss in conjunction with systemic hypotension: these involve "deliberate hypotension" (synonym "controlled hypotension", used intraoperatively under conditions of normovolemia and stable hemodynamics), "delayed resuscitation" (where the hypotensive period is intentionally prolonged until operative intervention), and "permissive hypotension" (synonym "hypotensive resuscitation", where all kinds of therapy are commenced including fluid therapy, thereby increasing systemic pressure without, however, reaching normotension). In this review the concept of "permissive hypotension" is delineated on the basis of macro- and microcirculatory changes secondary to hypovolemia and low driving pressure, and potential indications as well as limitations for the care of the traumatized patient are discussed.

Blood Pressure↗
PubMed1999

Checking for breathing: evaluation of the diagnostic capability of emergency medical services personnel, physicians, medical students, and medical laypersons.

STUDY OBJECTIVE: International guidelines for cardiopulmonary resuscitation (CPR) recommend determination of unconsciousness, breathlessness, and absence of pulse to diagnose cardiorespiratory arrest. Thus far, there have been no scientifically proven data available regarding the quality of assessing breathlessness. The study objective was to evaluate the effectiveness of checking for breathing in an emergency situation, to determine the necessary amount of time until diagnosis, and to document used techniques. METHODS: Four different populations were tested for their ability to assess breathlessness: emergency medical services (EMS) personnel, physicians, medical students, and laypersons. Each participant was asked to perform the diagnostic procedure twice, first with a breathing or not-breathing unresponsive test person and then with a modified megacode manikin (with the possibility of simulated respiratory function). The order of testing and the respiratory status were strictly randomized. Diagnostic accuracy, time interval to diagnosis, and used techniques were documented. RESULTS: A total of 261 persons were tested in 522 trials, with a median time interval of 12 seconds for obtaining a diagnosis. Regarding all participants, the correct diagnosis was achieved in 81.0% (EMS personnel, 89.7%; physicians, 84.5%; medical students, 78.4%; laypersons, 71.5%). Only 55.6% of all participants showed correct diagnostic skills (EMS personnel, 91.3%; physicians, 51.5%; medical students, 61.9%; laypersons, 18.5%). CONCLUSION: Checking for breathing was shown to be mostly inaccurate and unreliable. This diagnostic procedure takes more time than recommended in international guidelines. Therefore CPR training should focus more on the determination of breathlessness. Also, the guidelines for CPR should be revised.

Apnea↗
PubMed1996

[Preclinical diagnosis and management in severe craniocerebral trauma].

Both prehospital and hospital management of patients with severe head injury has clearly improved in the last decades. There is a greater knowledge of how secondary brain injury is caused and how it can be prevented. Intracranial mechanisms (e.g. haematoma and elevated intracranial pressure and systemic mechanism (e.g. shock and hypoxaemia) are two of the major causes of secondary brain injury. Adequate prehospital evaluation and treatment determine the later outcome for the patient. The Glasgow Coma Scale has become the standard score for assessing the level of consciousness. Early prehospital treatment must prevent secondary brain damage through adequate oxygenation (intubation, ventilation) and a sufficient cerebral perfusion pressure (treatment of shock). The neck of the patient should be positioned straight and the upper part of the body should be elevated to about 30 degrees. The prophylactic use of steroids, mannitol or high dose barbiturates is not indicated. Aggressive hyperventilation (pCO2 < 30 mmHg), especially during the first few days after severe brain injury, should be avoided.

Brain Damage, Chronic↗