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Biomedical subjects

C Kill

Publications and source records attributed to C Kill.

6 recordsLinked to original sources
PubMed2005

[Anesthesiological management of the EXIT procedure. Case report and literature review].

The ex-utero intra-partum (EXIT) procedure enables the surgeon to perform invasive procedures in an infant during cesarean section before clamping the umbilical cord. Specific anesthesiological concepts are necessary for ensuring sufficient umbilical perfusion. We report the case of a 33-year-old female undergoing cesarean section in the 36th week of pregnancy because of a large fetal cervical tumor. The EXIT procedure was performed in order to secure the infant's airway during delivery. The anesthesiological management and interdisciplinary tasks are discussed in the literature review.

Adult↗
PubMed2004

[Rapid sequence induction in prehospital emergency medicine: is it safe?].

OBJECTIVE: The use of 0,9 mg/kg Rocuronium allows endotracheal intubation within 60 seconds and therefore might be an alternative to succinylcholine for rapid sequence induction. We investigated the use of high-dose Rocuronium for RSI in prehospital emergency medicine. METHODS: Rocuronium was used in two physician staffed units of emergency medical service for RSI in 79 patients aged 4 - 81 yrs (mean 46 yrs). Anesthesia was induced with etomidate/fentanyl or ketamine and 1 mg/kg of rocuronium. Recorded data were number of intubations, time interval application rocuronium-intubation, rating of intubation conditions and side effects. RESULTS: In 75 of 79 (94,9 %) patients intubation could be performed at the first attempt. In three (3,8 %) patients a second attempt and in one pt. a third attempt was necessary. In 78 (98,7 %) patients intubation could be performed within 60 seconds, in one patient intubation was completed within three minutes. The intubation conditions were estimated as excellent (n = 69; 87,3 %) or good (n = 10; 12,7 %) in all patients. No specific side effects could be observed. CONCLUSIONS: The use of muscle relaxants improves the intubation conditions and may help to avoid unnecessary high doses of anesthetics in hemodynamic unstable emergency patients. This study shows that rocuronium might be an alternative to succinylcholine for RSI also in prehospital emergency medicine, if succinylcholine is contraindicated.

Androstanols↗
PubMed2003

[From clinical guidelines to clinical pathways: development of a management-oriented algorithm for the treatment of polytraumatized patients in the acute period].

INTRODUCTION: The treatment of polytraumatized patients in the acute period is an exemplary model of multidisciplinary cooperation in a very critical timeframe. Implementing standards formulated in the clinical guidelines of the German Association of Traumatology requires a detailed description of "how to do it." METHODS: Based on the guidelines and validated quality indictors, the optimal standard of care as the goal was defined. A clinical algorithm was developed and personal responsibilities and time limits were clearly assigned to each decision step and action. Checklists, documentation charts, and a full text supplement the algorithm. The complete pathway was adopted by representatives of all occupational groups involved in early trauma care in a consensus process. RESULTS: Improvement potentials were identified in those areas for which the guidelines did not provide explicit recommendations. These represent the key elements of the algorithm. Pathway-specific review criteria (quality indicators) were defined for scheduled reevaluation. CONCLUSIONS: Implementing clinical guidelines at the local level requires a problem-oriented and management-oriented elaboration towards a clinical pathway as the basis for a quantitative process and cost analysis.

Algorithms↗
PubMed1999

[Blood gas analysis in interhospital transfer--a useful extension of respiratory monitoring?].

OBJECTIVE: Investigation of blood gas analysis during hospital-to-hospital transport of ventilated ICU-patients to detect critical events, changes of gas exchange and reliability of non-invasive monitoring. METHODS: 47 ventilated patients (age 9-76 years, mean 50 years, diagnosis: ARDS = 16, intracranial bleeding = 14, severe trauma = 4, acute hemodynamic failure = 3, others = 10), transported by a special physician staffed intensive care ambulance using invasive hemodynamic monitoring. Blood gas analysis was performed before and during transport every 30 minutes and respirator mode, vital signs and events were documented. RESULTS: In 19 (40.4%) patients there were critical events during transport (paO2 < 70 mmHg, paCO2 < 25 mmHg, paCO2 > 55 mmHg, pH < 7.30, pH > 7.55). In 4 patients with PaO2 < 70 mmHg there was SpO2 > or = 97% (by pulsoximetry), correlation between SaO2 (invasive) and SpO2 (by pulsoximetry) was r = 0.81 (P < 0.001) with a maximum difference of 8 percent. In several patients critical changes of condition could be recognized in an early stage by blood gas analysis. CONCLUSIONS: Blood gas analysis during hospital-to-hospital transport of ICU-patients can be performed easily and allows to optimize artificial ventilation and to recognize earlier and safer severe problems of gas exchange.

Adolescent↗