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Clemens Kill

Publications and source records attributed to Clemens Kill.

6 recordsLinked to original sources
PubMed2005

Differences in time to defibrillation and intubation between two different ventilation/compression ratios in simulated cardiac arrest.

OBJECTIVE: During basic life support (BLS) by a two-rescuer-team early defibrillation and ALS procedures should be performed without interruptions of the BLS-ventilation/compression sequence. The objective of this study was to determine the impact of a ventilation/compression ratio of 5:50 versus 2:15 on the time intervals "Start BLS to first shock" and "Start BLS to intubation". METHODS: Using a random cross over design 40 experienced paramedics performed a standard BLS/ALS-algorithm according to ILCOR guidelines in a manikin model with ventricular fibrillation (resusci skillreporter anne, Laerdal, Norway) performing both the 2:15 and the 5:50 ventilation/compression ratio. BLS was started with bag/valve/mask ventilation, a semi-automatic defibrillator (corpuls 08/16S) was connected with the manikin, ECG-analysis and three shocks were performed and the tracheal intubation was prepared. Ventilation/compression sequence was only interrupted during ECG-analysis and defibrillation. Expiratory volumes and number of compressions were measured. Variables were compared using paired Students t-test. In addition paramedics were interviewed about work-flow and emotional stress during the tests. RESULTS: The time interval "Start BLS to first shock" was 78 s (2:15-group) versus 63 s (5:50-group), p<0.0001, the time interval "Start BLS to intubation" was 183 s (2:15-group) versus 150 s (5:50-group), p<0.0001, mean ventilation volumes per minute were 4490 ml (2:15-group) versus 4370 ml (5:50-group), p>0.1, mean number of compressions were 65 min-1. (2:15-group) versus 68 min-1 (5:50-group), p>0.1. The work-flow and emotional stress was appraised by the paramedics to be significantly superior in the 5:50 ratio (p<0.0001). CONCLUSIONS: The ventilation/compression ratio of 5:50 compared with 2:15 during BLS with an unsecured airway reduces the time until the first defibrillation and tracheal intubation was performed without changes in ventilation volume and compressions per minute. The Paramedics stated that the 5:50 ratio improved the work-flow and reduced the emotional stress.

Allied Health Personnel↗
PubMed2005

Does femoral nerve catheter placement with stimulating catheters improve effective placement? A randomized, controlled, and observer-blinded trial.

Continuous peripheral nerve blocks offer the benefit of extended postoperative analgesia and accelerated functional recovery after major knee surgery. Conventional nerve localization is performed over a stimulating needle followed by blind insertion of the peripheral catheter. Correct catheter placement is confirmed by testing for satisfactory analgesia. Stimulating catheters offer the advantage of verifying correct placement close to the nerve during catheter placement. The aim of this randomized trial was to determine whether accurate catheter positioning under continuous stimulation accelerates the onset of sensory and motor block, improves the quality of postoperative analgesia, and enhances functional recovery. We compared femoral nerve catheters inserted under continuous stimulation with catheters that were placed using the conventional technique of blind advancement in 81 patients undergoing major knee surgery. Time of catheter placement was similar in both groups with 4 min (3/7.3; median, 25th/75th percentile) in the conventional group and 5 min (4/8.8) in the stimulating catheter group. In both groups, 42% of the catheters could be correctly placed (motor response of the patella with a current < or =0.5 mA) at first attempt. In 22 patients (58%) of the stimulating catheter group, the catheter had to be redirected 1-20 times, including 2 that could not be correctly placed within 20 min. The onset time of sensory and motor block was almost similar in both groups. There were no differences in the postoperative IV opioid consumption, and visual analog scale pain scores at rest and movement, or maximal bending and stretching of the knee joint during the 5 days after surgery. We conclude that with continuous femoral nerve blocks, blind catheter advancement is as effective as the stimulating catheter technique with respect to onset time of sensory and motor block as well as for postoperative pain reduction and functional outcome.

Aged↗
PubMed2004

Successful treatment of severe anaphylactic shock with vasopressin. Two case reports.

Severe anaphylactic shock is a life-threatening situation that needs immediate treatment of progressive hemodynamic failure. We report two cases of severe anaphylactic shock treated with arginine-vasopressin (AVP): In a 42-year-old male patient anaphylactic shock was caused by the sting of a hornet. At the scene, he was found unconscious, cyanotic, with a heart rate of 130/min without measurable blood pressure. The patient was intubated and ventilated with 100% oxygen, intravenous epinephrine (1 mg over 2 min) had no effect on blood pressure. After injection of 10 IU vasopressin, followed by infusion of 40 IU vasopressin, hemodynamics could be stabilized at once. In the second case, a 47-year-old male patient was stung by a wasp. At the scene he was unconscious, blood pressure was not measurable, heart rate was 140/min. The patient was treated with 40 IU vasopressin followed by rapid infusion of 500 ml NaCl 0.9%. After injection of vasopressin, blood pressure raised to 80/50 mm Hg and heart rate decreased to 90/min. Both patients needed ventilator therapy for several days and recovered fully.

Adult↗
PubMed2003

Lacticacidosis after short-term infusion of propofol for anaesthesia in a child with osteogenesis imperfecta.

We describe the case of a 7-year-old boy with osteogenesis imperfecta, who underwent anaesthesia with propofol-fentanyl-nitrous oxide-suxamethonium for orthopaedic surgery of a distal femur fracture. He developed lacticacidosis after short-term propofol infusion (150 min, mean infusion rate 13.5 mg.kg-1.h-1) associated with a prolonged recovery time without serious haemodynamic changes. The highest lactate concentration was 9.2 mmol.l-1 at 160 min after discontinuation of propofol. There was no significant increase in body temperature. The boy fully recovered.

Acidosis, Lactic↗
PubMedDate not supplied

[Stimulating catheters for regional anesthesia: considerations in routine clinical use].

The use of peripheral catheter techniques for regional anaesthesia and analgesia is quite common today. Although electrical nerve stimulation facilitates the correct placement of the insertion cannula, nobody knows where exactly the tip of the advanced catheter will be located after insertion. With the help of stimulation nerve catheters the stimulation of the target nerve via the tip of the catheter during insertion enables a placement nearby the nerve without additional devices. These new catheter systems require--in comparison to the conventional--a modified insertion technique. This article illustrates how to use these catheters in clinical practice and provides information about investigations to success rate and failure.

Anesthesia, Conduction↗