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H Moecke

Publications and source records attributed to H Moecke.

12 recordsLinked to original sources
PubMed2004

[Assessment of psychiatric emergencies by physicians in the pre-hospital emergency medical system. A re-evaluation after 7 years].

OBJECTIVE: In the German emergency medical system (EMS) psychiatric emergency situations (PES) are now responsible for up to 15% of all calls for the emergency physician (EP). A survey which was first conducted in 1996 to reveal knowledge about PES, reported a significant need for training. Seven years later it is interesting to investigate whether different conditions in the EMS may have changed assessments and attitudes. METHODS: The questionnaire of 1996 was modified to enable a comparison of PES and other frequent emergency situations with respect to the estimated number and the subjective stress. Open and multiple-choice questions or visual analogue scales were used to obtain the following data: demographic data, frequency of and stress by PES and other medical emergencies, own knowledge, and interest about training programs. RESULTS: Of the EPs 274 responded (male/female: 74/26%, mean age: 38 years, mean experience as an EP 6 years, anaesthesiologists 69%). The frequency of PES was estimated at 5% and 44% of EPs thought that there had been an increase in recent years. Personal knowledge was judged to be good by only 24%. The interest in training programs even increased slightly compared to the first survey; of particular interest was training in drug abuse disorders. Subsequent to internal, neurological and surgical emergencies, PES are considered to rank fourth in frequency, however the strain imposed by PES is significantly higher than for these other emergency situations. DISCUSSION: The results indicate an increase of relevance of PES in the German EMS, however, assessments made by the EP only changed marginally over the time period. The subjective awareness of the frequency of PES underestimates the reality in emergency medicine. The importance of training programs remains high to improve knowledge and to reduce feelings of incapability.

Adult↗
PubMed2001

[Massive acute hypotonic hyperhydration following arthroscopic synovectomy].

We report the case of a 4 year old boy who developed a massive water intoxication as a complication during knee arthroscopy. The sodium plasma concentration dropped to 100 mmol/l postoperatively. This complication may be triggered by prolonged surgery time, excessive intra-articular pressure, capsular tears and low body weight. To prevent massive incorporation of hypoosmolar fluid, the inflation of a tourniquet as well as the use of NaCl 0,9% as irrigation fluid seems to be of advantage. The guidelines for replacing sodium in hyponatremia are discussed according to literature. In general, hyponatremia should be corrected in the same amount of time as it took for it to develop.

Acute Disease↗
PubMed2001

[Psychiatric emergencies in preclinical emergency service; incidence, treatment and evaluation by emergency physicians and staff].

Preclinical psychiatric emergency situations (PES) rank third in frequency of calls in the German emergency medical system (EMS). However, few data exist concerning relevance and treatment of PES. The aim of this study was to investigate this relevance in preclinical EMS and its appraisal by emergency physicians and paramedics. The protocols filled in by EMS physicians on emergency duty in a German district were evaluated concerning PES. In addition, the emergency physicians and paramedics of the district were asked to complete a validated questionnaire concerning the importance, their own understanding of PES, and interest in training programs. With 9.2%, preclinical PES ranked third in frequency of all EMS calls. The most frequent case was substance abuse disorder (70%), followed by suicide attempts or ideation (33%). Specific therapy for psychiatric disorders is hardly ever performed. Emergency physicians and paramedics estimated the importance of knowledge about PES as high but rated their own knowledge as poor. Assessing five typical PES, emergency physicians gave the correct diagnoses in 71% of cases (paramedics 39%) and the correct therapy in 32% (paramedics 14%). The interest in training programs was significantly higher in experienced EMS physicians. Preclinical PES is a relevant diagnosis within EMS and correct treatment is hampered by limited knowledge. Sufficient training is not yet available, although programs are necessary and the willingness to participate in them is high.

Acute Disease↗
PubMed2001

[Evaluation of a training program "Psychiatry for EmergencyPhysicians"].

OBJECTIVE: Psychiatric education was neglected in emergency medicine until lately. Although measures for assuring the quality of care are established, there are up to now no investigations about the effectiveness of the psychiatric programs which are used in the German Emergency Physicians' Basic Training Program (EPTP-B, "Fachkundenachweis Rettungsdienst"). Herewith a first evaluation of a training program for psychiatric emergencies is presented. METHODS: Participants of the EPTP-B in Hamburg were imparted defined contents to achieve the educational objective. Before and afterwards two semi-structured questionnaires had to be answered asking for previous knowledge, attitudes, educational success and necessity for further training. RESULTS: At the beginning of the course 42 medical doctors (m/f: 22/20, mean age: 32.2 +/- 4.6 years) estimated their knowledge as poor and the necessity for training as high. At the end, the majority rated the program as educative, informative (69%) and practical (81%). However, the training was judged to be too short (81%) and the participants still felt too distant from the educational objective. CONCLUSIONS: There are necessity, demand and interest for an intensified psychiatric education of emergency physicians who are confronted with a high number and variety of psychic disturbances. On-the-job training of the theoretical matters is essential.

Adult↗
PubMed2001

[Psychiatric emergencies in the physician-based system of a German city].

OBJECTIVE: Pre-clinical Psychiatric Emergency Situations (PES) gain more scientific interest. First investigations revealed them to be the third major cause for emergency physician (EP) calls. However, there is still very little data concerning prevalence, diagnosis and therapy. METHODS: A retrospective analysis of all anonymised EP protocols of the year 1995 in the city of Hamburg was performed. Data of each multiple-choice category was evaluated as well as handwritten and personal notes to determine prevalence, diagnoses and therapy of PES. RESULTS: 2550 out of 26,347 protocols (9.7%) revealed to have a psychiatric disturbance as a major cause for the call. The most frequent diagnoses in the overall young (average age: 43.1 +/- 17.6 years) and male (60.3%) population were found to be alcoholic intoxication (34%), state of agitation (23%) and suicide attempts (22%). In 55% the emergencies could be considered as purely psychiatric; in 35% as a combined somatic-psychiatric emergency. A specific psychopharmacological treatment was not performed. CONCLUSIONS: Psychiatric patients are a considerable group in pre-clinical emergency medicine, however, disturbances are much too rarely documented, diagnosed and treated. Training programs are necessary. Psychiatry has to play a more active role in planning and performing these programs.

Adult↗
PubMed2000

Postoperative pain control following remifentanil-based anaesthesia for major abdominal surgery.

Eighty patients undergoing major abdominal surgery using remifentanil-based anaesthesia were randomly allocated in a double-blind manner to receive an intravenous bolus of fentanyl, buprenorphine, morphine or piritramide 20 min before the end of surgery. A reduced dose was administered postoperatively when patients reported moderate pain. Subsequent analgesia was provided by patient-controlled analgesia (PCA). The mean time from the end of anaesthesia to spontaneous respiration was 9 +/- 5 min. At first pain assessment, 63% of patients reported no or mild pain; 80% of patients required the second opioid bolus, those receiving piritramide needed the bolus significantly later than patients receiving buprenorphine or fentanyl. First PCA requirement also occurred significantly later in the piritramide group. This technique provided effective postoperative pain relief and transition to routine PCA and did not compromise recovery.

Abdomen↗
PubMed1998

Emergency medicine in Germany.

During the last 25 years the German EMS system has developed into a professional organization that covers the whole country with essentially the same standards. Standardized ambulances and rescue helicopters, equipment, dispatch centers, and training requirements characterize the system. The challenge for the future will be the development and implementation of a creative quality management system to improve system performance in spite of pending budget reductions.

Emergency Medical Services↗
PubMed1997

[Quality management in emergency medicine].

Although the need for the implementation of a quality management concept for the German emergency medical system (EMS) has been discussed for more than 10 years, such a concept has not been realised on a broad scale. Standardised national data sheets were developed many years ago. They are used by many local agencies, but a data-gathering system on a state or national basis is still lacking. In times of reduced funds for health care expenditures, quality management could be a reliable way to ensure that the EMS provides safe services to the patient based on the current state of medical science in an efficient manner. Based on clear definitions, structure, process, and outcome quality can be analysed, and the results provide the basis for continuous quality-improvement strategies. As not all aspects of the system can be analysed continuously, one has to select areas of special importance. External and internal quality control are equally important. Quality control works on the basis that all EMS team members are motivated to perform on a professional level to ensure that each patient is treated adequately. It evaluates the system to create circumstances that enhance the achievement of this goal. Quality management is not only concerned with mishaps, because areas with documented good performance also provide important information.

Emergency Medical Services↗
PubMed1990

[The thrombolysis treatment of acute myocardial infarct at the site of the emergency. A randomized double-blind study].

Two million units of urokinase were administered intravenously as a bolus, either before (group I, n = 40) or after hospital admission (group II, n = 38), to 66 men and 12 women (mean age 55 +/- 8 years) with typical symptoms of acute myocardial infarction of less than 4 hours' duration. Time elapsed between onset of symptoms and urokinase administration averaged 85 +/- 51 min for group I and 137 +/- 50 min for group II (P less than 0.005). The complication rate was low, both during the pre-hospital and the hospital phases, without any significant differences between the two groups. The rate of open infarct vessels (by angiography before discharge from hospital) was 61% for group I and 67% for group II (no significant difference). Global left ventricular function, regional wall motion in the infarct area and maximal creatinekinase values did not significantly differ between the two groups (ejection fraction 51 +/- 10% and 53 +/- 14%, respectively; creatinekinase 838 +/- 634 U/l and 924 +/- 595 U/l, respectively). The data indicate that thrombolytic pre-hospital treatment carried a low risk. The gain of 45 min, however, seems to be of secondary importance in any significant diminution of the acute infarction size.

Coronary Angiography↗
PubMed1989

[Initial therapy of burn patients].

Severely burned patients should be admitted to a burn center within 24 hours following the thermal trauma. Fluid therapy and emergency treatment of accompanying injuries has to start at the scene of the accident and must be continued at the primary hospital. During primary and secondary transport of the burn victim 3 key problems have to be considered: 1. adequate fluid resuscitation, 2. maintenance of oxygenation and ventilation, 3. prevention of burn wound contamination and iatrogenic hypothermia. Self limitation on therapeutic essentials and refraining from a polyphragmatic approach are the basis for a rational concept for the initial therapy of burn casualties.

Burns↗