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L Lampl

Publications and source records attributed to L Lampl.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Hyperbaric oxygenation. An area for the anesthetist?].

Hyperbaric Oxygen (HBO) therapy is a kind of medical treatment in which a patient breathes 100% of oxygen inside a pressure chamber while the pressure of the chamber is increased to a point higher than sea level pressure. It is strongly based on clearly defined physical laws and physiological regularities. For the clinical use of HBO therapy, according to international recommendations, there are several commonly accepted indications in which HBO either is the only causative life-saving kind of treatment, or is an essential and oftenly decisive component of a comprehensive interdisciplinary intensive care therapy. Among potential adverse effects, barotrauma of the lungs and especially oxygen toxicity to the central nervous system have to be mentioned. Clinical use of HBO therefore requires special knowledge of its effects, risks, and adverse effects, a clear and distinct indication, and the ability and skills to keep complications under control by means of intensive care or emergency medical measures. The clinical use of hyperbaric oxygen with its interdisciplinary-like character of emergency medicine or intensive care therapy therefore should be an additional, most interesting field of activity for the anaesthesiologist.

Anesthesiology↗
PubMed1998

Biological significance of DNA damage induced by hyperbaric oxygen.

Hyperbaric oxygen (HBO) treatment as used therapeutically has been shown to induce DNA damage in the alkaline comet assay with leukocytes from test subjects. Using formamidopyrimidine-DNA glycosylase, a DNA repair enzyme which specifically nicks DNA at sites of 8-oxoguanines and formamidopyrimidines, we have detected enhanced DNA migration, indicating significant oxidative base damage, after HBO treatment. Increased DNA damage was seen immediately at the end of treatment, while 24 h later no effect was found. We now show that HBO-induced DNA strand breaks and oxidative base modifications are rapidly repaired, leading to a reduction in induced DNA effects of > 50% during the first hour. A similar decrease was found in blood taken immediately after exposure and post-incubated for 2 h at 37 degrees C in vitro and in blood taken and analysed 2 h after exposure, suggesting similar repair activities in vitro and in vivo. When the same blood samples showing increased DNA damage after HBO in the comet assay were analysed in the micronucleus test, no indications of induced chromosomal breakage in cultivated leukocytes could be obtained. The results suggest that the HBO-induced DNA effects observed with the comet assay are efficiently repaired and are not manifested as detectable chromosome damage.

Adult↗
PubMed1997

[Diagnosis of blunt thoracic trauma in emergency care. Use of continuous pulse oximetry monitoring].

Chest trauma cases benefit to a great degree from adequate, timely initiated and consistent prehospital treatment. However, prehospital determination and evaluation of blunt chest trauma is associated with a high degree of uncertainty. The purpose of our study was to examine and determine, in a collective of 255 trauma patients, the value of additional prehospital pulse oximetric monitoring regarding the optimization of the emergency physician's diagnosis and treatment of blunt chest trauma. We conclude from our findings that, in addition to the physical examination, with the application of pulse oximetry the prehospital diagnosis of lung contusion as well as the early detection of tension pneumothorax are more accurate. Therefore, the combination of physical examination and pulse oximetric monitoring is a requirement for the optimization of prehospital diagnosis and therapy in blunt chest trauma.

Adolescent↗
PubMed1996

[Intraosseous puncture in preclincal emergency medicine. Experiences of an air rescue service].

UNLABELLED: In prehospital emergency treatment, the timely establishment of a secure vascular access, especially in infants and small children, can be difficult or even impossible. An alternative to the puncture of peripheral or central veins is intraosseous (IO) puncture However, experience with this method in prehospital emergency medicine within the Federal Republic of Germany is extremely limited at present. After intensive theoretical and practical training of our trauma anaesthesiologists, IO puncture was introduced in our rescue helicopter program "Christoph 22" as an alternative to peripheral or central venous puncture in the prehospital treatment of patients up to 6 years of age. IO puncture is indicated after a maximum of three failed peripheral venous puncture attempts. The purpose of this study was to collect data and summarise first-hand experience on the prehospital use of the IO method as well as the practicability of our prescribed IO puncture algorithm in order to subject them to critical review and evaluation. MATERIALS AND METHODS: A restrospective study by the rescue helicopter service "Christoph 22" was carried out for the period 1 June 1993-31 August 1995. RESULTS: In a total of 1,455 primary rescue missions flown, the proportion of patients < and = 6 years of age, was 6.2% (n = 90). Ten patients in this partial collective (11.1%) were subjected to IO puncture (Fig. 3). In all of these cases (10/10), the first IO puncture attempt was successful. A standardized puncture technique was performed using the proximal tibia. The time required to successful placement of the IO infusion line was < and = 60 s in all cases. Complications, especially incorrect needle position, did not occur during the study period. Materials infused by IO infusion before hospitalisation included crystalloids (Lactated Ringer's, Päd OP) as well as colloids (hydroxyethylstarch, human albumin), adrenaline, atropine, ketamine, thiopentone, diazepam, fentanyl, succinylcholine, and vecuronium (Table 3). Prehospital induction of general anaesthesia using the IO infusion line was required by 2/10 children; dosage and onset of administered drugs was described by the trauma anaesthesiologists as being similar to that using an i.v. infusion line. Seven of the patients had been treated prior to the arrival of the rescue helicopter team by other emergency medical personnel; in all of these cases multiple peripheral and in 3 additional central venous puncture attempts had failed (duration of attempts: 10-50 min). Upon arrival of the rescue helicopter, 5 of these patients had been pulseless and non-breathing (Table 2). CONCLUSION: The IO infusion technique has proven to be a simple, fast, and safe alternative method of emergent access to the vascular system.

Aircraft↗
PubMed1996

[Semiquantitative capnometry--helpful in verification of tube position in trauma patients?].

Severely injured patients, in particular, benefit from initiation of endotracheal intubation and controlled ventilation before hospital admission. The most frequent and most serious mishap of this emergency procedure is inadvertent esophageal tube placement. A reliable and simple determination of proper tube placement involves capnometry, the measurement of carbon dioxide concentration during the respiratory cycle. The purpose of this study was to evaluate the dependability of semi-quantitative capnometry in verifying proper tube placement in the prehospital treatment of trauma patients. First, we determined and tested the suitability of the equipment used in this study (STAT CAP) in 40 patients under controlled hospital conditions; subsequently, we tested it under prehospital conditions on 40 trauma patients. Within the two study groups, the STAT CAP proved to be of high sensitivity (1.0) and specificity (1.0) in identifying tracheal tube position immediately after intubation manoeuvre, even in patients with a shock index > 1 (n = 14) and patients with cardiac arrest (n = 3). In cases of tracheal tube position, a CO2 signal was noted after two ventilations, on average, in both study groups. The average initial CO2 value recorded amongst the hospital study group was 30-50 mmHg, against 20-30 mmHg in the prehospital trauma group. The traditional signs used to verify endotracheal tube placement (direct visualization of the vocal cords and auscultation of breath sounds upon the chest) failed in three cases amongst the prehospital trauma group; in all of these cases the STAT CAP detected the (tracheal) tube placement correctly. We conclude that the STAT CAP reliably detects tracheal placement of endotracheal tube in non-arrested patients. In the arrested patient, interpretation of CO2 nonappearance requires caution. In addition to the traditional clinical signs, semi-quantitative capnometry is a meaningful supplement to verify tracheal tube placement in the prehospital management of trauma patients.

Adolescent↗
PubMed1995

Data processing in prehospital emergency medicine.

Information about the use of data processing systems in prehospital emergency medicine were collected, using a questionnaire sent to all German rescue helicopter bases. Twenty-seven of the 42 German rescue helicopter bases returned the questionnaire. At present, only 15 of them take advantage of electronic data processing. All of them enter their data manually by keyboard, automatic data transfer by means of a bar code reader is available at one base only. The stored data are used for statistical analysis (n = 15), quality assessment (n = 10), administration (n = 10), research (n = 9) and education (n = 7). Based on the data of this survey, one fifth of those who replied use their computer only for administrative purposes, the other also manage patient and mission data with their computer systems. Today, documentation of a rescue mission consists of patient data, vital data, mission data and information about the procedures carried out. The use of a computer system, however, requires more time and work than a handwritten record, when most of the data have to be entered manually using a keyboard. Future developments may include automated data transfer and digitization of handwritten documents to decrease the workload of the staff. For the automation of data transfer, configuration and synchronisation a standardized interface in all medical devices is required. There is a clear need for the use of data processing systems in emergency medicine.

Aircraft↗
PubMed1995

[Accidental hypothermia in trauma patients. Is it relevant to preclinical emergency treatment?].

Trauma patients are at great risk of accidental hypothermia (body temperature [BT] < 36 degrees C). Hypothermia influences the functioning of all organ systems and can lead to pathological changes, which in turn additionally complicate the trauma. Furthermore, hypothermia can, e.g., by influencing blood coagulation (reduction of thrombocyte aggregation, increased fibrinolysis) have a markedly unfavourable impact upon the in-hospital surgical treatment of the trauma patient. In a prospective study involving 302 trauma patients treated during primary helicopter rescue missions over a 1-year period, we studied the following factors: (1) incidence and degree of severity of hypothermia; (2) seasonal influence; (3) possibility of individual risk groups within the study group; (4) changes in BT during the prehospital treatment phase; and (5) their consequences for emergency treatment. METHOD. BT was taken upon commencement of emergency treatment and upon release of the patient to the receiving hospital. To avoid possible damage to the patient's tympanic membrane by the thermometer probe, we excluded all patients under 16 years of age and those with an indication of an ear or temporal-bone injury. In all cases standardized patient positioning was applied. The statistical evaluation was performed utilizing descriptive presentations and the Mann-Whitney U test and chi-square test. RESULTS. During study period, a total of 302 trauma patients were treated. On 228 of these, prehospital temperature monitoring was performed (151 males and 77 females, average age 41.8 years). Because of the established criteria for exceptions and equipment malfunction, no monitoring was performed on 74 patients. Traffic accidents (69%) were the major cause of injury (Table 2), predominantly the group with NACA III (32%), followed by NACA IV (22%) and NACA V (18%) (Table 3); 27% had multi-system trauma. BT monitoring disclosed that 49.6% or almost every second trauma patient, had hypothermia. The proportion of hypothermia II degrees (BT 34 degrees-30 degrees C) versus hypothermia III degrees (BT < 30 degrees C) was 6.6% to 0.5%. Our statistical evaluation did not disclose any significant connection between season of the year and frequency of accidental hypothermia. Special risk factors in regard to frequency and degree of severity turned out to be "entrapment" (98.1% of patients with an entrapment trauma [ET] versus 34.5% without such; P < 0.001) and age (56.8% of patients > 65 years of age without ET and 100% with ET; P < 0.001) (Figs. 2, 3). No significant changes in BT were noted during the prehospital treatment phase. Clinical symptoms pointing to hypothermia or other indicators, i.e., shivering, were only noted in 4.4% of the cases where the patients BT was below normal. CONCLUSION. Based upon our findings, accidental hypothermia poses a relevant problem in the prehospital treatment of trauma patients. It is not limited to a special season of the year. The variability or total absence of definite diagnostic symptoms underlines the necessity for prehospital BT monitoring, whereby tympanic-membrane thermometry has proven to be a worthwhile method.

Adolescent↗
PubMed1994

[Blood coagulation parameters as prognostic factors in multiple trauma: can clinical values be an early diagnostic aid?].

INTRODUCTION: Polytraumatized patients develop complex changes in blood coagulation and fibrinolysis even before their arrival at the emergency room (ER). Hemostaseological parameters (i.e. antithrombine 3, alpha-2-antiplasmine, D-dimers) obtained upon admission however, permit advance differentiation of later mortality vs. survival and of possible future secondary organ failure with varying specification. OBJECTIVES: Which clinical findings enable to identify such patients early in the ER even when no specialized hemostaseological laboratory is available? MATERIAL AND METHODS: a) Prospective study of 40 polytraumatized adults upon arrival at the hospital; b) Blood sampling at the earliest possible time during takeover in the ER; c) Injury Severity Score (ISS) for descriptive purposes; d) Evaluation of the prehospital emergency physician's records in regard to respiratory therapy, fluid resuscitation, and arterial blood pressure; e) Statistics; Wilcoxon test, Spearman correlation coefficient. RESULTS: All 40 patients (m:f = 28:12; mean age: 36 (SD: 16.6) years; mean ISS: 34.7 (SD: 11.4)) displayed advanced disseminated intravascular coagulation with secondary hyperfibrinolysis upon arrival in the ER. The amount of deviation from the hemostaseological norm could not be derived from either the correlation of the typical activated parameters of coagulation of fibrinolysis with the ISS or the analysis of the separate injuries. On the other hand the subgroup of patients displaying a systolic blood pressure of less than 100 mmHg at the site of the accident or upon arrival at the ER all had significantly lower antithrombine 3, protein C, and alpha-2-antiplasmine activities as well as increased concentrations of specific reaction products resulting from activated coagulation (thrombine-antithrombine 3-complex) and of fibrinolysis (D-dimers). CONCLUSION: In our study patients with multiple injuries displaying a systolic blood pressure of less than 100 mmHg either at the scene of the accident or upon arrival in the ER showed coagulation values which by other investigators were regarded as a sign of potential secondary organ failure or death.

Adult↗
PubMed1994

[Recommendations for emergency strategies in crush trauma].

In a retrospective study conducted from 1.1. 1988-31.12.1991, we at our rescue helicopter station "Christoph 22" identified the special circumstances, which arise for the trauma anaesthesiologist during prehospital treatment of entrapped trauma patients. During the time frame of our study, we observed a continuous increase of patients suffering an entrapment trauma (from 8.3% to 15.9%). Motor vehicle accidents were the primary cause of entrapment (78.4%). Patients with an entrapment trauma in comparison to those without, to a much higher degree suffered more severe injuries (proportion of multi-system trauma: 49.4% versus 26%). Upon arrival of the trauma anaesthesiologist at the scene, the vital functions in the majority of the cases were already disturbed and unstable. The emergency medical measures required at the emergency scene therefore had to be timely and to the point and taken in close coordination with the technical rescue team. The proven procedures which we apply in such cases will be illustrated. Hospital of preference should, if possible, always be a trauma center.

Accidents, Traffic↗
PubMed1993

[Pulse oximetry in the air rescue service. 1: Quantitative detection of interfering factors on the method].

The introduction of pulse oximetric monitoring in prehospital emergency medicine considerably contributed to emergency patients' safety, stability and protection. As inherent in any method of measurement, certain factors can interfere with it and limit its practical application. The emergency helicopter service at Ulm, in a prospective study involving 400 patients, systematically collected data on these limiting factors and evaluated them. The index "S" was established to quantify the time lost due to malfunctioning. Within the study group, the index average was S = 0.269, that is 26.9% of measurement time was subject to interference. The major cause was motion artifacts (68%) sensor probe dislocation (15%), low perfusion (14%) and radiation (3%). Regarding the volume of time lost due to specific interfering factors, motion artifacts (61.8%) and low perfusion (25.5%) were dominant, followed by sensor probe dislocation (10.3%) and radiation (2.4%). Interference therefore, both in time and frequency was primarily due to motion artifacts and low perfusion. The conclusions from this study led to the evaluation of two methods by which the interfering factors could be reduced: 1. ECG-synchronisation of the pulse oximetric signal; 2. The use of adhesive sensors.--The degree of increase in pulse oximetric measurement stability achieved by these two methods will be investigated in part 2 of this study.

Aircraft↗
PubMed1993

[Pulse oximetry in the air rescue service. 2: Methods of increasing the stability of pulse oximetry measurements--ECG-synchronized pulse oximetry and adhesive sensors].

Pulse oximetric monitoring in air rescue service (rescue helicopter) is primarily influenced by motion artifacts (especially those of a passive nature), by low perfusion and by the problem of probe dislocation. In a prospective study involving 162 unselected emergency patients treated by the medical team of the emergency helicopter service "Christoph 22" (Ulm), we studied the possibility of reducing these adverse factors by applying available state-of-the-art technology, such as ECG-synchronization and adhesive probes. By applying the thus modified methods of monitoring, the interference factor was reduced to S = 0.056, that is only 5.6% of measurement time was adversely effected. The increase in measurement stability resulted from the reduction in number of described artifacts (motion artifacts and low perfusion), as well as from the reduction in duration of interfered measurement time. ECG-synchronization very effectively influenced the passive motion artifacts. Their frequency was reduced by the factor 8.2, respectively 42. An effective reduction in number of probe dislocations can be achieved by applying adhesive probes. The high costs of such probes presently limits their application. Radiation can be eliminated by redesigning the probe. ECG-synchronization of pulse oximetric signal has proved to be a method to reduce the artifacts frequently experienced in air rescue and has considerably contributed to the increase of emergency patient safety.

Aircraft↗
PubMed1992

[Hemostatic disorders following polytrauma--the role of physiologic coagulation inhibitors during the preclinical phase].

Coagulation changes due to polytrauma are considered to be an important determinant for the outcome. In this context, physiological inhibitors of activated coagulation are highlighted with special reference to antithrombin-III (AT-III). Blood samples of 20 randomly selected adults with polytrauma (Injury Severity Score mean = 36.7 +/- 8.6) were investigated. To investigate the very early onset of coagulation changes, samples were taken as early as possible at the site of emergency (mean = 18.3 +/- 5.5 min. after trauma) as well as at hospital admission (mean = 78.0 +/- 10.4 min.). By means of a specially designed "mini-lab", basic processing of the samples harvested (centrifugation, pipetting, freezing) was done on the spot to obtain haemostaseological results that agree as closely as possible with the subsequent analyses. Due to the activation of intravascular coagulation as well as the consumption of physiological inhibitors, comprehensive coagulation disturbances become obvious at the time of hospital admission. These are intensified by haemodilution as a consequence of high-dose fluid replacement. However, significantly elevated levels of specific coagulation reaction products (thrombin-antithrombin-III-complex) give evidence of the consumption of inhibitory potential exceeding haemodilution.

Adult↗
PubMed1992

[Bilateral Gradenigo syndrome--on the value of an integrated therapy concept including hyperbaric oxygenation and chronic destructive inflammation of the skull base].

The case of a 30-year-old female with bilateral Gradenigo's syndrome is presented in order to detail commonly applied therapy. In particular, the importance of a comprehensive therapeutic approach is emphasized that includes such adjuvant therapeutic options as hyperbaric oxygenation and the administration of specific immunoglobulins. Indications, therapeutic benefits and limitations of treatment modalities are discussed in relationship to current concepts of therapy.

Adult↗
PubMed1992

[Disorders of hemostasis after polytrauma. On the extent of intrinsic fibrinolytic activity in the preclinical phase].

Coagulation disorders are of utmost importance in emergency surgery as well as for secondary organ failure of polytraumatized patients. In order to get hold of the early onset of these disorders, blood samples were harvested from 20 randomly selected patients (Injury Severity Score mean = 36.7 +/- 10.5) on the scene of emergency (mean = 18 [10-29] min after trauma) and at the time of hospital admission (mean = 78 [58-98] min after trauma). In addition to the activation of intravascular coagulation and the consumption of physiological inhibitors, high amounts (10- to 50-fold above normal) of degradation products (FgDP, FbDP, TDP, D-dimers) are present on the scene, already. The influence of hemodilution due to high-volume resuscitation is discussed.

Adolescent↗