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M Messelken

Publications and source records attributed to M Messelken.

7 recordsLinked to original sources
PubMed2006

Realistic assessment of the physician-staffed emergency services in Germany.

In Germany the emergency medical services, which include dispatching emergency physicians to the scene, are considered to be among the best in the world. However, the hospitals admitting these patients still report shortcomings in prehospital care. The quality of an emergency medical service depends on both formal qualification and experience in managing such emergencies. Therefore, we determined how frequently emergency medical service physicians in Germany actually encountered complex and demanding emergency situations outside the hospital and how often they had to carry out emergency interventions. We therefore evaluated data from more than 82,000 ground emergency medical service scene calls registered in the MIND ("minimaler Notarztdatensatz") data base of the state of Baden-Wuerttemberg, Germany and more than 47,000 helicopter emergency medical service scene calls from the "Luftrettungs-, Informations- und Kommunikationssystem" (LIKS) data base of the German ADAC air rescue service. The results, which were unexpectedly distinct, impressively demonstrate that in part emergency medical service staff only encountered some emergencies very rarely. In particular, patients with life-threatening conditions such as acute coronary syndrome, stroke, head trauma, as well as multiple trauma were only treated once every 0.4-14.5 months and cardiopulmonary resuscitation and intubation were only carried out once every 0.5-1.5 months. Furthermore, a time period of 6 months to more than 6 years may pass before a chest tube has to be placed. There are, of course, considerable differences between ground and helicopter emergency medical services. Particularly in areas where the frequency of such emergency cases is low, the clinical experience required to competently manage a demanding emergency situation cannot be gained or maintained just by working in the emergency medical system. As a result of the general pressure to cut costs and also of changes in hospital politics, however, only highly qualified and experienced emergency medical services may survive in Germany in the long term. In addition to formal qualifications and accompanying practice-related courses, future emergency medical service personnel should be drafted from clinical department staff that are experienced in treating severely ill and severely injured patients.

Air Ambulances↗
PubMed1996

[Quality management in autologous blood donation].

In many anaesthesia departments, the autologous transfusions concept is an integral part of the perioperative measures catalogue. All patients benefit from this procedure, especially those who face an operation during which much blood will be lost. If a patient donates his/her own blood for their operation, there should not be any increase in risk to this patient. By employing contemporary quality management practices, including computer technology, the quality of the execution and management of the components as well as the quality of the patient care can be evaluated according to the quality of the structure, process and results. By this assessment the efficiency of the procedure can be confirmed and the advantages of using this technique, when utilised by an anaesthesiologist experienced in transfusion, can be underlined. An overview of the pre-existing and expected perioperative risk is of special advantage to the anaesthesiologist to make a realistic and effective decision regarding the possibility of safely processing the autologous blood donation concept.

Adult↗
PubMed1996

[Mobile blood gas and laboratory monitoring. A new technology in clinical routine].

INTRODUCTION: Decision-making on therapy in acute cases involves clinical examination and monitoring of vital parameters and fluid balance; especially, however, laboratory parameters. The present study compared the results of a new bedside laboratory analysis system (PortLab, i-STAT Corp., Princeton NJ) with the analytical results obtained in our central laboratory. In a second phase personnel costs and turnover times of the two methods were evaluated comparatively. MATERIALS AND METHODS: The PortLab system consists of a basic unit (539 g) with an integrated display and disposable silicon cartridges with thin-film electrodes. Up to 8 parameters can be determined simultaneously in 60 microliters of whole blood. Fifty results obtained with the PortLab system of the parameters sodium, potassium, chlorid, glucose, BUN, hematocrit, the calculated haemoglobin and blood gas analysis were correlated with the results obtained by central laboratory analysis. In a second phase, all procedural steps, the time needed and the turnover times for laboratory analysis were compared with the expenditure for the same analyses performed with the PortLab system. RESULTS AND DISCUSSION: The results obtained using PortLab analysis correlated very well with those of the central laboratory (between 0.966 for the hematocrit and 0.994 for pO2). Three steps were required to perform bedside analysis with the PortLap system. The staff was occupied for 1 min. and 15 sec. and the results were ready within 4 min. and 45 sec. (pure analysis time < 2 min.). Analysis in the central laboratory required 8 steps, the intensive care staff was occupied for 6 min. and 15 sec., 5 min. and 15 sec. of which they were away from the patients' side. Analysis of blood gases required 4 steps, the result was ready in 4 min. 15 sec. The personnel was occupied for an equally long time. The use of PortLab saved personnel resources of 5 minutes per laboratory analysis and 3 minutes per blood gas analysis. CONCLUSION: The PortLab system proved easy to handle and reliable. Valuable personnel resources can be saved. This method cannot replace conventional laboratory analyses, but enables more extensive monitoring of patients and their laboratory parameters. The industry should develop analogous monitoring systems for modular solutions.

Blood Chemical Analysis↗
PubMed1995

[Preclinical resuscitation--which factors influence the long-term course? A 5-year follow-up].

OBJECTIVE: The factors that influence long-term survival after out-of-hospital resuscitations were investigated. PATIENTS AND METHODS: Between 1985 and 1989, out of a total of 8403 responded emergency calls, 505 resuscitations were undertaken out of hospital by the emergency medical service in Göppingen. All emergency calls were recorded uniformly. Of the 505 resuscitations, 154 were primarily successful (30.5%), and 58 were secondarily successful, i.e. the patients were ultimately discharged from hospital. In 56 of them the further course could be followed at least 5 years after the resuscitation (45 males, 11 females; mean age 57 [10-83] years). The patients' charts were analysed; in 51 cases data could be obtained from the family doctor, from ambulant care or from home visits. RESULTS: 34 patients (60.4%) were still alive 5 years after the resuscitation. The highest death rate (16%) was in the first post-resuscitation year. Prognostically unfavourable factors were: advanced age (P < 0.01), underlying cardiac disease (n = 49; P < 0.025), especially coronary heart disease (n = 34; P < 0.01). Patients with primary ventricular fibrillation and previous myocardial infarction (n = 10) had a poorer prognosis than those with acute infarction (n = 24; P < 0.05). Reduced survival chances occurred in those with impaired left ventricular function, as measured echocardiographically (P < 0.05), or with cardiac arrhythmias, Lown classes III and IV (P < 0.05), as well as in those with severe neurological sequelae (n = 8; P < 0.08). CONCLUSION: Long-term prognosis depends, in the first instance, on the resuscitated patient's basic condition and not so much on the circumstances of the resuscitation.

Adolescent↗