Supraglottic airway devices are increasingly used in anaesthesia and emergency medicine. This study was designed to investigate the oesophageal seal of the novel supralaryngeal airway device, I-Gel™ (I-Gel), in comparison with two of the laryngeal mask airways, Classic™ (cLMA) and ProSeal™ (pLMA), in a model of elevated oesophageal pressure. The three supralaryngeal airway devices were inserted into eight unfixed cadaver models with exposed oesophagi that had been connected to a water column producing both a slow and a fast oesophageal pressure increase. The pressure applied until the loss of oesophageal seal during a slow and fast pressure increase was measured. During the slow increase of pressure, the pLMA withstood an oesophageal pressure up to a median of 58 cm H₂O, while the cLMA was able to block the oesophagus up to a median of 37 cm H₂O, and I-Gel already lost its seal at 13 cm H₂O. One minute after maximum pressure had been applied, the pLMA withstood an oesophageal pressure of 59 cm H₂O, the cLMA of 46 cm H₂O, and I-Gel airway of 21 cm H₂O. A fast release of oesophageal fluid was accomplished through the oesophageal lumen of both the pLMA and I-Gel. Both the pLMA and cLMA provided a better seal of the oesophagus than the novel I-Gel airway. The pLMA and I-Gel drain off gastrointestinal fluid fast through the oesophageal lumen. Thus, tracheal aspiration may be prevented with their use. Further study is necessary.

Background. In Europe, ambulances are increasingly being equipped with blood products for prehospital use. Available evidence on the early administration of blood products comes from military medicine and the Anglo-American medical literature; the evidence cannot be easily transferred to European countries. Objectives. This study assesses the incidence of patients with massive haemorrhage after trauma and the potential need for prehospital blood transfusions. Methods. Data reported by 37 German air rescue stations between 2015 and 2020 were retrospectively analysed to predict the need for massive transfusion. Results. A total of 320,347 helicopter emergency medical service (HEMS) missions were performed and involved 2982 patients with potential need for massive transfusion after trauma (approximately 13 transfusions per helicopter per year). Men were most affected (73%). The median age of patients was 38 years. Traffic accidents accounted for 59% of the cases. Most patients sustained multiple injuries including traumatic brain injuries (62%), as well as thoracic (54%), abdominal (39%), and extremity injuries (41%). The median “rSIG” (reversed shock index multiplied with the Glasgow Coma Scale) decreased from 4.31 to 3.78. Conclusions. Although the incidence of haemorrhagic trauma patients is low, the prehospital administration of blood products might be useful as a potentially life-saving bridging treatment until hospital admission.

Zusammenfassung: Sowohl zivile Großschadenslagen wie z. B. die Starkregenkatastrophe 2021 in Rheinland-Pfalz und Nordrhein-Westfalen als auch der Angriffskrieg in der Ukraine machen deutlich, dass in der zivilen wie in der militärischen Notfall- und Rettungsmedizin immer wieder die Herausforderung bestehen wird, eine größere Anzahl an Opfern lokalisieren, stabilisieren, evakuieren und möglichst schnell in Behandlungseinrichtungen transportieren zu müssen. Dabei ist neben einer nichtausreichenden Transportkapazität häufig auch ein Mangel an Fachpersonal zu kompensieren. Dies unterstreicht die Notwendigkeit, neue Entwicklungen und Technologien auf ihr Potenzial zu überprüfen, zukünftig das Management und die Bewältigung von Großschadenslagen zu verbessern.Der Einsatz von Drohnen, also unbemannten (Luft‑)Fahrzeugen, bietet für diese Szenarien multiple Möglichkeiten, von der Aufklärung über logistischen Support bis hin zum Patiententransport mit telemedizinischer Behandlungssteuerung und -überwachung während des Transports.Das DRONEVAC-Konzept beruht auf dem Einsatz von unbemannten (Luft‑)Fahrzeugen (DROhNen), die mit medizinischer Ausrüstung und telemedizinischer Anbindung ausgestattet sind, um Patienten schneller, personalsparend und sicher zu finden und zu evakuieren (EVACuation).

Background/Objectives: During cardiopulmonary resuscitation (CPR), patients must be checked for signs of return of spontaneous circulation (ROSC). Point-of-care ultrasound (POCUS) may be more reliable for detecting the ROSC. We investigated whether a POCUS pulse check algorithm could be used in compliance with the CPR guidelines. Methods: This was a prospective controlled and blinded multicentre manikin study involving staff from two tertiary clinical centres and their emergency medical services. A standard operating procedure for POCUS pulse checks during CPR was evaluated using a simulator in a team of four. The POCUS pulse checks were performed at the central artery following basic and advanced life support. The first pulse check was performed in the setting of pulseless electrical activity, and the second was performed in the presence of ROSC. The participants also completed a questionnaire. Results: A total of 444 pulse checks (244 manual/200 POCUS) were performed in 100 scenarios. The participants comprised physicians (34%), nurses (15%), non-physician emergency medical services personnel (37%), and other medical personnel (14%). The pulse checks took an average of 6.7 s (SD 3.9 s). Manual pulse checks (7.3 s) took longer than ultrasound pulse checks (6.1 s; p < 0.01), which were performed after a mean of 7.1 min (SD 1.7 min), during the fourth rhythm analysis in 93% of cases, and at the femoral artery in 62% of cases. They were rated as “easy” to perform by 77% and “useful” by 94%. Conclusions: POCUS pulse checks basically seem easy to implement and appear to be feasible during CPR.

Der weltweite Einsatz von militärischen Kräften erfordert grundsätzlich eine sanitätsdienstliche Unterstützung, die so früh und effektiv wie möglich die notfallmedizinische Versorgung verwundeter Soldaten sicherstellt. Um dieses Ziel zu erreichen, wurde in den letzten Jahren ein strukturiertes Versorgungskonzept unter dem Begriff „Taktische Medizin“ mit der taktischen Verwundetenversorgung als einen wichtigen Baustein aufgebaut und seitdem kontinuierlich weiterentwickelt. Darin werden sowohl die zu erwartenden Verletzungen als auch die limitierten Ressourcen unter Feldbedingungen berücksichtigt. Dieser Artikel soll eine Übersicht über den aktuellen Stand der taktischen Medizin vermitteln. Global military missions require effective prehospital medical care for wounded soldiers as soon as possible. Tactical Combat Casualty Care (TCCC) is a structured algorithm that was developed to address this issue; it takes into consideration both the injuries that are to be expected as well as the limited resources available under field conditions. This article summarizes the current stateoftheart of TCCC.

Die Adipositas hat in Deutschland eine hohe Prävalenz: Fast die Hälfte aller Deutschen ist übergewichtig. Der Notarzt versorgt immer häufiger adipöse Patienten, bei denen anatomische und pathophysiologische Besonderheiten zu berücksichtigen sind. Gerade bei stark Übergewichtigen besteht die Gefahr, dass die Therapie zeitlich verzögert und mit schlechterer Qualität einsetzt als bei Normalgewichtigen. Der Grund: Die im Rettungsdienst üblichen Therapie- und Transportmöglichkeiten sind nicht immer auf die speziellen Erfordernisse von extrem übergewichtigen Patienten zugeschnitten. Es werden die rettungsmedizinischen Besonderheiten dieser Patienten erläutert. The prevalence of obesity is high in Germany, almost half of the population are overweight. Hence emergency doctors are increasingly confronted with obese patients for whom special anatomical and physiological factors need to be considered. Furthermore this could lead to poorer quality and delayed treatment as normally available emergency therapy and transport are not designed for the special needs of patients with extreme obesity. The following article describes the special factors in the emergency treatment of these patients. 1 Erstveröffentlichung des Beitrags in der Anästhesiol Intensivmed Notfallmed Schmerzther 2008; 43: 30 – 37. Die vorliegende Fassung ist geringfügig überarbeitet.