Özkan Timur, Lindner Tobias, Möckel Martin
Dtsch Med Wochenschr. 2021 May;146(10):647-656. doi: 10.1055/a-1226-8117. Epub 2021 May 6.
Treatment of critically ill non-trauma patients is challenging, due to the broad spectrum of underlying diseases in this clinical setting. It has been shown that outcome in these patients is poor due to high age, comorbidities and severeness of acute disease. In most cases it is crucial to establish diagnosis and start specific treatment immediately to improve patients' outcome. In contrast to the management of severely injured patients, general guidelines for the initial diagnostic and therapeutic approaches in these patients have been lacking until now. As a consequence, little is known about both: patients' characteristics and outcome. This article provides an overview of the current information available on this group of patients.All critically ill patients should first be managed in the resuscitation room, as it is necessary to provide the optimal infrastructure, including material and personal resources, to maintain high quality care. For non-trauma patients, indication can be defined using the ABCDE approach. Expertise in emergency ultrasound as a key diagnostic tool, profound knowledge of intensive care treatment and of diagnostic and therapeutic approaches according to current specific guidelines are required. These requirements can be implemented by assembling nursery and medical staff trained in emergency care, supported by accredited continued professional development and regular simulation trainings.The best transition from preclinical to in-hospital care is achieved through detailed preparation and the use of standardized handover tools. Subsequent patient management can be organized using the primary and secondary survey. These aim to detect and treat life threatening pathologies first and, within a second step, to expand the diagnosis and therapy according to the individual case. Special focus should be put on communication, using crew resource management training, and on the provision on an open and constructive approach to making mistakes.
由于这类临床环境中潜在疾病种类繁多，对重症非创伤患者的治疗具有挑战性。研究表明，由于高龄、合并症和急性疾病的严重程度，这些患者的预后较差。在大多数情况下，立即进行诊断并开始特异性治疗对于改善患者预后至关重要。与重伤患者的管理不同，迄今为止，这类患者初始诊断和治疗方法的通用指南一直缺乏。因此，对于患者特征和预后这两方面都知之甚少。本文概述了有关这类患者的现有信息。所有重症患者首先应在复苏室进行处理，因为需要提供包括物资和人力资源在内的最佳基础设施，以维持高质量护理。对于非创伤患者，可采用ABCDE方法来确定适应症。需要具备作为关键诊断工具的急诊超声专业知识、对重症监护治疗以及根据当前特定指南的诊断和治疗方法有深入了解。这些要求可通过组建经过急诊护理培训的护理和医务人员来实现，并辅以认可的持续专业发展和定期模拟培训。通过详细准备和使用标准化交接工具可实现从院前到院内护理的最佳过渡。随后可使用初级和次级评估来组织患者管理。这些评估旨在首先检测和治疗危及生命的病症，并在第二步中根据具体情况扩大诊断和治疗范围。应特别注重沟通，采用团队资源管理培训，并提供一种开放和建设性的对待错误的方法。
