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BACKGROUND: In contrast to prehospital care there is alack of specifications for the organization and equipment of medical emergency teams for in-hospital emergency care.; OBJECTIVE: Evaluation of the organization, team composition, training, equipment and tasks of medical emergency teams in the Federal Republic of Germany.; MATERIAL AND METHODS: Evaluation of aweb-based survey of all hospitals participating in the German Resuscitation Register between February and March2020. The participants were asked about team composition; emergency equipment; type, content and scope of special training or further training as well as other additional tasks in the everyday clinical routine when participating in the medical emergency team. Hospitals with ≤or >600beds were compared.; RESULTS: Atotal of21 (>600beds: 10, 48%; ≤600beds: 11, 52%) hospitals participated in the survey. Team composition requirements were present at 76% (n =16; ≤600beds: 8, 72% vs. >600beds: 8, 80%), training requirements for medical emergency teams at 38% (n =16; ≤600beds: 4, 36% vs. >600beds: 4, 40%) of hospitals, with afocus on cardiac life support (n =6, 28%; ≤600beds: 3, 27% vs. >600beds: 3, 30%) and airway management (n =4, 19%; ≤600beds: 3, 27% vs. >600beds: 1, 10%). A12-lead electrocardiogram (n =7, 33%; ≤600beds: 1, 9% vs. >600beds: 6, 60%; p =0.02), video laryngoscope (n =7, 33%; ≤600beds: 2, 18% vs. >600beds: 5, 50%), ventilator without (n =7, 33%; ≤600beds: 2, 18% vs. >600beds: 5, 50%) or with the possibility of non-invasive ventilation was part of the standard equipment in n =4, 19% (≤600beds: 1, 9% vs. >600beds: 3, 30%). A total of 85% (n =18; ≤600beds: 10, 100% vs. >600beds 8, 72%), had additional tasks in the daily clinical routine. While clinics with >600beds staffed medical emergency teams 100% of the time from the intensive care units, in clinics ≤600beds medical emergency teams were deployed significantly more often in the emergency department (n =5, 45%) and in the normal wards (n =5, 45%, p =0.03).; CONCLUSION: Training and equipment of medical emergency teams in the Federal Republic of Germany is heterogeneous. They should at least meet the standards commonly used in prehospital emergency medicine and include the availability of aportable 12-lead electrocardiogram, a ventilator with the possibility of noninvasive ventilation and a video laryngoscope. Regardless of the size of the hospital, continuous availability of all members of the medical emergency teams should be ensured. © 2021. The Author(s)., Hintergrund Im Gegensatz zur Präklinik fehlen für die innerklinische Notfallversorgung Vorgaben zu Organisation und Ausrüstung von innerklinischen Notfallteams (MET). Ziel der Arbeit Evaluation der Organisation, Qualifikation, Ausrüstung sowie Zusatzaufgaben von MET in der Bundesrepublik Deutschland. Material und Methoden Auswertung einer webbasierten Umfrage von Februar bis März 2020 aller am Deutschen Reanimationsregister teilnehmenden Krankenhäuser. Gefragt wurde nach Teamzusammensetzung, Ausrüstung, Qualifikation sowie Zusatzaufgaben im klinischen Alltag. Verglichen wurden Krankenhäuser mit ≤600 vs. >600 Betten. Ergebnisse Insgesamt nahmen 21 (>600: 10 [48 %]; ≤600: 11 [52 %]) Krankenhäuser an der Umfrage teil. Vorgaben zur Teamzusammensetzung gab es bei 76 % (n = 16; ≤600: 8 [72 %] vs. >600: 8 [80 %]). Ausbildungsvoraussetzungen für das MET bestanden an 38 % (n = 16; ≤600: 4 [36 %] vs. >600: 4 [40 %]) der Kliniken. Ein 12-Kanal-Elektrokardiogramm (12-Kanal-EKG) (7 [33 %]; ≤600: 1 [9 %] vs. >600: 6 [60 %]; p = 0,02), Videolaryngoskop (7 [33 %]; ≤600: 2 [18 %] vs. >600: 5 [50 %]) und Beatmungsgerät ohne (7 [33 %]; ≤600: 2 [18 %] vs. >600: 5 [50 %]) bzw. mit Möglichkeit zur nichtinvasiven Beatmung (NIV) gehörte in n = 4 [19 %] (≤600: 1 [9 %] vs. >600: 3 [30 %]) zur Standardausrüstung. Zusätzliche Aufgaben im Klinikalltag hatten 85 % (n = 18; ≤600: 10 (100 %) vs. >600 8 (72 %); ≤600: Notaufnahm/Normalstation jeweils 5 (45 %) vs. >600: Intensivstation 10 (100 %), p = 0,03). Diskussion Die Ausbildung und Ausrüstung von MET ist heterogen. Sie sollte mindestens den in der präklinischen Notfallmedizin gängigen Standards entsprechen und die Vorhaltung eines portablen 12-Kanal-EKG, NIV-fähigen Beatmungsgerätes und Videolaryngoskops umfassen. Unabhängig von der Krankenausgröße sollte eine kontinuierliche Abkömmlichkeit der MET gewährleistet sein.

Additional file 1. Supplemental figures and tables.

BACKGROUND: Pregnancy-related cardiovascular physiologic changes increase the likelihood of pulmonary edema, with the risk of fluid extravasating into the pulmonary interstitium being potentially at a maximum during the early postpartum period. Data on the impact of labor and peripartum hemodynamic strain on lung ultrasound (LUS) are limited, and the prevalence of subclinical pulmonary interstitial syndrome in peripartum women is poorly described. The primary aim of this exploratory study was to estimate the prevalence of pulmonary interstitial syndrome in healthy term parturients undergoing vaginal (VD), elective (eCD), and unplanned intrapartum cesarean deliveries (uCD). Secondary aims were to estimate the prevalence of positive lung regions (>= 3 B-lines on LUS per region) and to assess the associations between positive lung regions and possible contributing factors. METHODS: In this prospective observational cohort study, healthy women at term undergoing VD, eCD, or uCD were enrolled. Following international consensus recommendations, a LUS examination was performed within 4 hours after delivery applying an 8-region technique. Pulmonary interstitial syndrome was defined by the presence of 2 or more positive lung regions per hemithorax. Ultrasound studies were reviewed by 2 blinded reviewers and assessed for interobserver reliability. RESULTS: Seventy-five women were assessed (n = 25 per group). No pulmonary interstitial syndrome was found in the VD and eCD groups (each 0 of 25; 0%, 95% confidence interval [CI], 0-13.7). Pulmonary interstitial syndrome was found in 2 of 25 (8%, 95% CI, 1-26) women undergoing an uCD (P = .490 for VD versus uCD and P = .490 for eCD versus uCD). In 1 woman, this correlated clinically with the development of pulmonary edema. One or more positive lung regions were present in 5 of 25 (20%), 6 of 25 (24%), and 11 of 25 (44%) parturients following VD, eCD, and uCD, respectively (P = .136). Positive lung regions were predominantly found in lateral lung regions. The number of positive lung regions showed a weak correlation with patient age (r = 0.25, 95% CI, 0.05-0.47; P = .033). No significant association was found between LUS pattern and parity, duration of labor, labor augmentation, labor induction, estimated total intravenous fluid intake, or net intravenous fluid intake. CONCLUSIONS: Although many focal areas of increased extravascular lung water (20%-44% prevalence) can be identified on LUS, the overall prevalence of pulmonary interstitial syndrome was 2.7% (2 of 75; 95% CI, 0.3-9.3) among healthy term parturients soon after delivery. Focal areas of positive lung water regions were weakly correlated with maternal age.

BackgroundDiaphragmatic lesions as a result from blunt or penetrating trauma are challenging to detect in the initial trauma setting. This is especially true when diaphragmatic trauma is part of a polytrauma. Complications of undetected diaphragmatic defects with incarcerating bowel are rare but as in our patient can be serious. Case presentationA 57-year-old female presented to the Emergency Room of our Hospital in a critical condition with 3 days of increasing abdominal pain. The initial clinical examination showed peritonism with tinkling peristaltic bowel sounds of mechanical obstruction. A thoraco-abdominal CT-scan demonstrated colon prolapsed through the left diaphragmatic center with a large sero-pneumothorax under tension. As the patient was hemodynamically increasingly unstable with developing septic shock an emergency laparotomy was performed. After retraction of the left colon, which had herniated through a defect of the tendinous center of the left diaphragm and was perforated due to transmural ischemia, large amounts of feces and gas discharged from the left thorax. A left hemicolectomy resulting in a Hartmann type procedure was performed. A fully established pleural empyema required meticulous debridement and lavage conducted via the 7-10cm in diameter phrenic opening followed by a diaphragmatic defect reconstruction. Due to pneumonia and recurring pleural empyema redo-debridement of the left pleural space via thoracotomy were required. The patient was discharged on day 56. A thorough history of possible trauma revealed a bicycle-fall-trauma 7 months prior to this hospitalization with a surgically stabilized fracture of the left femur and conservatively treated fractures of ribs 3-9 on the left side. ConclusionThis is the first report on a primarily established empyema at the time of first surgical intervention for faeco-pneumothorax secondary to delayed diagnosed diaphragmatic rupture following abdomino-thoracic blunt trauma with colic perforation into the pleural space, requiring repetitive surgical debridement in order to control local and systemic sepsis. Thorough investigation should always be undertaken in cases of blunt abdominal and thoracic trauma to exclude diaphragmatic injury in order to avoid post traumatic complications.