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Article: Militärmedizin: evidenzbasierte Therapie unter besonderen Bedingungen

Sahm, Joachim / Schaaf, Sebastian / Schroeder, Daniel / Schwab, Robert / Schmidbauer, Willi / Jänig, Christoph Walter

2024 Volume 19, Issue 01, Page(s) 49–71

Keywords	Militärmedizin ; Triage ; Damage Control Resuscitation ; Damage Control Surgery ; Schussverletzungen ; Explosionsverletzungen
Language	German
Publishing date	2024-03-01
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2255461-0
ISSN	1862-6955 ; 1611-6550
ISSN (online)	1862-6955
ISSN	1611-6550
DOI	10.1055/a-2048-1988
Database	Thieme publisher's database

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Article ; Online: Education of schoolchildren in cardiopulmonary resuscitation - overview of the current literature.

Schroeder, Daniel C / Finke, Simon-Richard / Grübl, Tobias / Jänig, Christoph W / Böttiger, Bernd W

Current opinion in critical care

2023 Volume 29, Issue 6, Page(s) 616–620

Abstract: Purpose of review: Recognition of cardiac arrest and initiation of cardiopulmonary resuscitation (CPR) can be learned and adequately replicated by schoolchildren. Regular instruction of schoolchildren in CPR is therefore a core element to increase low ... ...

Abstract	Purpose of review: Recognition of cardiac arrest and initiation of cardiopulmonary resuscitation (CPR) can be learned and adequately replicated by schoolchildren. Regular instruction of schoolchildren in CPR is therefore a core element to increase low bystander CPR rates. Thereby, schoolchildren CPR training evolved as own scientific field within the last decade. Aim was to describe current evidence in terms of epidemiology, teaching approaches and political aspects. Recent findings: Schoolchildren demonstrate a high motivation to be trained in CPR. Teaching approaches that combine theoretical and practical learning sessions guarantee a sustainable learning effect. Schoolchildren can adequately perform chest compressions and mouth-to-mouth ventilation from the age of 12 years. Use of digital media is a highly promising teaching approach. CPR training conducted by teachers from the own school is effective and guarantees continuous development of CPR skills. Integration of schoolchildren CPR training into school curricula is the foundation for a sustainable increase of lay resuscitation rates in the population. Scientific and political promotion of schoolchildren CPR training is needed to sensitize the population and move bystander CPR in the social focus. Summary: While bystander CPR rates are low in Europe comprehensive establishment of schoolchildren CPR training may sustainably increase survival after cardiac arrest.
MeSH term(s)	Humans ; Child ; Cardiopulmonary Resuscitation ; Internet ; Out-of-Hospital Cardiac Arrest/therapy ; Schools ; Europe
Language	English
Publishing date	2023-10-09
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	1235629-3
ISSN	1531-7072 ; 1070-5295
ISSN (online)	1531-7072
ISSN	1070-5295
DOI	10.1097/MCC.0000000000001111
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Article: Patients at Risk for Transfusion-A Six-Year Multicentre Analysis of More Than 320,000 Helicopter Emergency Medical Service Missions.

Jänig, Christoph / Willms, Chadlia / Schwietring, Jens / Güsgen, Christoph / Willms, Arnulf / Didion, Nicole / Gruebl, Tobias / Bieler, Dan / Schmidbauer, Willi

Journal of clinical medicine

2023 Volume 12, Issue 23

Abstract: 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 ... ...

Abstract	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.
Language	English
Publishing date	2023-11-25
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12237310
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Article: Verbrennungen und thermomechanischen Kombinationsverletzungen

Janiak, Florian / Ettmüller, Katrin / Hentsch, Sebastian / Jänig, Christoph Walter

NOTARZT

2022 Volume 38, Issue 04, Page(s) 211–224

Keywords	Polytrauma ; Schwerstverletzung ; Explosionsverletzung ; Inhalationstrauma ; Volumentherapie ; multiple trauma ; severe injury ; explosion injury ; inhalation trauma ; volume therapy
Language	German
Publishing date	2022-08-01
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2039417-2
ISSN	1438-8693 ; 0177-2309
ISSN (online)	1438-8693
ISSN	0177-2309
DOI	10.1055/a-1661-6832
Database	Thieme publisher's database

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Article ; Online: Diagnose und zielgerichtete Therapie der Fournier-Gangrän mit septischem Verlauf: Vorstellung eines Behandlungsalgorithmus, Identifikation von Risikofaktoren, Betrachtung des Mikrobioms und Abgleich mit der Literatur.

Wöhler, Aliona / Schwab, Robert / Güsgen, Christoph / Schaaf, Sebastian / Weitzel, Carolin / Jänig, Christoph / Willms, Arnulf

Zentralblatt fur Chirurgie

2021 Volume 147, Issue 5, Page(s) 480–491

Abstract: Background: Fournier's gangrene is a necrotising fasciitis type I occurring in the perineal and genital region. The disease expands progressively and still has poor outcome, especially in critical ill patients. This study's focus was placed on the ... ...

Title translation	Diagnosis and Treatment of Severe Fournier's Gangrene: Introduction of a Surgical Approach, Evaluation of Risk Factors, Microbiological Characteristics and Review of the Literature.
Abstract	Background: Fournier's gangrene is a necrotising fasciitis type I occurring in the perineal and genital region. The disease expands progressively and still has poor outcome, especially in critical ill patients. This study's focus was placed on the evaluation of risk factors and comorbidities, on the bacteriological spectrum, laboratory analyses, mortality and the course according to the algorithmic approach. Method: The medical records were reviewed of 10 patients with severe Fournier's gangrene from 2010 to 2019 who underwent intensive care therapy for at least 48 hours. Ten patients with Fournier's gangrene and sepsis and intensive therapy lasting at least 48 hours were recorded and analysed descriptively. Results: The patient cohort consisted of six men and four women with a median age of 62 years (range 42 - 78 years). The median time between the onset of symptoms and hospitalisation was four days (range 3 - 5 days). The commonest aetiological event was a minor trauma. Predisposing factors included diabetes mellitus (30%) and overweight (80% BMI > 25). 90% of patients exhibited polymicrobial infection. All patients had systemic sepsis with SOFA-Score between 3 and 17 points. The mortality rate was 40%. Significant differences between surviving and deceased patients were shown by PCT, INR and aPTT (p < 0.05). Conclusion: Severe Fournier's gangrene continues to be a major challenge with a high mortality rate. Only rapid diagnosis, urgent extensive surgical debridement and intensive care therapy can lead to a favourable outcome in these critically ill patients. Vacuum-assisted closure can be successfully used in the management of soft-tissue defects.
MeSH term(s)	Adult ; Aged ; Debridement ; Female ; Fournier Gangrene/diagnosis ; Fournier Gangrene/surgery ; Humans ; Male ; Middle Aged ; Negative-Pressure Wound Therapy ; Risk Factors ; Sepsis
Language	German
Publishing date	2021-02-08
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	200935-3
ISSN	1438-9592 ; 0044-409X
ISSN (online)	1438-9592
ISSN	0044-409X
DOI	10.1055/a-1319-1734
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Article ; Online: Patients at Risk for Transfusion—A Six-Year Multicentre Analysis of More Than 320,000 Helicopter Emergency Medical Service Missions

Christoph Jänig / Chadlia Willms / Jens Schwietring / Christoph Güsgen / Arnulf Willms / Nicole Didion / Tobias Gruebl / Dan Bieler / Willi Schmidbauer

Journal of Clinical Medicine, Vol 12, Iss 23, p

2023 Volume 7310

Abstract: 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 ... ...

Abstract	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.
Keywords	emergency medical services ; haemorrhagic shock ; blood transfusion ; massive transfusion ; air ambulance ; Medicine ; R
Subject code	610
Language	English
Publishing date	2023-11-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Vergleich der Anwendung verschiedener extraglottischer Atemwegshilfen durch Laien am Phantom.

Jänig, Christoph / Balogh, Oliver / Krappitz, Stephanie / Willms, Arnulf / Schmidbauer, Willi / Piepho, Tim

Medizinische Klinik, Intensivmedizin und Notfallmedizin

2021 Volume 117, Issue 5, Page(s) 374–380

Abstract: Background: Supraglottic airways (SGA) are an established method of airway management both in prehospital medicine and clinical settings. Endotracheal intubation is the gold standard, but SGA offer advantages in terms of faster application learnability.! ...

Title translation	Manikin-based comparison of the use of different supraglottic airways by laypersons.
Abstract	Background: Supraglottic airways (SGA) are an established method of airway management both in prehospital medicine and clinical settings. Endotracheal intubation is the gold standard, but SGA offer advantages in terms of faster application learnability. Objectives: In the present study it was investigated whether the time until the first sufficient ventilation in the three examined SGAs applied by bystander differed significantly. Materials and methods: A total of 160 visitors to a shopping mall were assigned to one of the three SGA after permutative block randomization. The primary endpoint of the present study was the required placement time until the first sufficient ventilation. Results: Participants managed to place the i‑gel laryngeal mask airway (i-gel, Intersurgical Beatmungsprodukte GmbH, Sankt Augustin, Germany) after a median time of 11 s, whereas the median time until the first sufficient ventilation using a classic laryngeal mask airway (LMA; 26 s) or a laryngeal tube (LT; 28 s) was significantly longer. Thus, the time savings when using the i‑gel compared to the LT and LMA were each significant (p < 0.001), whereas the times between LT and LMA did not differ significantly (p 0.65). Conclusion: The results show that laypersons are able to successfully apply various supraglottic airways to the phantom after a short learning period. The i‑gel laryngeal mask could be placed with the highest success rate and speed.
MeSH term(s)	Airway Management/methods ; Humans ; Intubation, Intratracheal/methods ; Laryngeal Masks ; Manikins ; Tracheostomy
Language	German
Publishing date	2021-06-14
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2636018-4
ISSN	2193-6226 ; 1435-1420 ; 0723-5003 ; 2193-6218 ; 0175-3851
ISSN (online)	2193-6226 ; 1435-1420
ISSN	0723-5003 ; 2193-6218 ; 0175-3851
DOI	10.1007/s00063-021-00834-z
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Article ; Online: Status quo of the use of DCS concepts and outcome with focus on blunt abdominal trauma : A registry-based analysis from the TraumaRegister DGU®.

Willms, Arnulf / Güsgen, Christoph / Schwab, Robert / Lefering, Rolf / Schaaf, Sebastian / Lock, Johan / Kollig, Erwin / Jänig, Christoph / Bieler, Dan

Langenbeck's archives of surgery

2021 Volume 407, Issue 2, Page(s) 805–817

Abstract: Introduction: Damage control surgery (DCS) is a standardized treatment concept in severe abdominal injury. Despite its evident advantages, DCS bears the risk of substantial morbidity and mortality, due to open abdomen therapy (OAT). Thus, identifying ... ...

Abstract	Introduction: Damage control surgery (DCS) is a standardized treatment concept in severe abdominal injury. Despite its evident advantages, DCS bears the risk of substantial morbidity and mortality, due to open abdomen therapy (OAT). Thus, identifying the suitable patients for that approach is of utmost importance. Furthermore, little is known about the use of DCS and the related outcome, especially in blunt abdominal trauma. Methods: Patients recorded in the TraumaRegister DGU® from 2008 to 2017, and with an Injury Severity Score (ISS) ≥ 9 and an abdominal injury with an Abbreviated Injury Scale (AIS) score ≥ 3 were included in that registry-based analysis. Patients with DCS and temporary abdominal closure (TAC) were compared with patients who were treated with a laparotomy and primary closure (non-DCS) and those who did receive non-operative management (NOM). Following descriptive analysis, a matched-pairs study was conducted to evaluate differences and outcomes between DCS and non-DCS group. Matching criteria were age, abdominal trauma severity, and hemodynamical instability at the scene. Results: The injury mechanism was predominantly blunt (87.1%). Of the 8226 patients included, 2351 received NOM, 5011 underwent laparotomy and primary abdominal closure (non-DCS), and 864 were managed with DCS. Thus, 785 patient pairs were analysed. The rate of hepatic injuries AIS > 3 differed between the groups (DCS 50.3% vs. non-DCS 18.1%). DCS patients had a higher ISS (p = 0.023), required more significant volumes of fluids, more catecholamines, and transfusions (p < 0.001). More DCS patients were in shock at the accident scene (p = 0.022). DCS patients had a higher number of severe hepatic (AIS score ≥ 3) and gastrointestinal injuries and more vascular injuries. Most severe abdominal injuries in non-DCS patients were splenic injuries (AIS, 4 and 5) (52.1% versus 37.9%, p = 0.004). Conclusion: DCS is a strategy used in unstable trauma patients, severe hepatic, gastrointestinal, multiple abdominal injuries, and mass transfusions. The expected survival rates were achieved in such extreme trauma situations.
MeSH term(s)	Abdominal Injuries/surgery ; Humans ; Injury Severity Score ; Multiple Trauma ; Registries ; Retrospective Studies ; Wounds, Nonpenetrating/surgery
Language	English
Publishing date	2021-10-05
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1423681-3
ISSN	1435-2451 ; 1435-2443
ISSN (online)	1435-2451
ISSN	1435-2443
DOI	10.1007/s00423-021-02344-0
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Article: Diagnose und zielgerichtete Therapie der Fournier-Gangrän mit septischem Verlauf: Vorstellung eines Behandlungsalgorithmus, Identifikation von Risikofaktoren, Betrachtung des Mikrobioms und Abgleich mit der Literatur

Wöhler, Aliona / Schwab, Robert / Güsgen, Christoph / Schaaf, Sebastian / Weitzel, Carolin / Jänig, Christoph / Willms, Arnulf

Zentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie

2021 Volume 147, Issue 05, Page(s) 480–491

Abstract: Hintergrund: Die Fournier-Gangrän ist eine nekrotisierende Fasziitis Typ I der genitalen und perinealen Regionen, die insbesondere bei schweren Verläufen und systemischer Sepsis mit einer hohen Letalität vergesellschaftet ist. Der Schwerpunkt wurde auf ... ...

Abstract	Hintergrund: Die Fournier-Gangrän ist eine nekrotisierende Fasziitis Typ I der genitalen und perinealen Regionen, die insbesondere bei schweren Verläufen und systemischer Sepsis mit einer hohen Letalität vergesellschaftet ist. Der Schwerpunkt wurde auf die Evaluation der Risikofaktoren und Komorbiditäten, auf das bakteriologische Spektrum, laborchemische Analysen, Mortalität und den Verlauf nach dem algorithmischen Vorgehen gelegt. Material und Methoden: Es wurden 10 Patienten am Bundeswehrzentralkrankenhaus Koblenz im Zeitraum von 2010 bis 2019 mit einer Fournier-Gangrän und Sepsis sowie einer mindestens 48-stündigen Intensivtherapie erfasst und deskriptiv analysiert. Ergebnisse: Die Patientenkohorte bestand aus 6 männlichen und 4 weiblichen Patienten mit einem Durchschnittsalter von 62 Jahren (Range 42 – 78 Jahre). Der durchschnittliche Zeitpunkt zwischen Auftreten der Beschwerden und der Krankenhausaufnahme betrug 4 Tage (Range 3 – 5). Die häufigste Genese war ein Bagatelltrauma bei bestehender entgleister Diabeteserkrankung (30%). Diabetes mellitus (60%) und Adipositas (80% mit BMI > 25) waren führende Risikofaktoren. Bei 90% der Patienten bestand eine polymikrobielle Besiedlung. Alle Patienten wiesen eine Multiorgandysfunktion auf und hatten einen SOFA-Score zwischen 3 und 17 Punkten. Die Mortalitätsrate betrug in unserem Patientenkollektiv 40%. Signifikante Unterschiede zwischen überlebenden und verstorbenen Patienten zeigten PCT, INR und aPTT (p < 0,05). Schlussfolgerung: Die Fournier-Gangrän ist insbesondere bei septischem Verlauf nach wie vor eine Erkrankung mit hoher Letalitätsrate. Bei foudroyantem Verlauf bedarf es einer unmittelbaren Diagnosestellung sowie eines aggressiven operativen Vorgehens, um die Letalität so gering wie möglich zu halten. Nach initialem radikalem Débridement sowie stabilisierenden intensivmedizinischen Maßnahmen folgen weitere operative Eingriffe. In der postakuten Phase hat sich die Anwendung der Vakuumtherapie zur Defektverkleinerung bewährt.
Keywords	Fournier-Gangrän ; nekrotisierende Fasziitis Typ I ; Fournierʼs Gangrene Severity Index (FGSI) ; Mortalität ; operatives Management ; Fournierʼs gangrene ; Fournierʼs Gangrene Severity Index (FGSI) ; mortality ; surgery
Language	German
Publishing date	2021-02-08
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	200935-3
ISSN	1438-9592 ; 0044-409X
ISSN (online)	1438-9592
ISSN	0044-409X
DOI	10.1055/a-1319-1734
Database	Thieme publisher's database

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Article: Notfallmedizinische Aspekte bei Laufveranstaltungen.

Finke, Simon-Richard / Jänig, Christoph / Deschler, Andreas / Hanske, Jan / Herff, Holger / Hinkelbein, Jochen / Böttiger, Bernd W / Schmidbauer, W / Schroeder, Daniel C

Notfall & rettungsmedizin

2021 Volume 26, Issue 3, Page(s) 189–198

Abstract: Background: The number of short- and long-distance running events in Germany is increasing. Running as a popular sport is practiced by a large number of people of different ages, risk groups, and degrees of professionalism, which results in a wide range ...

Title translation	Medical emergencies during running events.
Abstract	Background: The number of short- and long-distance running events in Germany is increasing. Running as a popular sport is practiced by a large number of people of different ages, risk groups, and degrees of professionalism, which results in a wide range of medical emergencies. Objective: The present article elucidates incidence, pathophysiology and therapy of relevant emergencies during running events. Aim was the optimization of work processes of emergency personnel. Materials and methods: A literature search was conducted in PubMed. Results: Exercise-associated muscle cramps, gastrointestinal symptoms, collapse, compartment syndrome, and tendinopathy are common clinical manifestations. Cardiac arrest and sudden cardiac death are rare events. Consciousness and seizures are major complications. Disseminated intravascular coagulation, exercise-associated hyponatremia, heat stroke, rhabdomyolysis, and thromboembolism are associated with high morbidity and mortality. Substances increasing pain resilience as well as performance-enhancing substances are popular among amateur and professional runners and are associated with a high incidence of side effects. Conclusion: General symptoms including vomiting, fever, collapse, muscle-pain, nausea and weakness are the leading symptoms during running events. A careful anamnesis is important for targeted clinical therapy. Symptom control is the main task. Fluid management the most challenging task for healthcare providers in the prehospital setting.
Language	German
Publishing date	2021-12-02
Publishing country	Germany
Document type	English Abstract ; Journal Article ; Review
ZDB-ID	1424737-9
ISSN	1436-0578 ; 1434-6222
ISSN (online)	1436-0578
ISSN	1434-6222
DOI	10.1007/s10049-021-00959-w
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