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The proportion of elderly, frail, and multimorbid people has increased dramatically in recent decades resulting from demographic changes and will further increase, which will impact acute medical care. Prospective, randomized studies on geriatric intensive care are still lacking. There are also no international or national recommendations regarding the management of critically ill elderly patients. Based on an expert opinion, this consensus paper provides 16 statements that should be considered when dealing with geriatric critical care patients.

Ultrasound is an important diagnostic tool especially in emergency and intensive care medicine. It is always available at the bedside and shortens time to diagnosis. Many specialties have integrated ultrasound into diagnostic algorithms as part of the extended physical exam. Numerous differential diagnoses can be easily excluded using point-of-care ultrasound and therefore adequate treatment is initiated faster. Emergency or focused ultrasound is therefore of outstanding relevance to any emergency or critical care physician. Integration into medical school curricula is becoming more common tough no nationwide standards are in place yet.

A 52-year-old man suffered an out-of-hospital cardiac arrest (OHCA) and bystander reanimation was immediately started. The initial electrocardiogram indicated ventricular fibrillation. After repetitive defibrillations as well as intravenous administration of amiodarone, a temporary return of spontaneous circulation (ROSC) could be established. Due to unstable cardiovascular conditions with recurrence of ventricular fibrillation, mechanical resuscitation with the help of the LUCAS™ device was initiated, and the patient was admitted to our hospital for emergency coronary angiography after a cumulative period of approximately 90 min. The initial blood gas analysis displayed a significant lactate acidosis with a pH value of 6.7. Therefore, in a multidisciplinary team, the decision was made against an extracorporeal membrane oxygenation and for a coronary angiography under continuation of mechanical resuscitation. After multiple stenting of the right coronary artery and left anterior descending coronary artery, permanent ROSC could be established. The patient was admitted to our intensive care unit, where he was further treated according to the S3-guideline for infarct-related cardiogenic shock. In the course of time, the patient was quickly extubated without any neurological deficits.

The establishment of primary percutaneous interventions for the treatment of myocardial infarction, increasingly complex coronary and noncoronary interventions in severely ill patients, and the increasing rise in the number of catheter examinations in elderly and morbid patients due to demographics frequently necessitates involvement of intensive care physicians for primary care of unstable patients and management of complications within the cath lab. In the context of complication and risk management, therefore, all cardiac catheter labs should develop a checklist in collaboration with the respective emergency/intensive care team. Team-oriented interdisciplinary management through standardization of emergency scenarios remains the key to success, despite all progress.

Extracorporeal cardiopulmonary resuscitation (eCPR) may be considered as a rescue attempt for highly selected patients with refractory cardiac arrest and potentially reversible etiology. Currently there are no randomized, controlled studies on eCPR, and valid predictors of benefit and outcome which might guide the indication for eCPR are lacking. Currently selection criteria and procedures differ across hospitals and standardized algorithms are lacking. Based on expert opinion, the present consensus statement provides a proposal for a standardized treatment algorithm for eCPR.

The so-called point-of-care ultrasound (POCUS) is of increasing importance for diagnostics and therapy control in intensive care medicine. Based on focused thorax sonography, echocardiography, and abdominal sonography, the most important working and differential diagnoses can be demonstrated or excluded depending on the leading symptom. Sonographic-based algorithms allow a structured evaluation especially of patients with the common leading symptoms dyspnea and thoracic pain.

Background: Long QT syndrome (LQTS) can lead to ventricular arrhythmia, especially torsade de pointes (TdP) tachycardia and/or ventricular tachycardia (VT). The aim of this study is to characterize patients with life-threatening cardiac arrhythmias associated with drug-induced LQTS and to identify risk factors of distinct presenting arrhythmias., Material and Methods: In this retrospective study, we present 33 consecutive cases of life-threatening cardiac arrhythmias associated with drug-induced long QT, which were direct admitted as emergency to a medical intensive care unit (MICU) during an observational time of 6 years., Results: Of 33 identified cases, 55 % presented with TdP with the need of resuscitation and 45 % showed nonsustained VT, respectively. In the total cohort the mean corrected QT interval (QTc) was 532 ± 29 ms, with 530 ± 31 ms (n = 14) in men and 533 ± 28 ms (n = 19) in women (p = 0.80), respectively. Cardiac drugs with QTc interval prolonging effect were reported in 24 % of cases, and the other 76 % involved noncardiac medications. Although hypokalemia is the most common risk factor for drug-induced malignant arrhythmias, a QTc interval of at least 500 ms seems to be the major determinant of the risk of drug-induced proarrhythmias. Interestingly, patients with TdP exhibit more bradycardia as such with VT., Conclusions: This is the first study of patients with drug-induced life-threatening cardiac arrhythmias who were admitted as a case of emergency to a MICU. Physicians should be aware of drug-induced LQTS and be able to identify patients at risk and avoid specific drugs in such patients.

We present a case of a 34-year-old woman with cardiogenic shock after successful resuscitation. In the medical history migraine was known. Emergency echocardiography demonstrated left ventricular dysfunction with hypokinetic basal and midventricular segments and hyperkinetic apex. Cerebral computed tomography suggested a massive subarachnoid haemorrhage (SAH) with transtentorial herniation, so that taking into account the clinical history (severe headache) the diagnosis of a SAH-associated inverted takotsubo cardiomyopathy could be made. In the case of subarachnoid haemorrhage it should be noted that extracerebral organ dysfunction, e.g. inverted takotsubo cardiomyopathy, frequently occurs.

Physicians specializing in dysphagia are needed in modern intensive care medicine. Long-term intubation is associated with aspiration and swallowing disorders. Early and standardised dysphagia management should be initiated during a patient's stay on intensive care unit. A clinically experienced, interdisciplinary team is required to provide optimal care for critically ill patients with dysphagia. Intensive care physicians should therefore know about basics in dysphagiology.

A 52-year-old woman was admitted to our emergency department with a suspected diagnosis of a thoracic disc prolapse. She presented with acute thoracic and vertebral pain of sudden onset that increased on movement and change of body position. An emergency echocardiography that was performed at the bedside showed aortic insufficiency, dilation of the aortic root, and membrane dissection in the ascending aorta. A thoracic contrast-enhanced CT angiogram verified acute aortic dissection Stanford type A, which resulted in immediate referral to the department of cardiothoracic surgery for an emergency replacement of the ascending aorta. In the emergency department, emergency bedside echocardiography facilitates the rapid evaluation of potential differential diagnoses in patients presenting with acute thoracic pain.