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Background In patients up to the age of 40 years old severe trauma is the most frequent cause of death in Germany. According to the current S3 guidelines on treatment of polytrauma and the severely injured, since 2011 the presence of a shock room coordinator should be considered, who can improve the survival of patients by optimized treatment quality and times. The aim of the present study was to analyze various parameters of shock room treatment for polytraumatized patients before and after implementation of a shock room coordinator for treatment of polytrauma. Material and methods To ensure an adequate period of time between the implementation of the shock room coordinator in 2011, data from 2009 and 2012 were included for comparative purposes. All scanned protocols of shock room treatment in the period from 1 January 2009 to 31 December 2009 and from 1 January 2012 to 31 December 2012 were inspected and evaluated. Results In total 213 shock room treatments from 2009 and 420 from 2012 were included. The mean number of shock room treatments in 2009 was 17.8 per month and in 2012 the mean number was 35 per month. The mean number of shock room treatments was nearly doubled in comparison (p & x202f;< 0.001). The mean time for shock room treatment in 2009 was 74.8 & x202f;min and in 2012 the mean time was 69 & x202f;min and was therefore reduced by 5.8 & x202f;min (p & x202f;= 0.56). Conclusion The treatment of polytraumatized patients in the presence of a shock room coordinator and after implementation of the standard operating procedure (SOP) was neither statistically nor clinically relevantly shortened.

Background The evacuation of an intensive care unit, or even an entire hospital, is a rare event. Nevertheless, due to multiple challenging logistical efforts, intensive preliminary planning for such a scenario is obligatory since, in the event of an occurrence, it presents a high potential risk for the patients. Evacuation of a neonatal intensive unit is particularly vulnerable to risks and, due to the lack of alternatives, much more difficult to manage. Action In the late evening of 19 September 2014, serious water damage on the third floor of the obstetrics department of the University Hospital of Cologne took place. The most severely affected ward was the neonatal intensive care unit with 10 beds, together with the immediate care unit (premature ward) with 16 beds, both located directly below. The whole area was so severely affected by the flow of water that the entire area had to be evacuated. Fortunately, all 26 patients were able to be moved within the campus of the university hospital. Of these, 6 children were moved to the infant station located in the same building on the 6th floor. The remaining 20 patients had to be transferred to other buildings on the campus via underground passages, which are not normally used. All transfers of patients took place without incident. Conclusion Evacuation scenarios must be an essential part of a hospital emergency plan. In particular for high-risk areas, e.& x202f;g. intensive care stations, such a scenario should be planned in advance. In case of an emergency, it is important to have a predefined management structure.

Umbilical cord catheters (UCC) are important for the primary care of critically ill newborns. To analyze anatomical variations of the umbilical vein (UV) and its further course, we performed abdominal spiral-CT examinations on stillborns. The aim of the study was to explore the high incidence of mal-positioned UCCs and to improve their positioning. Eighteen stillborns were investigated (29.2 weeks +/- 6.7 weeks (IQR)). CTs were performed using either air or contrast medium injection into the UV. We measured the diameter at the narrowest points of (i) the umbilical vein, (ii) the segmental portal vein, (iii) the left portal vein, (iv) the umbilical recess, and (v) the ductus venosus. The branching angles between (a) the umbilical vein and intrahepatic veins and (b) the ductus venosus and umbilical recess were measured. The diameter of the UV increases from 3.4 to 11 mm (median [IQR]:4.6 mm [4.2-6.9]: r(2)=0.64). The left portal vein has a larger diameter (3.6 mm [2.6-4.55]; r(2)=0.43) than the left segmental portal vein (2.3 mm [1.8-2.75]; r(2)=0.23). The diameter of the ductus venosus (2.5 mm [1.6-3.4]; r(2)=0.59) is half that of the umbilical recess (5.1 mm [3.3-6.2]; r(2)=0.43). The most obtuse angle is formed by the junction between the umbilical recess and ductus venosus (151 degrees [133-159]; r(2)=0.001). The branch angle from the outgoing UV into the left portal vein is more obtuse (128 degrees [123-144]; r(2)=0.0001) than that of the segmental portal vein (115 degrees [105-119]; r(2)=0.0001). To avoid mal-positioning, our data suggest the use of a soft catheter. The UV and its extensions are wide enough to admit a 4 Fr. catheter without complete obstruction. Clin. Anat. 31:269-274, 2018. (c) 2017 Wiley Periodicals, Inc.

Correct positioning of a central venous catheter (CVC) tip in pediatric patients is very important. Malpositioning may lead to direct complications, such as arrhythmia and increase the risk of thrombosis, infections, valve failures or pericardial tamponade. The aim of this review was to identify and summarize published formulae for the correct positioning of the CVC tip in children and to discuss the benefits of these formulae for the daily routine. A systematic and standardized search in Medline and PubMed was performed to identify published formulae. Formulae for insertion depth of the CVC tip over the right internal jugular vein are discussed. The keywords pediatric or pediatric, children, central venous catheter, CVC, central venous, length, insertion, optimal, formula, depth, correct position and right position, internal jugular vein were used to identify the formulae. A total of 854 publications were found and 127 publications were analyzed. The publications were subsequently assessed and classified independently by a specialist in anesthesiology and a specialist in pediatrics. A total of six publications described different body height-based formulae for calculation of a CVC insertion depth. No prospective evaluation of these formulae was performed to show if it is possible to place a CVC tip at the optimal position. The benefit of a formula for daily practice is very limited due to the problem of choosing the right insertion point. The recommended insertion depth should be considered as an indicator and a verification of the CVC tip position should be done using an imaging technique.

A 3-year-old boy with known morbid obesity was transferred to the pediatric intensive care unit after cardiopulmonary resuscitation. Recurrent phases of hypocalcemia triggered reversible QTc prolongation resulting in ventricular tachycardia similar to torsade de pointes. Diagnostic workup with the findings of hypocalcemia, hyperphosphatemia, elevation of parathormone, symmetrical hyperdensities in the bifrontal regions and basal ganglia suspected of being calcifications in combination with the known morbid obesity suggest the diagnosis of pseudohypoparathyroidism type la (Albright's osteodystrophy), which was confirmed by molecular genetic findings. Therapy of end organ multihormone resistance is symptomatic.

Central venous catheterization is widely used in neonatology. Although ultra-sonic guidance for central venous catheter placement is available, complications occur significantly more frequently in infants, especially neonates, than in adults. This study seeks to determine the characteristics, topographical conditions, regional relationships, and diameters of the venous structures of the upper extremity and the thoracic central venous system in extremely small preterm neonates (mean: 900 g). Nine formaldehyde-fixed preterm stillborns were prepared (mean 27 2/7 weeks' gestational age). The anatomical preparation involved the complete thoracic wall, neck and shoulder region, and preparation of the upper extremities. It was shown that the course of the internal jugular vein can be influenced by rotation of the head. Maximum head rotation (80 degrees) to the contralateral side leads the internal jugular vein to overlap the common carotid artery and sharpens the confluence angle of the internal jugular into the brachiocephalic vein. We propose that this has the potential to result in dislocation of the catheter. Less rotation of the head (<30 degrees) is favorable as the internal jugular vein and common carotid artery run in parallel. Commonly used central venous catheters (2F-4F) may not occlude the vascular lumen completely. Small central venous cannulation using a single-orifice catheter through arm veins (1F) may also not occlude peripheral vessels of the upper extremity (cephalic and basilic veins). The right internal jugular vein has a straight course, appears suitable for central venous access and less hazardous, especially when using stiff catheters. The use of small straight wire guides is recommended. Clin. Anat. 24:711-716, 2011. (C) 2011 Wiley-Liss, Inc.