ZusammenfassungEndokrinologische Erkrankungen begegnen einem in der Notfallmedizin insgesamt selten, noch seltener kommt es vor, dass man mit einem lebensbedrohlichen endokrinologischen Notfall konfrontiert wird. Da dieser häufig mit unspezifischen Allgemeinsymptomen einhergeht und oft als solcher verkannt wird, soll dieser Beitrag auf dieses Krankheitsbild aufmerksam machen, sensibilisieren und ein Konzept zum präklinischen Umgang vorstellen.

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Background Pain management in the pre-hospital setting remains a particular challenge for paramedics and emergency physicians, especially in children. This study evaluates the pre-hospital use and effect of analgesics in children with trauma or pain due to other reasons. Methods This study is a retrospective analysis of the database of a German air rescue service and was conducted over a period of 9 years (2012–2020) to assess pain in general and whether patients with trauma pain due to other reasons received treatment with analgesics. We included all patients in the registry under the age of 16 years. Patients with a Glasgow Coma Scale of 3 at hospital admission and incomplete records were excluded. The intensity of pain was determined by the emergency physician on scene at arrival and hospital admission in a ten-point rating scale (0 = no pain). Effective pain reduction was analyzed. Results Out of 227,458 cases, a total of 22,025 emergency cases involved pediatric patients aged 0–16 years. 20,405 cases were included in the study. 12,000 (58.8%) children had suffered a trauma, 8108 (39.7%) had pain due to other reasons and 297 (1.5%) had both. In total, 4,608 (38.4%) of the children with trauma were assessed having a numerical rating scale (NRS) > 4 at EMS arrival. These patients received mainly ketamine (34.5%) and the opioids fentanyl (38.7%) and piritramide (19.1%). The value on the NRS was significantly lower at admission to hospital (mean 1.9) compared with the EMS arrival (mean 6.9). In 4.9% the NRS at hospital admission was still > 4. 282 patients within the non-trauma group had a pre-hospital NRS of > 4. The pain therapy consisted of opioids (35.8%) and ketamine (2.8%). 28.4% patients in the non-trauma group received no pain medication. In 16.0% the NRS at hospital admission was still > 4. Conclusions German emergency physicians achieved a sufficient pain therapy in pediatric patients with a NRS > 4 after trauma. In case of non-trauma, the pain management by the emergency physicians is restrained and less successful. The most common analgesic medications administered were ketamine and fentanyl, followed by piritramide. Trial registration: The study has been retrospectively registered at DRKS (DRKS00026222).

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BackgroundPain management in the prehospital setting remains a particular challenge for paramedics and emergency physicians, especially in children. This study evaluates the prehospital use and effect of analgesics in children with trauma or severe disease. MethodsThis study is a retrospective analysis of the database of a German air rescue service and was conducted over a period of 9 years (2012 – 2020) to assess pain in general and whether patients with trauma or severe disease received treatment with analgesics. We included all patients in the registry under the age of 16 years. Patients with a Glasgow Coma Scale of 3 at hospital admission and incomplete records were excluded. The intensity of pain was determined by the emergency physician on scene at arrival and hospital admission in a ten-point rating scale (0=no pain). Effective pain reduction was analyzed. ResultsOut of 227,458 cases, a total of 22,025 emergency cases involved pediatric patients aged 0 – 16 years. 20,407 cases were included in the study. 12,000 (58,8%) children had suffered a trauma, 8,108 (39,7%) had severe diseases and 297 (1,5%) had both. In total, 4,608 (38,4%) of the children with trauma were assessed having a numerical rating scale (NRS) > 4 at EMS arrival. These patients received mainly ketamine (34.5%) and the opioids fentanyl (38.7%) and piritramide (19.1%). The value on the NRS was significantly lower at admission to hospital (mean 1.9) compared with the EMS arrival (mean 6.9). In 4.9% the NRS at hospital admission was still >4. 282 patients had a disease with an initially pain determined >4. The pain therapy consisted of opioids (35.8%) and ketamine (2.8%). 28.4% patients in the disease group received no pain medication. In 16.0% the NRS at hospital admission was still >4.ConclusionsGerman emergency physicians achieved a sufficient pain therapy in pediatric patients with a NRS >4 after trauma. In case of a disease the pain management by the emergency physicians is restrained and less successful. The most common analgesic medications administered were ketamine and fentanyl, followed by piritramide. Trial registration: The study has been retrospectively registered at DRKS (DRKS00026222)