Growth mindset … Psychologie des Erfolges

… je mehr man über den Tellerrand schaut, umso mehr erkennt man den unglaublichen Fundus an Wissen, der vorhanden und nutzbar ist. Internet sei Dank.

Vor längerem wurde ich u.a. auch durch einen Bericht über Al Gore auf “TED talks” aufmerksam. Interessante Menschen weltweit tragen hier ihre interessanten Konzepte vor. Wenn man durchblättert stößt man auch auf Bill Gates und seinem legendärem Talk zu der Bekämpfung von Malaria. Schon der Hammer, wie er in diesem Vortrag ein Weckglas öffnet und die darin eingesperrten Mosquitos fliegen lässt.

Nun sind wir bei Bill Gates. Ich kann mich noch an die Einführung von PCs in unseren Alltag erinnern und die Glaubenskriege, die bzgl. Microsoft, Apple etc. ausgetragen wurden. Microsoft hatte natürlich immer sein Fett abgekriegt, und damit auch Bill Gates.

Bill Gates fasziniert jedoch immer mehr. Seine Aktivitäten hinsichtlich seiner Stiftung werden viele von Ihnen kennen. Schauen Sie doch mal in seinen Blog rein (www.gatesnotes.com). U.a. beschreibt er auch kurz Bücher, die ihn begeistert haben. Eines dieser Bücher der Psychologin Carol Dweck beschäftigt sich mit unserer inneren Einstellung und dem, was wir erreichen können. Die Zusammenfassung von Bill Gates, dass in uns beides steckt, “fixed mindsets” und “growth mindsets” dürften eine relativ gute Einschätzung geben, wie dies bei uns persönlich ist.

Vielleicht sollten wir das “growth mindset” hinsichtlich einer Weiterentwicklung von Notfallmedizin in Deutschland pflegen und kultivieren. Die avisierte Zusatzweiterbildung Klinische Notfallmedizin vermutlich in 2017 ist ja ein Erfolg der eigenen Überzeugung und der Beharrlichkeit.

Das war´s für heute aus Nürnberg. Genießen Sie die Ostertage mit einem schönen Osterfladen! Stay tuned and join again!

Il sistema sanitario italiano e la gestione delle maxiemergenze

Simeu alla trasmissione Zapping di Radio Rai 1

La sicurezza delle nostre città in caso di emergenza per un eventuale attentato terroristico: a questo argomento, di primissima attualità a seguito delle esplosioni di Bruxelles dello scorso martedì, la puntata di Zapping di Radio Rai 1 di venerdì 25 marzo ha dedicato un articolato approfondimento. Fra gli ospiti della trasmissione, Maria Pia Ruggieri, presidente nazionale Simeu, (dal minuto 00.40.40 circa) si è concentrata in particolare su come è organizzato il sistema sanitario per la gestione delle maxiemergenze e in cosa consiste un Peimaf ospedaliero, il Piano di emergenza interno per il massiccio afflusso di pazienti.

Altri ospiti della puntata sono stati Andrea Manciulli, direttore del Rapporto sul terrorismo jihadista per l’Assemblea Nato e Renata Pepicelli esperta di Islam dell’Università  romana Luiss.

ECG of the Week – 28th March 2016

The following ECG series is froma 58 year old male who was referred by his GP following 14 hours of central chest pain. His past medical history included hypertension, hypercholesterolaemia, and smoking.



ECG at GP’s
Click to enlarge

ECG on arrival ED
Performed ~ 60 minutes after ECG above
Click to enlarge

ECG performed ~60 minutes after initial ED ECG
Click to enlarge

Things to think about

  • What are the key features on each of the ECG’s ?
  • How would you manage this patient ?

ECG of the Week – 28th March 2016

The following ECG series is froma 58 year old male who was referred by his GP following 14 hours of central chest pain. His past medical history included hypertension, hypercholesterolaemia, and smoking.



ECG at GP's
Click to enlarge

ECG on arrival ED
Performed ~ 60 minutes after ECG above
Click to enlarge

ECG performed ~60 minutes after initial ED ECG
Click to enlarge

Things to think about

  • What are the key features on each of the ECG's ?
  • How would you manage this patient ?

Is possible chest wall rigidity after illicit intravenous fentanyl administration clinically significant?

fentanyl3 out of 5 stars

Could chest wall rigidity be a factor in rapid deaths from illicit fentanyl abuse? Burns G et al. Clin Toxicol 2016 Mar 21 [Epub ahead of print]

Abstract

Wooden chest syndrome” describes marked muscle rigidity — especially involving the thoracic and abdominal muscles — that is an occasional adverse effect associated with the intravenous administration of lipophilic synthetic opioids such as fentanyl. It can make ventilation difficult, and seems to be reversed by naloxone.

The authors of this interesting speculative paper hypothesized that chest wall rigidity might be at least partially responsible for some deaths related to intravenous injection of fentanyl, which increasingly is appearing in samples of heroin. To investigate this theory, they examined forensic data from all lethal fentanyl intoxications in Franklin County, Ohio over 9 months in 2015.

They identified 48 such deaths. Intravenous administration was confirmed in 23 cases and suspected in 22 others; 3 exposures were by ingestion. Fifteen of the cases had “undetectable” (< 0.5 ng/ml) of the metabolite norfentanyl, which the authors say suggests death was nearly immediate. In 2 cases, EMT documents suggest that manual ventilation was difficult until naloxone was administered.

The conclusion:

[W]e believe sudden onset chest wall rigidity may be a significant and previously unreported factor leading to an increased mortality, from illicit IV fentanyl use.

The authors may be right, although the limited data presented certainly doesn’t prove it. If they are, there could be an important clinical corollary. The general rule-of-thumb is that once a patient with apparent opioid overdose is intubated, there is no point in giving naloxone, since airway and ventilation are controlled and waking the patient up would just lead to misery. However, if ventilation is difficult, cautious administration of naloxone might decrease rigidity and enable ventilation and oxygenation. This certainly needs more consideration and study.