Praxis
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Review
[Clinical-toxicological case (1). Dosage of N-acetylcysteine in acute paracetamol poisoning].
There are currently three protocols used for the administration of N-acetylcysteine in the treatment of acute paracetamol poisoning. In the USA only the oral protocol is approved, while in Europe an intravenous protocol is used. ⋯ N-acetylcysteine is effective also when started more than 15 h after the ingestion. Patients who present with liver failure after paracetamol poisoning should be treated with a prolonged course of N-acetylcysteine.
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This review summarizes some of our current knowledge on the burn-out syndrome and details factors contributing to the high rate of emotional melt-down in health professionals. Possible coping strategies are detailed, and some personal thoughts how to prevent emotional exhaustion are given.
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Chronic obstructive pulmonary disease (COPD) is rather common. It is nearly always associated with excessive smoking. ⋯ This review addresses nonpharmacological treatment of these episodes of acute decompensation. The value of mechanical ventilation is discussed in view of two recent advances: noninvasive ventilation by face or nose mask as alternative to tracheal intubation and improved notions about the pathogenesis of fluids and salt retention as causes of occasionally occurring edema.
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Delirium, i.e. an acute confusional state, is frequently observed in a general hospital. Prevalence of delirium increases with higher age, usually in patients with cognitive deficits (e.g. signs indicative of some dementia) and particularly in those older patients with severe somatic illness. ⋯ In this article the authors summarize data on prevalence, symptomatology as well as etiology and pathogenesis of delirium. In addition, syndromes which may have symptoms similar to delirium are discussed, and their treatment is recommended.
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After a short review on pathophysiologic mechanisms of comatose states and their complications, a cohort of 392 comatose patients (Glasgow Coma Scale < or = 8) hospitalized in intensive care is analyzed in order to estimate the relative frequency of the different causes of nontraumatic coma. Depending on pathology, the following practical, sequential procedure is recommended: at first, identification and treatment of disorders of vital functions, objective estimate of the severity of the coma and rapid diagnostic orientation with a targeted neurologic investigation; then, simple therapeutic interventions in order to treat reversible causes of a metabolic encephalopathy as well as immediate measures for neuroprotection (anticonvulsive and antihypotensive therapy, oxygen, etc.). An initial, adequate control of the comatose patient is mandatory in order to limit disabling cerebral complications.