Therapeutische Umschau. Revue thérapeutique
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The General Practitioner (GP) doesn't usually treat polytrauma often. However in Switzerland there are many remote areas where he is first on the scene of the accident. Thus it is important that he knows basic treatment principles in this situation such as the ABC according to the ATLS guidelines. We give a short overview of these important principles.
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Psychiatric emergencies and crises are unforseeable by nature and can have devastating consequences. They can arise both in the course of chronic mental illness and in people who had not shown any previous signs of mental illness. ⋯ This is the reason why establishing a psychiatric diagnosis in emergency situations must be primarily driven by the question as to whether the differential diagnosis is an internal illness or rather intoxication. The most prevalent psychiatric emergencies in clinical practice are nervous breakdowns, psychomotor agitation and violence, suicidal tendencies, delirium, psychoses as well as addictions.
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Pituitary apoplexy, diabetes insipidus, thyroid storm, myxedema coma, parathyrotoxic crisis, hypocalcemia tetany, pheochromocytoma and Addison crisis, diabetic ketoacidosis, diabetic hyperosmolar nonketotic coma, hypoglycemia and carcinoid crisis are the most important endocrine crises. Some of them are common, others very rare. All physicians nevertheless need to have at least a basic knowledge of all of them, since symptoms and signs of endocrine crises overlap with those of other severe disease states, and the failure to recognise endocrine crises as such and to begin rapidly the specific therapy can have fatal consequences.
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Consciousness and wakefulness require normal functioning of the cerebral cortex, as well as of the midbrain reticular formation and its ascending projections. Bilateral structural lesions or functional disturbances of these brain areas can impair consciousness and can produce coma. ⋯ Ancillary tests are used to answer specific diagnostic questions. The treatment of coma depends on its etiology.