By Horst Berzewski
Ein Buch f?r Notf?lle – nicht nur f?r Psychiater ... Seit Mitte der 1980er Jahre werden die Rettungsdienste zunehmend mit Patienten konfrontiert, die prim?r oder vorherrschend an einer psychischen St?rung leiden. Im Vordergrund stehen psychiatrische St?rungen, die einer sofortigen Behandlung bed?rfen: Delirien, Verwirrtheits- und Erregungszust?nde, Panikattacken oder Suizidversuche. Zunehmend trifft der Notarzt auf Patienten, die sich durch akute psychosoziale Belastungen ?berfordert f?hlen. Ein pl?tzlich auftretender, nicht vorhersehbarer Schicksalsschlag oder eine unerwartete Intensivierung und Akzentuierung einer chronischen Konflikt- oder Belastungssituation k?nnen zu einer Krise f?hren. Die komplett aktualisierte und ?berarbeitete Auflage dieses Buches deckt alle Aspekte des psychiatrischen Notfalls ab – vom ersten Kontakt ?ber Anamnese, Diagnosefindung und gezielte Therapie bis hin zu h?ufigen juristischen Fragen und Problemen. Besonders hervorzuheben ist die klare und schnelle Orientierung f?r den Notarzt und das Rettungsteam; insbesondere die detaillierten Therapieanweisungen sind hier von gro?em Nutzen. Da nahezu jeder Arzt irgendwann mit psychiatrischen Notf?llen konfrontiert wird, ist dieser Leitfaden ein wertvoller Begleiter f?r den Berufsalltag in Klinik und Praxis. Vorbereitet sein f?r den Fall der F?lle ...
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Extra info for Der psychiatrische Notfall 3. Auflage
B. Kinder, psychisch Kranke). 4 Rechtsunbeachtlich ist auch der Wille des Suizidenten (umstrittene Rechtsprechung des BGH). wenn das Unterbleiben einer Behandlung gesundheitliche Schäden oder den Tod zur Folge hat, ist der Wille des Patienten zu respektieren. Falls dies nicht geschieht, können die Voraussetzungen der Körperverletzung, Nötigung oder Freiheitsberaubung vorliegen. Dementsprechend gehört es zu den Pﬂichten des Arztes, die Notwendigkeit einer Behandlung eindringlich und umfangreich darzustellen, um den Patienten von seiner Weigerung abzubringen.
2 · Quantitative Bewusstseinsstörungen 4 4 4 4 4 Herzdruck und Herzschmerzen, Tachykardien, starker Harndrang, Mundtrockenheit, Fusionsstörungen. Bevor die Bewusstseinsstörung eintritt, manifestieren sich Muskelverkrampfungen und die charakteristische Pfötchenstellung der Hände. Die Patienten kommen oft unter dramatischen Begleitumständen in Erste-Hilfe-Stationen und nehmen häuﬁg Bereitschaftsärzte in Anspruch. Die Diagnose ist bei charakteristischer Entwicklung der Symptomatik leicht zu stellen.
Die vasovagale Reaktion besteht in einer Hemmung des vaskulären und kardialen Sympathikus bei gleichzeitiger Aktivierung des kardialen Parasympathikus. Nachfolgend kommt es zu einer peripheren Vasodilatation und einer Abnahme der Herzfrequenz und Herzkontraktibilität. Sie tritt bei gesunden Personen nach langem Stehen oder im Sitzen auf. Begünstigend wirken: 4 warme, schlecht durchlüftete Räume, 4 enge Kleidung, 4 viele Menschen im Raum, 4 vorausgegangene unspeziﬁsche Stressfaktoren wie Schlafentzug, längere Nahrungskarenz, 4 vorausgegangener übermäßiger Alkoholgenuss, 4 banale Infekte oder 4 länger bestehende Erschöpfungszustände.