Praxis
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Acute abdominal pain remains a diagnostic challenge even today. Although computer-assisted diagnostic aids have been designed, these are not yet well established in clinical practice. ⋯ In the first section of this presentation some practical issues are discussed with regard to basic diagnostic steps (history, clinical findings, laboratory tests, plain abdominal film, abdominal ultrasound), as seen from the internist's point of view. In the second part interdisciplinary management of complicated peptic ulcer disease, acute pancreatitis, acute diverticulitis, right lower quadrant pain, and spontaneous bacterial peritonitis are briefly outlined.
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Dyspnea is abnormal respiration experienced as unpleasant, concomitant with excessive respiratory labor. This review limits differential diagnoses of dyspnea to common pulmonary causes in which dyspnea often assumes a "sudden" character. ⋯ The following disease states are illustrated with respect to history, clinical presentation and emergency treatment: hyperventilation-syndrome, pulmonary embolism, pneumothorax, central airway-stenosis, asthma and chronic obstructive pulmonary disease. In the case of asthma the conception of "home management" and telemedicine are presented.
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Nowadays, more people seem to die in hospitals or other establishments than in their own homes. The following paper reports on 50 consecutive cases of death that occurred in a clinic of internal medicine. The analysis concentrated on the circumstances, the symptoms and the treatment of the patients during the 12 h. preceding and immediately before death as well as on the opinion of the relatives and the attending staff. ⋯ So we should sometimes question ourselves about the sense and the need of certain nursing interventions. We should spend more time during our medical training on the question of palliative care and on the problem of the relationship of doctors to death and to the dying. We feel that establishing a "science of death" or a segregation of the dying in specialized institutions makes no sense.
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Computer-based clinical information systems are capable of effectively processing even large amounts of patient-related data. However, physicians depend on rapid access to summarized, clearly laid out data on the computer screen to inform themselves about a patient's current clinical situation. In introducing a clinical workplace system, we therefore transformed the problem list-which for decades has been successfully used in clinical information management-into an electronic equivalent and integrated it into the medical record. ⋯ Computer technology has an immense potential for the further development of problem list concepts. With multimedia applications sound and images will be included in the problem list. For hyperlink purpose the problem list could become a central information board and table of contents of the medical record, thus serving as the starting point for database searches and supporting the user in navigating through the medical record.
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The aim of assessing the emergency patient's threshold of consciousness is to diagnose and manage reversible and treatable conditions fast and effectively. Diagnosis and treatment procedures can be summarized on three levels. First assessment and treatment of hypoxia and shock, second: differentiation of types of coma, in order to decide further treatment measures and the choice of hospital admittance, and third: initiation of antidotes and other appropriate preclinical therapies.