Therapeutische Umschau. Revue thérapeutique
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Status epilepticus and stroke are life-threatening neurological emergencies and immediate recognition and medical management are imperativ. There is a serious risk of neurological sequelae. To limit secondary brain damage a prolonged seizure has to be treated without delay. ⋯ A paralysis with acute onset is suspicious for ischaemic or haemorrhagic stroke. A precise neurological examination is mandatory for accurate neuroradiological work-up and to initiate appropriate investigations for risk factors. These patients require an immediate interdisciplinary treatment in a tertiary care centre with neuropaediatry, neuroradiology and neurosurgery.
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Shock remains a significant cause of morbidity and potential mortality in the pediatric population. It is defined as a impaired perfusion with a too high oxygen demand in comparison to oxygen delivery. The cause of hypoxia may be found in a hypovolemic condition due to hemorrhage or loss of gastro-intestinal fluids, a disorder in volume distribution or a cardiac dysfunction. ⋯ Early and aggressive volume therapy is indicated, filling the cardiac system with crystalloids or colloids. Later on under clinical conditions inotropic drugs will improve cardiac output and oxygen delivery. Only by recognizing these patients as early as possible we will be able to reduce morbidity and mortality of this potentially dangerous syndrome.
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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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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.