Therapeutische Umschau. Revue thérapeutique
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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.
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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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The examination of living victims of physical and sexual assault as well as the documentation of injuries are tasks of the emergency physician. His observations and the documentation by photography, diagrams and description of findings are the basis for further legal proceedings. This article addresses the duties and responsibilities as well as the practical procedures of the physician regarding the announcement of incidents indicating crimes against the corporal and sexual integrity of patients to the authorities and the documentation of findings in general and addresses some special situations likely to occur in any medical emergency.
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The management of recent sexual and physical assault in women has two aims: to provide medical and psychological care for the victim and to prevent possible health consequences of the trauma on one hand, and to facilitate the forensic assessment with regard to the perpetrator's prosecution on the other. The victim should always be encouraged to report an offence to the police and forensic medicine should be called in to assist in the victim's examination, whenever possible. ⋯ The profound emotional impact of sexual and physical assault requires knowledgeable and sensitive crisis intervention on the part of the counsellor and referral for ongoing counselling and support must be made available. A well trained and competent sexual assault care team with a sympathetic and non-judgemental attitude can contribute profoundly to the assaulted woman's regaining control over her life and being able to overcome the experienced trauma.