[Violence and aggression in hospitals-what if the personnel need help?] / Gewalt und Aggression im Krankenhaus ­ Was, wenn das Personal Hilfe braucht?

In view of the increasing violence and aggression against medical personnel in healthcare facilities, there are considerations by the legislature to punish violent offenders in hospitals more severely. Hospital and emergency room staff are increasingly confronted by physically and psychologically violent patients or their relatives. Sometimes medical treatment in a hospital or emergency room is an exceptional physical or mental situation for many patients and their relatives. In addition, the consumption of alcohol and drugs, long waiting times, psychiatric illnesses and dissatisfaction with medical care or communication problems are considered to be the cause of violence against medical personnel in healthcare facilities. In addition to the physical consequences for the affected employees, the psychological consequences, such as job dissatisfaction, fear of work and posttraumatic stress disorder also pose major challenges for the employer. In order to fulfil the obligation of care towards employees, the latter should provide concepts for protection against violence as part of the company health management. Structural, organizational and personal measures as well as concepts for dealing with aggressive patients are the cornerstones of employee protection. Professional training courses on de-escalation, self-protection and self-defense can also contribute to the protection of employees and are gladly accepted by the staff. Even in the extreme case of a rampage situation, hospital deployment and alarm plans have to be developed and established.

[The Acute Abdomen: Etiology and Clinical Presentation]. / Das akute Abdomen: Ätiologie und Klinik.

Abdominal pain is one of the most common complaints that lead to an emergency department visit. Depending on the interpretation of the definition, 20-40 % of these patients present with an acute abdomen. This term summarizes a variety of diseases that often occur in the abdominal cavity, mostly acute, and can be accompanied by symptoms such as nausea and vomiting. The challenge for the physician is to differentiate a whole range of vital diseases from less urgent causes of complaints. Extra-abdominal differential diagnoses should also be considered. Initial diagnosis often requires a great deal of clinical experience.The targeted medical history and clinical assessment together with the selection of the appropriate technical investigation play a central role. The goal must be to move from symptom-based to causal therapy as quickly as possible and to clarify whether a patient needs to be referred to an emergency operation or whether there is time for further differential diagnostic measures. The prognosis of the acute abdomen often depends on the time latency until the definitive therapy is initiated. Rapid and determined action by the experienced initial examiner are important prerequisites for a favorable course of the disease process.