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Die präklinische Behandlung von akut erregten, deliranten oder psychotischen Patienten durch den Notarzt

Preclinical therapy of patients with acute agitation, delirious or psychotic symptoms by emergency physicians

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Zusammenfassung

Hintergrund: Patienten mit psychiatrischen Krankheitsbildern stellen im Rettungsdienst keine Rarität dar; dennoch sind bislang keine Studien veröffentlicht, in denen die notärztliche Behandlung dieser Patientengruppe untersucht wurde. Methoden: In der hier vorgelegten Studie wurde die Verteilung dieser Fälle bei Notarzteinsätzen untersucht. Zudem wurde geprüft, ob sich die Behandlungsstrategien von Notärzten verschiedener Fachdisziplinen unterscheiden. Ergebnisse: Rund 13% der Einsätze wurden wegen einer psychiatrischen Erkrankung notwendig. Die Einteilung der Diagnosen erfolgte in Kategorien: Intoxikationen und Suchterkrankungen (53,4%), Suizidversuche (19,6%), Erregungszustände (12,8%), endogene psychiatrische Erkrankungen (6,4%). Eine spezifische Behandlung mit psychotropen Medikamenten erfolgte selten (15%). Zumeist wurde durch den Notarzt eine internistische Medikation (z. B. Antihypertensiva, Antiemetika) appliziert. Die in der Akutpsychiatrie häufig eingesetzte unverzügliche Behandlung mit hochpotenten Neuroleptika wurde nur sehr selten angewendet, auch Benzodiazepine wurden selten eingesetzt (11,7% aller Fälle), waren insgesamt jedoch die am meisten verwendeten Medikamente bei psychiatrischen Patienten. Schlussfolgerung: Insgesamt besteht eine deutliche Diskrepanz zwischen dem Einsatz psychotroper Medikamente im Vergleich zu somatischen Behandlungsstrategien. Hier besteht Bedarf an weiteren Untersuchungen und notärztlicher Fortbildung.

Abstract

Background: Psychiatric diagnoses are common in emergency medicine. Until now no studies on the treatment of these patients by emergency physicians have been published. Methods: We performed a chart analysis of the distribution of psychiatric diagnoses and treatment by emergency physicians in a suburban environment near Frankfurt, Germany. Results: 13% of all included operations were due to psychiatric diseases. The diagnoses were allocated to the following categories: intoxications (53,4%), suicide attempts (19,6%), delirium or agitation (12,8%) and endogenous psychiatric disorders (6,4%). Psychotropic drugs were rarely given by emergency physicians in only 15% of all cases. Benzodiazepines were the most frequently (11,7% of all cases) used psychotropic drugs. Somatic drugs (antiemetics, antihypertonics) were used much more frequently. Conclusions: There is a discrepancy between the use of somatic drugs and psychotropic drug-therapy in psychiatric emergencies. Further examinations on this topic and trainings of emergency physicians are necessary.

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  1. Psychiatrische Klinik, Johannes-Gutenberg-Universität Mainz

    P. Tonn, S. Reuter, B. Treder & N. Dahmen

  2. Psychiatrische Klinik, Johannes-Gutenberg-Universität, Untere Zahlbacher Straße 8, 55131, Mainz

    P. Tonn

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  1. P. Tonn
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Tonn, P., Reuter, S., Treder, B. et al. Die präklinische Behandlung von akut erregten, deliranten oder psychotischen Patienten durch den Notarzt. Notfall & Rettungsmedizin 7, 484–492 (2004). https://doi.org/10.1007/s10049-004-0689-z

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