pediagenosis: Emergency
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Showing posts with label Emergency. Show all posts
Showing posts with label Emergency. Show all posts

Saturday, April 24, 2021

Urology Problems

Urology Problems


Urology Problems
The urinary tract includes the kidneys, ureters, bladder, (prostate), urethra, and external genitalia. Symptoms perceived by patients reflect the embryological origin as well as the current anatomy of these organs.

Urology Problems, Urinary retention, Urinary tract stones,  Sexually transmitted disease, Prostatitis

History
Any previous history of urogenital problems, and a specific focus on:
     Colicky pain: intense pain that comes and goes suggests intermittent contraction of a hollow organ, e.g. ureter. Patients with ureteric colic cannot find a comfortable position. Pain may be referred to the genitals.
     Back pain: the kidneys are retroperitoneal.
     Ask about urinary frequency, flow, blood or clots.
     Fever: with chills and rigors (shaking) suggests sepsis (Chapter 38).
   Dysuria: burning pain when passing urine implies urethral inflammation. Abnormal discharge from the genitals suggests STI.
    Sexual history: if other symptoms suggest it is likely to be relevant.
Ear, Nose, Throat and Dental Problems

Ear, Nose, Throat and Dental Problems


Ear, Nose, Throat and Dental Problems
Ear, nose and throat (ENT) examination needs patience and practice to master. Patients may cough or sneeze, showering you with their body fluids, so protect yourself with gloves, apron, mask and eye protection. Adequate light and topical anaesthesia makes examination easier and your patient more comfortable.

Ear, Nose, Throat and Dental Problems,

Ear
Common diagnoses
Otitis media/sinusitis
Ear pain is usually caused by infection in the middle ear – otitis media. The eardrum appears dull with prominent blood vessels. Sinusitis presents as headache and a feeling of pressure in the face. These are self-limiting conditions caused by a viral upper respiratory tract infection, blocking drainage from airspaces within the head. Analgesics and decongestant drugs are helpful; antibiotics are not.
Obstetrics and Gynaecology Problems

Obstetrics and Gynaecology Problems


Obstetrics and Gynaecology Problems
Assume that any woman of childbearing age is pregnant until proven otherwise. Pregnancy up to the time of foetal viability (approx 23/40 weeks) is managed by gynaecology, after that by obstetrics.

Obstetrics and Gynaecology Problems

Resuscitation
PV bleed + abdo pain + shock = ruptured ectopic pregnancy
A ruptured ectopic pregnancy can bleed faster than blood can be replaced. Immediate surgery is necessary: ensure large bore intra-venous access, with minimal volume resuscitation (Chapter 3). Speculum examination allows exclusion of possible alternatives: ‘cervical shock’ (see below) or toxic shock syndrome (Chapter 38).

Sunday, September 13, 2020

Loss Of Function And Independence

Loss Of Function And Independence

Loss Of Function And Independence

Caring for patients with multiple long-term conditions, frailty, and functional or cognitive impairment is an increasing challenge for families and health and social services. These patients often present to the Emergency Department with a relatively minor functional decline, but one that renders the patient ‘off their legs’, ‘bedbound’ or ‘acopic’ (unable to cope).

Observational Medicine

Observational Medicine

Observational Medicine

Observational medicine units are an expansion of traditional Emergency Department activity. Patients who are likely to be fit for discharge within 24 hours are held in a unit managed by the Emergency Department.

Psychiatry: The Disturbed Patient

Psychiatry: The Disturbed Patient

Psychiatry: The Disturbed Patient

Mental state examination: ABCSMITH

The mental state examination is a structured way of collecting and presenting information about patients with psychiatric symptoms.

Appearance grooming/hygiene/dress/eye contact

Behaviour agitation/withdrawn/gestures/co-operation

Cognition inattention/orientation/reasoning

Speech speed/fluency/pressure/volume

Mood sad/happy/angry/flat/labile/apathetic

Insight presence/degree

Thought process content/possession/speed/flow

Hallucinations/delusions presence/organisation/system

Psychiatry: Self - Harm and Capacity

Psychiatry: Self - Harm and Capacity

Psychiatry: Self - Harm and Capacity
Deliberate self-harm
Most of the patients who self-harm (e.g. overdose or cut them-selves) do so as a response to a stress in their life. Common precipitants are problems with relationships or finances.
The majority of deliberate self-harm (DSH) patients seen in the Emergency Department do not have ongoing suicidal intent; of those presenting with an overdose, only a very small fraction go on to commit suicide. Therefore the challenge is to identify patients with a high ongoing risk of suicide.
Toxicology: Specific Poisons

Toxicology: Specific Poisons

Toxicology: Specific Poisons

Paracetamol (acetaminophen)

Paracetamol overdose (OD) is the most common toxicological emergency and the most common cause of liver transplant and death due to poisoning. Patients who start N-acetylcysteine (NAC) within 12 hours of ingestion are very likely to survive.

Toxicology: General Principles

Toxicology: General Principles

Toxicology: General Principles

Self-poisoning is the most common toxicological problem: serious adverse effects are rare with good basic supportive management. The difficulty of performing human toxicological research means that the evidence base is very limited. Expert advice on the management of poisoning is available through a system of national poisons information centres.

Friday, December 13, 2019

Eye Problems

Eye Problems


Eye Problems
Eye problems seen in the Emergency Department are usually the result of trauma affecting the anterior part of the eye, but can also be manifestations of systemic, CNS or vascular disorders.
A brief general history should include details of diabetes, stroke, hypertension, neurological or cardiac problems and drug treatment. Ask about trauma and the use of hand or power tools prior to the symptoms, as shards of metal or ceramic material are common foreign bodies.

Friday, November 8, 2019

Abdominal Pain

Abdominal Pain


Abdominal Pain
The abdominal cavity contains the organs that digest food, filter blood and enable reproduction, any of which may give rise to abdominal pain. As with chest pain, patients presenting with a ‘textbook’ collection of symptoms are the exception rather than the rule.
Tibia, Ankle and Foot Injuries

Tibia, Ankle and Foot Injuries


Tibia, Ankle and Foot Injuries
History
Mechanism of injury
High-energy injuries commonly result from axial loading, direct blows or crush injuries, e.g. falls or jumps, motor vehicle accidents. Tibial shaft injuries are severe, and risk neurovascular injury and compartment syndrome.
Back Pain, Hip And Knee Injuries

Back Pain, Hip And Knee Injuries


Back Pain, Hip And Knee Injuries
Back pain
Lumbar back pain is a common presentation to the Emergency Department, and can be very challenging to manage. Patients may arrive at the Emergency Department with an agenda that includes hospital admission for analgesia and rehabilitation. This is not practical or desirable: after exclusion of significant pathology, early mobilisation is the most effective treatment. Back pain may also be caused by hip disease and retroperitoneal organs, e.g. aorta, pancreas.
Shoulder And Elbow Injuries

Shoulder And Elbow Injuries


Shoulder And Elbow Injuries
The extreme mobility of the shoulder joint, which relies on soft tissues – muscles, ligaments and cartilage – for stability, comes at a price. The shoulder is relatively unstable, and prone to stiffness if not used. There is a wide range of injury patterns, which change according to the age of the patient.
Wrist And Forearm Injuries

Wrist And Forearm Injuries


Wrist And Forearm Injuries
Injuries to the wrist and forearm are common, often resulting from a fall onto an outstretched hand (FOOSH). It can be difficult to distinguish subtle fractures from soft tissue injury on clinical history and examination alone, so X-ray is usually necessary.

Thursday, September 12, 2019

Hand Injuries

Hand Injuries


Hand Injuries
Hand injuries are a common presentation to the Emergency Department, and the importance of good hand function in day-to-day life requires excellent results. The spectacular range of hand function relies on complex interplay between muscles, tendons, bones and ligaments, all of which may be damaged.
Burns

Burns


Burns
Burns are a common problem, but the vast majority are relatively minor. Serious burns undergo initial assessment and resuscitation as per any trauma (Chapter 8).
Wounds

Wounds


Wounds
Wounds often involve visible areas, the face and upper limb, where cosmetic as well as functional outcome is important. Wounds are generally incised – caused by sharp objects, or lacerated – caused by blunt force. An abrasion is a wound where the upper layers of the skin are removed, but there is no surface break. A wound where the depth exceeds the width or length is described as a puncture wound.
Minor Head And Neck Injury

Minor Head And Neck Injury


Minor Head And Neck Injury
Minor head and neck injuries are extremely common reasons to attend the Emergency Department. Within this group of patients there is a very small number who have sustained serious damage: the challenge is to accurately and efficiently identify these. This task is complicated by the fact that alcohol is involved in more than half of these cases. Minor head injury is defined as Glasgow Coma Scale (GCS) 13 or above, and may be associated with a period of loss of consciousness (LOC), and/or amnesia.

Wednesday, June 19, 2019

Major Head And Neck Injury

Major Head And Neck Injury


Major Head And Neck Injury
This chapter covers patients who have suffered a significant head (Glasgow Coma Scale; GCS  13) and/or neck injury, often as part of multi-system trauma (Chapters 8 and 9). Of trauma-related deaths, 70% are from head injury, and many of these deaths are preventable.

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