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By Piers Page, Greg Skinner

An easy-to-use advisor to the administration of universal clinical emergencies; this ebook is a vital for all junior medical professionals or medical scholars. Emergencies almost always current first to the junior surgeon, both due to direct commentary at the ward, or a mobile name from nursing employees whilst on name. the major to their administration is well timed acceptance and intervention. This publication provides the junior surgeon and senior clinical pupil the boldness to do that. The textual content covers emergencies from either a problem-based and disease-based method, with the e-book being divided into sections - displays and ailments.

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164–186) Respiratory Ž Pneumonia/empyema (see p. 208–211) Ž Pneumothorax/tension pneumothorax (see p. 204–207) Ž Pleural effusion (see p. 216–218) Ž PE (see p. 200–203) Gastrointestinal Ž Oesophagitis/gastro-oesophageal reflux Ž Oesophageal rupture Ž Pancreatitis (see p. 372–375) Ž Cholecystitis (see p. 380–382) Ž Peptic ulceration Ž Subphrenic abscess Musculoskeletal Ž Trauma/rib fracture Ž Muscle strain Ž Costochondritis Ž Bony metastases/myeloma Ž Cervical spondylitis Other Ž Psychogenic/panic attacks Ž Herpes zoster infection (shingles) Further reading Ž OHCM, 7th edn.

G. vasculitic disorders) Ž RS Ž Bronchial breathing, coarse crackles and dull percussion indicate infection Ž Bibasal fine crackles suggest pulmonary oedema Ž Stony dull percussion and reduced air entry may reveal a pleural effusion—is there an underlying malignancy? Ž Abdominal Ž Hepatomegaly or splenomegaly can be present in systemic diseases or malignancy Investigations Ž ABGs Ž Can give an indication of lung function if the patient is severely unwell—check the A–a O2 gradient (see p. 422–424) Ž FBC, CRP, coagulation screen Ž Raised inflammatory markers will suggest infective cause Ž Coagulopathy may be revealed as cause or exacerbating factor Ž U&Es Ž ¥Urea may make you consider whether this is haematemesis (but large bleeds may make patients swallow significant quantities of blood) 33 34 CHAPTER 2 Presentations Ž Autoantibody screen Ž May highlight connective tissue/autoimmune disease Ž CXR Ž Look for pulmonary tuberculous granulomas or opacities suggestive of neoplasia Ž Wedges of decreased density in the lung fields may indicate PE (although will often not be present) Ž Consolidation will suggest pneumonia, but may obscure an underlying neoplasm Ž Pleural effusion should make you suspicious of underlying malignancy Ž ECG Ž May show changes suggestive of PE (see p.

Every 15 minutes) until patient is stable Ž Gain IV access and take bloods for investigation as detailed below Ž Consider IV fluid boluses if the patient is haemodynamically unstable (see p. g. g. g. 5–5 mg by slow IV injection Ž and metoclopramide, 10 mg by IV Ž 12-lead ECG Ž ABG if SpO2 low or any respiratory distress Ž Check temperature—pyrexia may indicate pneumonia (see p. 208–211), pericarditis (see p. 148–151) or SIRS/sepsis (see p. e. cardiovascular, respiratory, gastrointestinal or musculoskeletal.

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