Medicina d’Emergenza Diagnosi e trattamento
Brown A.F.T., Cadogan M.D.
La quinta edizione di questo manuale, un vero successo internazionale, è stata completamente aggiornata ed ampliata, con l’intento di includere le più recenti linee guida basate sull’evidenza in medicina di urgenza e di emergenza. Il testo segue un approccio standard, chiaro e ben organizzato, concepito per esaltare la [...]
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Congratulations to Anthony (Tony) F T Brown on his new appointment as the first Professor of Emergency Medicine at the University of Queensland, School of Medicine. Professor Brown shares his evidence based critical care lecture series with the wider medical community through this blog.
Prof Anthony F.T. Brown (MB ChB, FRCP, FRCS(Ed), FACEM, FCEM) is a senior [...]
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AFTB lecture notes - Acute Pulmonary Oedema (APO)
DIAGNOSIS
Acute heart failure syndrome (AHFS) spectrum can be divided for therapeutic management into:
Dyspnoea + /- congestion with elevated systolic blood pressure (SBP) >140 mmHg, usually with abrupt onset APO (most frequent type)
Dyspnoea + /- congestion with normal SBP 100-140 mmHg, usually with [...]
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AFTB lecture notes - Aortic Dissection
EPIDEMIOLOGY
Incidence: 3 cases per 100 000 people per year; up to 25% missed diagnosis ante-mortem. ‘Typical’ case 60-80 years old M>F. Overall in-hospital mortality 27%.
Risk factors:
Inherited disease (especially younger patients < 40 yrs) - Marfan’s syndrome (fibrillin gene mutations), Ehlers-Danlos syndrome type IV (collagen defects), Turner syndrome, annulo- [...]
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AFTB lecture notes - Venous Thromboembolism
AETIOLOGY: Venous Thromboembolism
Acute provoking risk factors: hospitalisation, surgery, trauma or fracture of lower limbs or pelvis, immobilisation incl plaster cast, long haul travel, recent oestrogen therapy in last 2 weeks, IV device such as cannula.
Chronic predisposing factors: Inherited: Protein C, S, antithrombin III [...]
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RISK STRATIFICATION OF PATIENTS WITH SUSPECTED AMI
Less than 30% patients currently admitted to CCU have final diagnosis AMI. Conversely 2-5% AMI patients are inadvertently sent home, accounting for 25% of all emergency care malpractice dollars awarded in litigation.
Twenty-five percent AMI patients have atypical symptoms and signs, 50% an initial non-diagnostic ECG. EDs +/- chest pain [...]
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EMERGENCY DEPARTMENT / EARLY MANAGEMENT STEMI or NSTEACS
Targeted clinical examination and 12-lead ECG within 10 minutes.
Oxygen, aspirin 75-325 mg orally (odds reduction in vascular events of 46%), nitrates S/L or IV (unless SBP < 90 mmHg, bradycardia < 50), and adequate parenteral analgesia for everyone.
Reperfusion strategy, for ST elevation or LBBB on ECG presenting within [...]
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AFTB lecture notes - Acute asthma
CLINICAL RECOGNITION OF SEVERE OR CRITICAL ASTHMA
Severe asthma indicated by any one of (admit every patient with severe):
PEFR (or FEVI) >33≤50% predicted or best, or < 100 L/min (or I L for FEVI).
Unable to complete sentences in one breath.
Respiratory Rate ≥ 25 / min.
Pulse > 120 / min (≥110 / min [...]
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CARDIOPULMONARY RESUSCITATION (CPR)
LATEST GUIDELINES
International Liaison Committee on Resuscitation (ILCOR). 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiac Care Science with Treatment Recommendations. Resuscitation 2005; 67: 157-342. [Reference]
European Resuscitation Council Guidelines for Resuscitation 2005. Adult, paediatric and neonatal resuscitation, and much more (see later). Resuscitation 2005; 67 (Suppl 1):S1-S190. [
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COMMUNITY ACQUIRED PNEUMONIA - ADULTS (CAP)
• Risk factors for CAP include:
Age over 50 years, asthma, smoking, pre-existing COPD, DM, CRF, CCF, alcoholism, liver disease, neoplasia, stroke, seizures, aspiration, immunosuppression, institutionalisation, indigenous.
Johnson P, Irving L et al. Community-acquired pneumonia. MJA 2002; 176:341-347 [Reference]
• Most common organism is Strep pneumoniae + most severe illness and deaths. Also Mycoplasma pneumoniae, [...]
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