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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MYOCARDIAL INFARCTION / ACUTE CORONARY SYNDROMES (ACS) - Part I
EPIDEMIOLOGY
Over 32,000 deaths per year in Australia: largest single cause.
50% reduction age-adjusted mortality (by risk-factor modification) since 1960, still falling now, but those with chronic CAD are increasing commensurately.
Still 60-70% die prehospital (this proportion unchanged) - thus overall 28-day mortality has improved little, compared with reduced [...]
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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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Posted in AFTB lecture, CT, education, elearning, emergency medicine, evidence based medicine, lecture, neurology, radiology, review on Oct 27th, 2008
ACUTE STROKE
EPIDEMIOLOGY
Stroke is the third commonest cause of death (11%), and the commonest cause of adult disability in western world.
80-85% are ischaemic (thrombotic or embolic) and 15-20% the more lethal haemorrhagic stroke, of which over 50% will die.
ACTIVE MANAGEMENT
Early CT scan
Ideally within 1 hour ED arrival, if any of: indications for lysis or early anticoagulation; [...]
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STATUS EPILEPTICUS (SE)
DEFINITION
Synonyms: overt, geneneralised tonic-clinic, major motor SE
Defined as a seizure lasting over 5 mins, or two or more seizures without recovery in between.
AETIOLOGY (ADULTS)
Idiopathic (24-38%).
If known epileptic, inadequate/ceased medication most common single cause.
Remote symptomatic (3-17%) - eg. prior CVA, head injury or cerebral palsy.
Progressive encephalopathy (5-15%) - eg. progressive neurological [...]
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SUBARACHNOID HEMORRHAGE
EPIDEMIOLOGY
5% of all acute strokes. Case fatality rate 50% overall (10-15% pre-hospital), up to 50% survivors residual disability and 50% ‘good’ outcomes have neuropsychological and cognitive impairment.
Initially misdiagnosed in 12-50% as ‘migraine’ or ‘tension-headache’, as headache can abate or disappear. Up to 15% re-bleed early, and 40% in next 4 weeks.
CLINICAL FEATURES
Sudden, instantaneous onset, [...]
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MENINGOCOCCAL DISEASE: ‘MENINGOCOCCAEMIA’.
Epidemiology:
Potentially pathogenic meningococci present in 2-10% asymptomatic carriers. Droplet / oropharyngeal secretion spread (viability in air only a few seconds).
Developed-world: disease predominantly serogroups B, C, Y, W135 (in Australia 62% is B, 32% C but over 60% deaths are group C).
Developing-world: predominantly serogroup A.
Increased risk in smokers, recent illness, crowded conditions and multiple [...]
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ADULT BACTERIAL MENINGITIS
Presentation (%)
Fever (75-85%), headache (87%), objective neck stiffness or meningismus (70-83%), signs of cerebral dysfunction such as confusion (69%), delirium or declining consciousness. Triad of fever, neck stiffness and altered mental status in 44%; but at least two of possible tetrad of headache, fever, neck stiffness and altered mental status occur in 95%.
Vomiting [...]
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HEADACHE
Life-threatening Causes:
Meningitis
Subarachnoid Hemorrhage
Space Occupying Lesion
Hypertensive Encephalopathy
Temporal Arteritis
Pre-eclampsia
Common causes of headache
Migraine: common or classical
Tension headache
Post-traumatic headache
Disease in other cranial structures
E.g. glaucoma, iritis, sinusitis, otitis, TMJ dysfunction
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