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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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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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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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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