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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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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SPONTANEOUS PNEUMOTHORAX
CLINICAL APPRAISAL
Determine the following three criteria concerning the diagnosis of a spontaneous pneumothorax. Use an inspiratory CXR (PA, or lateral, if PA is normal and suspicion high). Expiratory CXRs are no longer recommended:
Chronic lung disease (CLD) ?: cystic, fibrotic, bullous or emphysematous lung disease. Patient will be admitted overnight irrespective of treatment.
Degree of collapse [...]
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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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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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