Download e-book for iPad: Acute Medicine: Clinical Cases Uncovered by Chris Roseveare

By Chris Roseveare

ISBN-10: 1405168838

ISBN-13: 9781405168830

Acute drugs is the principal a part of origin and professional basic clinical education and is among the so much quickly increasing united kingdom medical institution specialties.

Acute drugs: medical circumstances Uncovered combines sufferer instances and results, drawn from real-life stories, almost about the curriculum for education typically (Acute) medication. It presents self-assessment MCQs, EMQs and SAQs to provide clinical scholars, junior medical professionals, nurses and allied healthcare pros the correct guidance for all times at the wards.

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127) enables a more detailed assessment of conscious level and should be used for any patient who scores ‘V’ or worse on the AVPU score What is the significance of reduced conscious level in the acute setting? • Reduced conscious level may result in impairment of the natural protective reflexes for the airway (coughing/choking) 37 and therefore requires medical measures to prevent aspiration of secretions or vomit into the lung. It is generally considered that this is more likely when the GCS is <8 • Reduced conscious level may reduce the effectiveness of breathing • The cause of the reduced consciousness may be relevant to the underlying process leading to the patient’s admission.

The heart rate calculation can be more difficult when the rhythm is irregular. In this case: • Count out 30 big squares (equivalent to 6 s of ECG time) • Count the number of R-waves within this period • Multiply by 10 to give the rate per minute See Fig. 4. 62 Figure 4 An ECG showing an irregular tachycardia, recorded at 25 mm/second. By counting up 30 big squares (6 s) and then counting the number of QRS complexes in this time period, the heart rate can be calculated: in this case the rate is 190 beats/min.

G. tricuspid/ pulmonary valves) or expiration (mitral or aortic valve lesions) 50 5 The chest • Percuss anteriorly and posteriorly over the chest wall, checking for areas of dullness • Auscultate both anteriorly and posteriorly, asking the patient to breathe slowly through their mouth • If crackles are heard, ask the patient to cough and then re-auscultate to see whether the crackles are reduced (when caused by secretions within the airways) or unchanged (suggestive of interstitial fibrosis, consolidation or pulmonary oedema) 6 The abdomen • Inspect for scars and obvious abnormalities • Check that the patient has no areas of tenderness (if so approach these with caution, asking the patient to tell you if you inflict significant discomfort) • Palpate gently over all quadrants of the abdomen, then more deeply to feel for masses • Next palpate specifically for the liver, pressing initially in the right lower quadrant and asking the patient to breathe in, while slowly moving the hand towards the chest • The spleen is palpated similarly, moving the hand from the right lower quadrant to the left upper quadrant as the patient breathes 51 • Enlargements of kidneys may be apparent by pressing deeply in the flanks with one hand while using the other hand to press from behind (balloting the kidney) • Percuss in the flanks for evidence of dullness: if present, rotate the patient away from you to see if it ‘shifts’ (ascites) • External genitalia should normally be inspected • Rectal examination should be considered for most patients, although this is not always indicated 7 Neurological system • Check tone, power, coordination and all reflexes • Check sensation in each dermatomal area (usually light touch only, unless symptoms suggest a problem that may need to be assessed in more detail) • Examine cranial nerves (including papillary responses) • Examine fundi using ophthalmoscope 8 Legs, feet and locomotor system • Ensure that the patient’s legs have been uncovered and inspected for evidence of erythema, warmth, tenderness and swelling • Check for asymmetry (measure calf circumference if any doubt) 52 • Check for ulcers or pressure sores • Check for peripheral oedema around ankles and sacral area • Check peripheral pulses (dorsalis pedis and posterior tibial – if not palpable always feel for popliteal and femoral pulses) • Carefully inspect any joints which the patient has described as painful, or which appear swollen or de-formed: look, feel and move, taking care not to cause pain if the joint is inflamed or appears abnormal 9 Remember urinalysis • Bedside analysis of urine should be considered part of any clinical examination Blood tests: which, when and why?

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Acute Medicine: Clinical Cases Uncovered by Chris Roseveare

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