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The third version of this vintage textual content is streamlined and taken with the desires of the operating severe care health professional and lines very important new therapy concepts. geared up by way of organ structures, this article, the one serious care resource that incorporates evidence-based studying, courses physicians from preliminary sufferer evaluation and differential prognosis via healing plan.
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Extra resources for Acute medicine
This man is desperately ill and may die soon. General supportive measures • High-flow oxygen and respiratory support with the aim of maximising oxygen delivery. Use of continuous positive airway pressure may decrease intubation rates, but no decrease in mortality has yet been shown. Consider intubation if there is acute respiratory failure which is not responding to medical treatment. 5 mg iv, with antiemetic). • Fluids: the hypotensive hypoxic patient with bilateral crackles will not respond well to a fluid challenge, but give a cautious fluid bolus (250 mL) if hypotensive with a clear chest, even with a raised JVP.
2, but otherwise concentrate on the following. • What is she wearing? This may have some relevance as to at what time the collapse occurred. • Signs of injury: in particular look at the pressure areas for signs that she has been immobile for a period. Specifically consider whether she has a fractured hip by looking for a short, externally rotated leg. • Temperature: is she hypothermic? Use a low-reading thermometer and take a rectal temperature. • Cardiovascular: check heart rate and rhythm, peripheral perfusion and BP.
Introduction ‘Collapse of unknown cause’ is one of the commonest and yet one of the most difficult differential diagnoses in acute medicine. The case described here is typical: an elderly person has fallen to the floor, perhaps injuring themselves in the process, and sorting out what has happened and why is problematic because (i) the patient is often unable to give a clear account, (ii) there is a wide differential diagnosis of syncope (Table 2) and (iii) the ‘collapse’ may not have a single cause – the blame may be attributable to the combination of a loose carpet, poor vision, an arthritic knee and recent introduction of antihypertensive therapy.
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