Download ABC en emergencias by Alberto J. Machado PDF

By Alberto J. Machado

ABC en emergencias fue pensado como una herramienta de trabajo. Un ayuda memoria, o una guía rápida acerca de cómo enfrentamos, y que puntos relevantes no dejar de considerar, en distintas situaciones frecuentes en Emergencias.

Emergencias es l. a. especialidad médica que estudia los hechos y situaciones patológicas de aparición súbita que ponen en riesgo o comprometen l. a. salud.

En Emergencias el tiempo nos corre, y el momento en que tomamos diferentes conductas, durante los angeles evolución del paciente, inftuye directamente en el pronóstico.

En ninguna otra especialidad, se pone en juego l. a. capacidad de decisión tiempo dependiente.

La acción organizada y sistematizada frente a una emergencia, es l. a. que redundará en mayores beneficios, permitiéndonos valorar que "es" y que "no es" de riesgo very important. Un manejo desorganizado, transforma l. a. situación, que de por sí ya es crítica, en un caos con el perjuicio directo sobre el paciente.

ABC en emergencias es un instructional de consulta rápida, cuando tenemos poco tiempo para consultar.

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G. g. g. g. indd 23 1/31/2009 1:42:24 PM Chapter 4 Thorax Acute breathlessness Diagnosis Background Key symptoms Key signs Additional information Bronchiolitis Usually due to Respiratory Coryzal symptoms Hyperinflated chest Dehydration or respiratory Poor feeding Tachypnoea >50 breaths/min distress warrants an emergency Age <1 yr Shortness of breath Tachycardia >160 bpm admission Common in winter Cough Hyper-resonant chest percussion Syncytial Virus Droplet spread Widespread fine crackles Self-limiting Acute exacerbation of asthma Wheeze Reversible airways obstruction Shortness of breath Tachypnoea Almost daily PEFR variability Chest tightness Tachycardia Nocturnal cough Hyperinflated chest Wheeze worse on waking Widespread polyphonic wheeze ≥20% PEFR improves ≥20% with beta agonist Admit if severe attack Prolonged expiration ± Reduced air entry Precipitated by: Cold air, ± Difficulty completing sentences infection, exercise, emotion, allergens, drugs Acute exacerbation of COPD History of stable COPD Often history of smoking Increasing breathlessness over days Tachypnoea Consider admission if: Hyperinflated chest Severe dehydration Common in winter Chest tightness Cough and sputum (± purulent) Confusion and/or cyanosis Exacerbated by: Infection, Cough and increased sputum Coarse crackles New onset peripheral oedema Reduced exercise tolerance Bilateral wheeze Respiratory distress environmental pollutants ≈30% have no identifiable cause Croup Usually a viral infection Cough Barking cough (Acute laryngotracheitis) Affects larynx and trachea Coryzal symptoms Stridor Commonly children aged 1–3 yrs Noisy breathing Hoarse cry/voice Autumn and spring epidemics Symptoms worse at night ± Intercostal recession Self-limiting ± Shortness of breath ± Tachypnoea Causes: IHD, cardiomyopathy, Breathless on exertion Tachypnoea hypertension, mitral Orthopnoea Tachycardia regurgitation, aortic stenosis, PND Hypotension arrhythmia, PHT, fluid overload, Nocturnal cough Displaced apex alcohol abuse, hyperthyroidism, Weight loss S3 (Gallop rhythm) Paget’s, anaemia Fatigue Bibasal end-inspiratory crackles ± Frothy pink sputum Wheeze (cardiac asthma) ± Haemoptysis ± Cyanosis Acute left ventricular failure Consider admission Generalised anxiety disorder (See Anxiety or Insomnia) Pneumonia (See Cough) Differential Diagnosis in Primary Care, 1st edition.

G. g. femur) bones Age >40 yrs Bowing of tibia, femur and/or forearm M>F Commonly affects spine, skull and long bones ≈1% cases develop sarcoma *Sensorineural hearing loss: Weber’s Test:Tuning fork is louder in the normal ear. Rinne’s test: Air conduction > bone conduction in both ears. g. g. g. g. indd 23 1/31/2009 1:42:24 PM Chapter 4 Thorax Acute breathlessness Diagnosis Background Key symptoms Key signs Additional information Bronchiolitis Usually due to Respiratory Coryzal symptoms Hyperinflated chest Dehydration or respiratory Poor feeding Tachypnoea >50 breaths/min distress warrants an emergency Age <1 yr Shortness of breath Tachycardia >160 bpm admission Common in winter Cough Hyper-resonant chest percussion Syncytial Virus Droplet spread Widespread fine crackles Self-limiting Acute exacerbation of asthma Wheeze Reversible airways obstruction Shortness of breath Tachypnoea Almost daily PEFR variability Chest tightness Tachycardia Nocturnal cough Hyperinflated chest Wheeze worse on waking Widespread polyphonic wheeze ≥20% PEFR improves ≥20% with beta agonist Admit if severe attack Prolonged expiration ± Reduced air entry Precipitated by: Cold air, ± Difficulty completing sentences infection, exercise, emotion, allergens, drugs Acute exacerbation of COPD History of stable COPD Often history of smoking Increasing breathlessness over days Tachypnoea Consider admission if: Hyperinflated chest Severe dehydration Common in winter Chest tightness Cough and sputum (± purulent) Confusion and/or cyanosis Exacerbated by: Infection, Cough and increased sputum Coarse crackles New onset peripheral oedema Reduced exercise tolerance Bilateral wheeze Respiratory distress environmental pollutants ≈30% have no identifiable cause Croup Usually a viral infection Cough Barking cough (Acute laryngotracheitis) Affects larynx and trachea Coryzal symptoms Stridor Commonly children aged 1–3 yrs Noisy breathing Hoarse cry/voice Autumn and spring epidemics Symptoms worse at night ± Intercostal recession Self-limiting ± Shortness of breath ± Tachypnoea Causes: IHD, cardiomyopathy, Breathless on exertion Tachypnoea hypertension, mitral Orthopnoea Tachycardia regurgitation, aortic stenosis, PND Hypotension arrhythmia, PHT, fluid overload, Nocturnal cough Displaced apex alcohol abuse, hyperthyroidism, Weight loss S3 (Gallop rhythm) Paget’s, anaemia Fatigue Bibasal end-inspiratory crackles ± Frothy pink sputum Wheeze (cardiac asthma) ± Haemoptysis ± Cyanosis Acute left ventricular failure Consider admission Generalised anxiety disorder (See Anxiety or Insomnia) Pneumonia (See Cough) Differential Diagnosis in Primary Care, 1st edition.

G. g. g. g. g. g. g. g. g. g. g. g. g. g. g. g. epistaxis) Moves on inspiration Dull to percussion Abdominal aortic aneurysm (AAA) Weakness of the infra-renal aortic wall Causes irreversible vessel Often asymptomatic or Vague abdominal or back pain Upper abdominal pulsation Expansile pulsatile mass above umbilicus ± Bruit Severe lumbar pain may indicate a leaking or dissecting aneurysm ± Weak/absent peripheral pulses dilatation Age 40–70 yrs M>F Risk factors include: Family history, smoking, hypertension, increasing age, PVD Aneursyms >5 cm diameter are high risk Gastric Carcinoma (See Upper Abdominal Pain) Intussusception Invagination of bowel segment into adjacent distal segment Usually affects ileo-caecal segment Acute onset Sausage-shaped abdominal mass Severe colicky abdominal pain “Redcurrant jelly” stools Emergency paediatric referral Intermittent every 10–15 min May appear well between attacks Causes bowel obstruction Inconsolable screaming epsiodes Commonly 3 months to 2 yrs age Vomiting Often idiopathic Pyloric stenosis Diffuse hypertrophy and hyperplasia of the pylorus and antrum Recurrent projectile vomiting Dehydration Vomitus contains undigested Lethargy gastric carcinoma should be Visible stomach peristalsis excluded food Commonly infants 2–8 wks old Persistent hunger M>F Weight loss Persistent vomiting causes Infrequent or absent bowel hypokalaemia and Symptoms in adults are rare and Palpable “olive” mass in RUQ or epigastrum movement hypochloraemic alkalosis Differential Diagnosis in Primary Care, 1st edition.

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