By Chris Roseveare

Acute medication is the significant a part of beginning and expert basic scientific education and is among the so much speedily increasing united kingdom clinic specialties.

Acute medication: medical situations Uncovered combines sufferer circumstances and results, drawn from real-life reviews, near to the curriculum for education regularly (Acute) drugs. It offers self-assessment MCQs, EMQs and SAQs to offer scientific scholars, junior medical professionals, nurses and allied healthcare pros definitely the right instruction for all times at the wards.

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60 • Confirm that the name on the ECG relates to the patient being assessed • Take note of the date and time that the ECG was taken • Confirm the ‘print rate’ of the ECG (usually 25 mm/second) – see Fig. g. ‘complaining of chest pain’, ‘short of breath’, ‘after treatment’, etc. Is there an abnormality of rate or rhythm? Information about heart rate and rhythm can be obtained from a number of sources. • A 12-lead ECG (usually includes a ‘rhythm strip’ at the bottom of the page) • A single lead ‘rhythm strip’ printout • By observing a cardiac monitor connected to the patient • By palpating the patient’s pulse • By auscultating the heart or palpating the apex beat Although this section deals predominantly with the interpretation of the ECG in isolation, it should never be forgotten that findings should always be confirmed by clinical assessment.

If 42 the symptom was brought on by exertion, change of posture, eating, sudden movement or trauma, this may help to define the cause. ’ may be as helpful as establishing what brought it on. Relief following rest may reinforce the likelihood of the cause being exertional; specific drug remedies such as an antacid in the case of gastro-oesophageal reflux or glyceryl trinitrate in the case of angina may also help to define a cause. Table 4 Conditions associated with symptoms of truly ‘sudden’ onset Symptom Causes sudden onset of Comments Cardiac-type chest Aortic dissecting Often described as ‘tearing’ or pain aneurysm ‘ripping’; usually radiates to the back ‘Cardiac’ chest pain from myocardial infarction or angina usually builds over a few minutes 43 Pleuritic pain chest Pneumothorax Nerve entrapment/ muscular strain Breathlessness Pleuritic chest pain caused by pulmonary embolism usually starts more gradually Pulmonary embolism Pneumothorax Bronchospasm Airway obstruction Hyperventilation Cardiac arrhythmia Headache Unilateral weakness Subarachnoid haemorrhage ‘Thunderclap’ migraine Stroke 44 Usually worst at onset – symptoms can evolve over a few hours Table 5 illustrates how questioning around this area can be helpful in the case of a patient with cardiac-type chest pain.

Untreated, this will rapidly lead to cardiopulmonary arrest. 30 Airway obstruction requires immediate treatment; senior or anaesthetic assistance is likely to be required. Consider the questions below. Is the airway obstructed? • Listen (without a stethoscope) to the breath sounds: complete obstruction will result in the absence of breath sounds at the mouth or nose; partial obstruction results in harsh or gurgling inspiratory sounds • Look at the chest/abdominal wall – complete obstruction may result in paradoxical ‘see-saw’ movements of the chest and abdomen Why is the airway obstructed?

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