Acute medicine by Coll. PDF

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CT scan of the brain. • Blood (and other) cultures depending on clinical suspicion. • Arterial blood gases if patient very unwell. Management Any clear cause of bradycardia or complication of the collapse should be treated on its merits. However, if the diagnosis is simply ‘heart block’ with no obvious precipitant that can be removed, then management should depend on the state of the patient: If the patient is well Some patients can tolerate complete heart block at a pulse rate of 30 bpm if their left ventricular function is good.

However, fever and radiographic consolidation can be a feature of pulmonary infarction. • Musculoskeletal pain: this can be difficult to differentiate. If the diagnosis is unclear, anticoagulate until PE is excluded. • Less common and rare conditions: pain indistinguishable from pleurisy AM_C01 12/15/10 10:16 Page 37 ACUTE MEDICINE: PACES STATIONS AND ACUTE SCENARIOS can be due to shingles (herpes zoster) and pleurisy can be the presenting symptom of systemic lupus erythematosus, in which case check the relevant serology (antinuclear factor and DNA binding) and be particularly suspicious if pleurisy is recurrent.

Additional consideration should be given to: • 24-hour ambulatory ECG, which will be required if cardiac syncope is suspected (it will not be evident on the resting ECG); • postural testing on a tilt table. Management Management will depend on the precise diagnosis. • Education: to avoid trigger events, recognise the onset symptoms and teach manoeuvres to abort episodes. breathlessness and cough. You are asked to assess her: is the • Although the presumption is that the problem is due to an attack of asthma, are there any features that are unusual?

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Acute medicine by Coll.


by Mark
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