text.skipToContent text.skipToNavigation
background-image

Rapid Emergency and Unscheduled Care von Phipps, Oliver (eBook)

  • Erscheinungsdatum: 25.02.2016
  • Verlag: Wiley-Blackwell
eBook (ePUB)
22,99 €
inkl. gesetzl. MwSt.
Sofort per Download lieferbar

Online verfügbar

Rapid Emergency and Unscheduled Care

Cardiovascular

Abdominal aortic aneurysm

Definition

An abdominal aortic aneurysm (AAA) is defined as an enlargement of the aorta by at least 1.5 times its normal diameter. The normal diameter of the aorta is ~2cm and increases with age. Most AAA are small and not dangerous; however when they increase in size, they are prone to rupture causing a life-threatening condition.
Epidemiology

It is estimated that in 95% of patients, AAA is a complication of atherosclerosis. Risk factors include being male, hypertension, increasing age, smoking and a family history of AAA.
History

Asymptomatic and often detected on routine abdominal imaging or NHS screening programme.
Patient may feel pulsatile mass in abdomen.
Backache.
Aching pain in the epigastrium and central abdomen to the back.
In rupture the patient will have severe abdominal pain, often epigastric and radiating to the back.
May be accompanied by collapse.
Symptoms can be similar to renal colic. Examination

The patient should be assessed using the ABCDE approach with appropriate step interventions. Specific points to increase the likely diagnosis of a ruptured AAA include:

Signs of shock
Abdominal tenderness and guarding
Palpable abdominal mass - often pulsatile
Weak or absent lower limb pulses Investigations

Bloods:

FBC
U&Es
LFTs
Clotting screen
Cross-match
Arterial blood gas
ECG
CXR and AXR
CT abdomen
FAST ultrasound scan Management

Transfer direct to the emergency department (ED) with pre-alert.
ABCDE approach.
Oxygen (set SpO2 target).
IV access×2.
Cautious IV fluid resuscitation to maintain blood pressure (systolic~90mmHg or radial pulse presence), ideally with blood products.
Analgesia.
Early discussion with appropriate surgeons.
Prepare for theatre. Acute coronary syndrome

Definition

Acute coronary syndrome (ACS) is an umbrella term that encompasses:

Unstable angina
Non-ST segment elevation myocardial infarction (NSTEMI)
ST segment elevation myocardial infarction (STEMI) Aetiology

ACS is commonly caused by rupture of an atheromatous plaque in a coronary artery. This results in the accumulation of fibrin and platelets to repair the damage. This results in a thrombus formation leading to partial or complete occlusion of the coronary artery and distal myocardial cell death.
Epidemiology

Around 114000 patients with ACSs are admitted to the hospital each year in the United Kingdom. Coronary heart disease (CHD) is the most common cause of death in the United Kingdom with around one in five men and one in seven women dying each year from CHD.
History

Consider the history of chest pain or discomfort.
Cardiovascular (CVS) risk factors.
Family history of CHD.
History of CHD, previous treatment and investigations:
Pain or discomfort in the chest and/or the arms, back or jaw lasting longer than 15minutes
Chest pain with nausea and vomiting, sweating and/or breathlessness
Abrupt deterioration in stable angina, with recurring chest pain discomfort occurring more frequently with little or no exertion and often lasting longer than 15minutes. Examination

Clinical examination is often of little value in diagnosing ACS.
It can identify alternative causes of chest pain (localised tenderness).
Look for evidence of the aforementioned symptoms (sweat

Produktinformationen

    Format: ePUB
    Kopierschutz: AdobeDRM
    Seitenzahl: 216
    Erscheinungsdatum: 25.02.2016
    Sprache: Englisch
    ISBN: 9781119035879
    Verlag: Wiley-Blackwell
    Serie: Rapid
    Größe: 2499 kBytes
Weiterlesen weniger lesen

Rapid Emergency and Unscheduled Care

Cardiovascular

Abdominal aortic aneurysm

Definition

An abdominal aortic aneurysm (AAA) is defined as an enlargement of the aorta by at least 1.5 times its normal diameter. The normal diameter of the aorta is ~2cm and increases with age. Most AAA are small and not dangerous; however when they increase in size, they are prone to rupture causing a life-threatening condition.
Epidemiology

It is estimated that in 95% of patients, AAA is a complication of atherosclerosis. Risk factors include being male, hypertension, increasing age, smoking and a family history of AAA.
History

Asymptomatic and often detected on routine abdominal imaging or NHS screening programme.
Patient may feel pulsatile mass in abdomen.
Backache.
Aching pain in the epigastrium and central abdomen to the back.
In rupture the patient will have severe abdominal pain, often epigastric and radiating to the back.
May be accompanied by collapse.
Symptoms can be similar to renal colic. Examination

The patient should be assessed using the ABCDE approach with appropriate step interventions. Specific points to increase the likely diagnosis of a ruptured AAA include:

Signs of shock
Abdominal tenderness and guarding
Palpable abdominal mass - often pulsatile
Weak or absent lower limb pulses Investigations

Bloods:

FBC
U&Es
LFTs
Clotting screen
Cross-match
Arterial blood gas
ECG
CXR and AXR
CT abdomen
FAST ultrasound scan Management

Transfer direct to the emergency department (ED) with pre-alert.
ABCDE approach.
Oxygen (set SpO2 target).
IV access×2.
Cautious IV fluid resuscitation to maintain blood pressure (systolic~90mmHg or radial pulse presence), ideally with blood products.
Analgesia.
Early discussion with appropriate surgeons.
Prepare for theatre. Acute coronary syndrome

Definition

Acute coronary syndrome (ACS) is an umbrella term that encompasses:

Unstable angina
Non-ST segment elevation myocardial infarction (NSTEMI)
ST segment elevation myocardial infarction (STEMI) Aetiology

ACS is commonly caused by rupture of an atheromatous plaque in a coronary artery. This results in the accumulation of fibrin and platelets to repair the damage. This results in a thrombus formation leading to partial or complete occlusion of the coronary artery and distal myocardial cell death.
Epidemiology

Around 114000 patients with ACSs are admitted to the hospital each year in the United Kingdom. Coronary heart disease (CHD) is the most common cause of death in the United Kingdom with around one in five men and one in seven women dying each year from CHD.
History

Consider the history of chest pain or discomfort.
Cardiovascular (CVS) risk factors.
Family history of CHD.
History of CHD, previous treatment and investigations:
Pain or discomfort in the chest and/or the arms, back or jaw lasting longer than 15minutes
Chest pain with nausea and vomiting, sweating and/or breathlessness
Abrupt deterioration in stable angina, with recurring chest pain discomfort occurring more frequently with little or no exertion and often lasting longer than 15minutes. Examination

Clinical examination is often of little value in diagnosing ACS.
It can identify alternative causes of chest pain (localised tenderness).
Look for evidence of the aforementioned symptoms (sweat

Weiterlesen weniger lesen

Kundenbewertungen