By Jeanmonod, Tomassi, Mayer, Rebecca Jeanmonod MD, Michelle Tomassi MD, Dan Mayer
A case-based publication geared up by means of the pinnacle 10 universal proceedings of sufferers offering to emergency departments. This process permits the reader to benefit the pathophysiology of the key illnesses, and research each one case in a fashion that extra heavily approximates the medical perform of medication; now not understanding which organ method is broken or compromised ahead of studying the sufferer. The situations are in line with actual sufferers and the illnesses are both universal in emergency perform, or are harmful diagnoses to not be overlooked. The case descriptions comprise questions in regards to the patient's presentation and simple information regarding the sickness, illustrating key parts from the historical past, actual, and while priceless ancillary reports that support result in a analysis. each one bankruptcy ends with a move diagram displaying how illnesses of other organ platforms can current with comparable preliminary lawsuits. This booklet is a perfect source for clinical scholars, citizens and trainees in emergency drugs.
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Extra resources for Case Studies in Emergency Medicine
CT imaging with oral contrast is very helpful in these difficult patients. Routine use of preoperative contrast-enhanced CT or MR can decrease the rate of negative surgical exploration from 15% to about 5%. Moreover, a negative CT or MR has a negative predictive value of about 98%, effectively ruling out a diagnosis of acute appendicitis. r Treatment: surgical intervention is the standard of care for acute appendicitis in the United States. Open or laparoscopic appendectomies are basically equivalent in terms of operative time, length of hospital stay, post-operative pain, and time to return to work.
He has no splenomegaly. r Extremities and skin: he has no peripheral edema. Other than the changes secondary to acne, his skin has no lesions. r Genital exam: the patient has normal-size testicles without tumors, a normal penis without discharge, and no inguinal adenopathy. His rectal exam is unremarkable. r Neurologic exam: he is alert and oriented, without any focal deficits. The patient’s reflexes are normal bilaterally. His gait is normal. 8, with a normal differential except for 10% eosinophils.
The patient’s legs are of equal size, with no palpable cords. Neurologic: the patient’s cranial nerves II–XII are grossly intact. He has 5/5 strength and reflexes are 2+ in the upper and lower extremities. Pertinent abnormal labs: the patient has a mildly elevated white count at 12 000, but without left shift. His chemistry profile is significant for hypochloremia at 97 and a low bicarbonate at 18. Radiographs: the patient’s chest X-ray is unremarkable, with no free air below the diaphragm. His flat and upright abdominal films show distended loops of small bowel, no free air in the biliary tree, no air fluid levels, and no large bowel distension.