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Cough fracture

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182. Principles of Control of Bleeding for First Aiders

or chest, as well as fractures. Severe bleeding may also occur from complications of pregnancy. Symptoms and signs may include: • pain, tenderness or swelling over or around the affected area • the appearance of blood from a body opening, e.g.: o bright red and/or frothy blood coughed up from the lungs o vomited blood which may appear bright red or as dark brown "coffee grounds" o blood-stained urine o vaginal bleeding or bleeding from the penis o rectal bleeding which may be bright red or black

2016 Australian Resuscitation Council

183. Chronic obstructive pulmonary disease: fluticasone furoate plus vilanterol

exacerbations, but not exacerbations requiring admission to hospital, compared with vilanterol 25 micrograms alone. Fluticasone furoate/vilanterol 100/ 25 micrograms improved trough FEV 1 after 24 weeks' treatment compared with placebo but not compared with vilanterol alone. Safety Safety No statistical analysis of safety data from studies is available. Local corticosteroid effects, pneumonia (including requiring admission to hospital) and non-traumatic fractures were seen more frequently with fluticasone (...) . An additional study (Martinez et al. 2013) had the same design as that by Kerwin et al. (2013), but for methodological reasons, statistical analysis of the results for fluticasone furoate/vilanterol 100/ 25 micrograms could not be performed. Statistical analysis of safety data was not presented in any of the studies included in this review, which limits the conclusions that can be drawn. Local corticosteroid effects, pneumonia (including pneumonia requiring admission to hospital) and non-traumatic fractures

2013 National Institute for Health and Clinical Excellence - Advice

184. Newborn Nursing Care Pathway

: • Symmetry • Shape • Respirations • Heart rate • Cardiovascular function Assess mother’s/ family/ supports understanding of newborn physiology and capacity to identify variances that may require further assessments Norm and Normal Variations • Circumference about 1cm 12 – 24 hr Variance • Mucousy / noisy respirations • Signs of respiratory distress Retractions Grunting Nasal flaring Tachypnea • Deviation in chest shape • Fractured clavicle • Asymmetrical movement • Breasts inflamed • Supernumerary (...) nipples • Coughing Intervention • Nursing assessment • Refer to appropriate PHCP prn Norm and Normal Variations • Refer to POS Parent education/ Anticipatory Guidance • Normal newborn breathing • Hiccoughs resolve on own • Occasional sneezing is infant’s mechanism to clear nasal passages • Do not squeeze swollen breasts – they are due to maternal hormones Variance • Refer to POS Intervention • Refer to POS Norm and Normal Variations • Refer to POS Parent education/ Anticipatory Guidance • Refer to >12

2015 British Columbia Perinatal Health Program

185. Diabetes - type 2

cancer following FDA review [ ]. The adverse effects section for pioglitazone has been updated with information that bone fractures have been reported in both men and women [ ]. Information from a systematic review has been added to the basis for recommendation in the section on managing cardiovascular risk [ ]. The adverse effects and interactions sections have been updated to reflect changes to the manufacturer's Summary of Product Characteristics for vildagliptin [ ]. November 2016 — minor update (...) on fitness to drive from the DVLA's At a glance guide to the current medical standards of fitness to drive . A tabulated version of the treatment recommendations for blood glucose control, to aid navigation. August 2011 — minor update. There is a small increased risk of bladder cancer associated with pioglitazone use. This information is based on advice from the MHRA and the EMA. Issued in September 2011. July 2011 — minor update. Cough is included as a very rare but possible adverse effect

2019 NICE Clinical Knowledge Summaries

186. Hypercalcaemia

of in the UK, and chronic hypercalcaemia is usually asymptomatic. Consider a diagnosis of hypercalcaemia if: There is an incidental finding of a corrected serum calcium concentration of 2.6 mmol/L or higher on blood testing. There are suggestive clinical features (which are often non-specific and relate to the severity and rate of onset of hypercalcaemia): Skeletal Bone pain, skeletal deformities. Osteoporosis, fractures associated with underlying bone disorders (fragility fractures in hyperparathyroidism (...) , or pathological fractures in malignancy). See the CKS topic on for more information. Neuromuscular and neuropsychiatric Drowsiness, delirium, coma. See the CKS topic on for more information. Fatigue, lethargy, muscle weakness, insomnia. See the CKS topics on and for more information. Impaired concentration and memory, confusion. See the CKS topic on for more information. Depression, anxiety, irritability, psychosis. See the CKS topics on , , and for more information. Neurological signs (for example upper

2019 NICE Clinical Knowledge Summaries

187. Meningitis - bacterial meningitis and meningococcal disease

countries is estimated to be 2–5 per 100,000 population. It is one of the top 10 causes of infection-related death worldwide, with 30–50% of survivors experiencing permanent neurological sequelae. Clinical features of acute bacterial meningitis include: Non-specific symptoms: fever, nausea and vomiting, lethargy, irritable or unsettled mood, refusal of food and drink, headache, muscle ache or joint pain, and respiratory symptoms such as a cough. More specific symptoms and signs: stiff neck, altered (...) in overcrowded households or in military barracks. Further risk factors for pneumococcal disease include [ ; ] : Basal skull fractures with leakage of cerebrospinal fluid, cochlear implants, otitis media, sinusitis, and sickle cell disease . Complications What are the complications of bacterial meningitis? Acute bacterial meningitis is one of the top 10 causes of infection-related death worldwide, with 30–50% of survivors experiencing permanent neurological sequelae [ ]. Although overall mortality from acute

2019 NICE Clinical Knowledge Summaries

188. Cerebral palsy

, spontaneous general movements of the neck, trunk, and limbs in all directions. These movements are continual except during focused attention, or if the child is unsettled or crying, and are best seen in the reclined or supine position. Absent or abnormal fidgety movements (exaggerated amplitude, speed, or jerkiness) can be indicative of CP. Be aware that in some children, features of CP such as feeding difficulties (suggested by poor weight gain, coughing and choking while eating, and long mealtimes) may (...) , drinking, and swallowing — the child or young person should be referred to a specialist with training in assessing and treating dysphagia if there are clinical concerns about: Coughing, choking, gagging, altered breathing pattern or change in colour while eating or drinking. Recurrent chest infection. Mealtimes regularly being stressful or distressing for the child or young person or their parents or carers. Prolonged meal duration. Concerns about speech, language and communication — during routine

2019 NICE Clinical Knowledge Summaries

189. Polymyalgia rheumatica

throat, and dry cough. Chronic osteomyelitis — variable pain and disability and possible evidence of soft tissue swelling and bony tenderness. Systemic features (such as weight loss and malaise) are common. Tuberculosis — variable presentation but may include malaise, night sweats, fever, and weight loss. For more information, see the CKS topic on . Infective endocarditis — night sweats, anorexia, weight loss, splinter haemorrhages, Osler nodes, finger clubbing, and splenomegaly. Inflammatory (...) causing relapse. Corticosteroids are required for more than 2 years. The person is experiencing (or is at high risk of) adverse effects from corticosteroids. Assess and manage osteoporotic fracture risk. For more information see the CKS topic on . Basis for recommendation Basis for recommendation These recommendations are based on the British Society for Rheumatology (BSR) and British Health Professionals in Rheumatology (BHPR) guidelines for the management of polymyalgia rheumatica (PMR

2019 NICE Clinical Knowledge Summaries

190. Pulmonary embolism

, which is associated with considerable morbidity and mortality. PE should be suspected in people with one or more of the following (especially if there are risk factors for PE): Dyspnoea, chest pain, cough, haemoptysis, features of DVT (including leg pain and swelling [usually unilateral], lower abdominal pain, redness, increased temperature, and venous distension), dizziness, and syncope. Tachypnoea or tachycardia, hypoxia, pyrexia, elevated jugular venous pressure, gallop rhythm, pleural rub (...) progress to shock or death due to acute right ventricular failure. The deep veins of the lower limbs are most commonly affected, but thrombosis may affect other sites, including the upper limbs, cerebral veins, and splanchnic veins [ ; ; ; ]. Non-thrombotic sources of emboli include [ ; ] : Tumours — most commonly prostate and breast cancers. Fat — from long-bone fractures. Amniotic fluid in pregnant women. Sepsis — for example, tricuspid valve endocarditis in people who inject illicit drugs

2019 NICE Clinical Knowledge Summaries

191. Leg ulcer - venous

. History of leg fracture or trauma. Sedentary lifestyle. Prolonged standing. Prevalence How common is it? Venous leg ulcers are the most common type of leg ulcers, accounting for 60–80% of cases [ ; ] . The estimated prevalence in the UK is between 0.1–0.3% [ ], and this increases with age. The prevalence is predicted to increase dramatically because people are living longer, often with multiple comorbidities [ ]. The estimated lifetime risk of developing a venous leg ulcer is 1% [ ; ]. Venous leg

2019 NICE Clinical Knowledge Summaries

192. Drugs to avoid in 2015

disorders, hyperoxaluria, and bone fractures in adolescents. Orlistat alters the gastroin- testinal absorption of many nutrients (fat-soluble vitamins A, D, E and K), leading to a risk of deficiency, and also reduces the efficacy of some drugs (thy- roid hormones, some antiepileptics). Oral contraceptive efficacy can be reduced if orlistat provokes severe diarrhoea (Prescrire Int n° 57, 71, 107, 110, Rev Prescrire n° 374). There are currently no drugs capable of inducing permanent weight loss (...) efficacy in the prevention of osteoporotic fractures and no efficacy for “bone loss” during prostate cancer, and carries a disproportionate risk of adverse effects, including back pain, mus- culoskeletal pain, and serious infections (including endocarditis) due to the immunosuppressive effects of this monoclonal antibody (Prescrire Int n° 117 and 130)(a). – Strontium ranelate has only modest effi- cacy in preventing recurrent vertebral fractures. Yet its adverse effects include neuropsychiatric

2015 Prescrire

194. Acute pain management: scientific evidence (3rd Edition)

tool chosen should be appropriate to the individual patient; developmental, cognitive, emotional, language and cultural factors should be considered (U). ? Scoring should incorporate different components of pain including the functional capacity of the patient. In the postoperative patient this should include static (rest) and dynamic (eg pain on sitting, coughing) pain ( U). ? Uncontrolled or unexpected pain requires a reassessment of the diagnosis and consideration of alternative causes

2015 National Health and Medical Research Council

195. Managing menopausal symptoms after breast cancer - a guide for women

to seek advice from a physiotherapist - ask your general practitioner or breast care nurse for a referral. Keep your weight within normal limits for your height. Avoid stimulants for coughing, like cigarettes Avoid food and drinks containing high levels of caffeine, as this can irritate the bladder and can increase incontinence. Visit your local continence advisory service. Ask your general practitioner or breast care nurse for more information. Bone and joint pain Painful joints can be a problem

2016 Cancer Australia

198. Gastrointestinal Complications (PDQ®): Health Professional Version

anesthesia and pudendal blocks. Diet Inadequate fluid intake.* Altered bowel habits Repeatedly ignoring defecation reflex. Excessive use of laxatives and/or enemas. Prolonged immobility* and/or inadequate exercise Spinal cord injury or compression, fractures, fatigue, weakness, or inactivity (including bedrest). Intolerance with respiratory or cardiac problems. Bowel disorders Irritable colon, diverticulitis, or tumor.* Neuromuscular disorders (disruption of innervation leads to atony of the bowel (...) abdominal distention occurs, movement of the diaphragm is compromised, leading to insufficient aeration with subsequent hypoxia and left ventricular dysfunction. Hypoxia can, in turn, precipitate angina or tachycardia. If the vasovagal response is stimulated by the pressure of impaction, the patient may become dizzy and hypotensive. Movement of stool around the impaction may result in diarrhea, which can be explosive. Coughing or activities that increase intra-abdominal pressure may cause leakage

2018 PDQ - NCI's Comprehensive Cancer Database

199. Osteoarthritis

by activity; multiple joints affected; possible systemic symptoms. See the CKS topics on , , , and for more information. Septic joint — suggested by a red, hot, swollen joint associated with systemic symptoms. Fracture of the bone adjacent to the joint — suggested by a history of trauma. Malignancy including bony metastases — suggested by persistent and progressive bone pain unrelated to activity; rapid worsening of symptoms; night pain; unexplained mass or swelling. See the CKS topic on for more

2018 NICE Clinical Knowledge Summaries

200. Smoking cessation

and an increased risk of bone fracture. It is a cause of rheumatoid arthritis, especially among men. Progressive harm to the cognitive system. People who smoke are over 50% more likely to develop cognitive impairment than those who do not. Smoking is an important environmental risk factor for the development of dementia, due to the increased vascular risk. Cataracts, age-related macular degeneration. Periodontal disease and tooth decay. An increased risk of developing meningococcal disease. An increased risk (...) Circulation improves. 1 month Physical appearance improves owing to improved skin perfusion. Skin loses its grey pallor and becomes less wrinkled. 3–9 months Coughing and wheezing declines. 1 year Excess risk of heart attack reduces by half. 10 years Risk of lung cancer falls to about half that of a continuing smoker. 15 years Risk of heart attack falls to the same level as someone who has never smoked. Source: [ ] Management Management : covers the assessment of whether a person is ready to stop smoking

2018 NICE Clinical Knowledge Summaries

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