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Cough fracture

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1281. Common Post-operative Complications to Look Out For

is nearly 50% and requires urgent treatment with bronchial suction, positive pressure ventilation, prophylactic antibiotics and IV steroids. : Rapid, shallow breathing, severe hypoxaemia with scattered crepitations but no cough, chest pains or haemoptysis, appearing 24-48 hours after surgery. it occurs in many conditions where there is direct or systemic insult to the lung - eg, multiple trauma with shock. The complication is rare and various methods have been described to predict high-risk patients (...) J Surg. 2013 Jan205(1):85-101. doi: 10.1016/j.amjsurg.2012.02.019. Epub 2012 Aug 4. ; Preoperative and Intraoperative Predictors of Postoperative Acute Respiratory Distress Syndrome in a General Surgical Population. Anesthesiology. 2013 Jan118(1):19-29. ; Deep venous thrombosis and pulmonary embolism after surgical treatment of ankle fractures: a case report and review of literature. J Foot Ankle Surg. 2012 Jul-Aug51(4):457-63. doi: 10.1053/j.jfas.2012.04.016. Epub 2012 May 24. ; Inpatient

2008 Mentor

1282. Choking and Foreign Body Airway Obstruction (FBAO)

. This at least gives the victim who is unable to speak the opportunity to respond by nodding! Consider the diagnosis of choking particularly if: The episode occurs whilst eating and onset was very sudden. The victim is an adult - may clutch his or her neck, or points to throat. The victim is a child - there may be clues - eg, seen eating or playing with small items just before the onset of symptoms. Assess severity [ , ] Mild obstruction The patient is able to breathe, cough effectively and speak. Children (...) are fully responsive, crying or verbally respond to questions; may have a loud cough (and be able to take a breath before coughing). [ ] Severe obstruction This is indicated by: The victim being unable to breathe or speak/vocalise. Wheezy breath sounds. Attempts at coughing that are quiet or silent. Cyanosis and diminishing conscious level (particularly in children). The victim being unconscious. Epidemiology Incidence Choking is a risk whenever food is consumed. FBAO represents a true medical emergency

2008 Mentor

1283. Chest Pain

, , trauma, rib pain (including fracture, , ), radicular pain, nonspecific musculoskeletal pain (eg, ). . Gastrointestinal: , oesophageal rupture, , , , , gastritis. Skin: infection. Psychological - eg, , , . Others: , diabetic mononeuritis, tabes dorsalis. Assessment The aim is to exclude a life-threatening cause, which needs immediate treatment, from other causes of chest pain. Diagnosis of chest pain is difficult but the history often gives an indication of the underlying cause. As the patient walks (...) in nature and more easily localised (usually dermatomal). Associated symptoms may be useful in determining the underlying cause but may be nonspecific (eg, breathlessness may be associated with a cardiac, musculoskeletal, respiratory or psychological cause): Anorexia, nausea, vomiting may suggest a gastrointestinal or cardiac cause of chest pain depending on the individual context. Breathlessness, cough, haemoptysis may indicate a respiratory or a cardiac cause of chest pain. Excessive sweating may

2008 Mentor

1284. Chest X-ray - Systematic Approach

are requested to look for achalasia of the cardia or fractured ribs. CXR should be taken with the patient in full inspiration but some people have difficulty holding full inspiration. The major exception is when seeking a small pneumothorax as this will show best on full expiration. A CXR in full inspiration should have the diaphragm at the level of the 6th rib anteriorly and the liver pushes it up a little higher in the right than on the left. Do not be unduly concerned about the exact degree of inflation (...) of the bowel but also after laparotomy or laparoscopy. Finally look at the soft tissues and bones. Are both breast shadows present? Is there a fractured rib? If so, check again for a pneumothorax. Are the bones destroyed or sclerotic? There are some areas where it is very easy to miss pathology and so it is worth repeating examination. Attention may be merited to apices, periphery of the lungs, under and behind the hemidiaphragms and behind the heart. The diaphragm slopes backwards and so some lung tissue

2008 Mentor

1285. Coma

There are a number of potential causes for coma and these can be divided in many different ways - eg, reversible/irreversible, according to systems, duration of onset, etc. The following table divides the causes into systems. Causes of comatose states Trauma . Depressed cranial fracture. Intracerebral haemorrhage. . Toxic Ethanol. Drug overdose - eg, opiates, benzodiazepines, neuroleptics. Sedatives. Recreational drugs - eg: Gamma-hydroxybutyrate [ ] Ecstasy Cocaine Poisons- eg, , solvents. Metabolic (...) lost cognition and external awareness, but retain noncognitive brain function and normal or near-normal sleep-wake cycles. Gag, cough, sucking and swallowing reflexes may be preserved. Classification and diagnosis can be difficult and require expert repeated multidisciplinary neurological/neurosurgical assessment and input of family, friends and carers to be sure of the state in a given patient. It is thought that misdiagnosis is a common problem. Given the ethical, legal and prognostic

2008 Mentor

1286. Venous Leg Ulcer

clinically. A leg ulcer is defined as the loss of skin below the knee on the leg or foot, which takes more than two weeks to heal. [ ] History The following history may suggest venous ulceration: Pre-existing varicose veins. Deep vein thrombosis. Phlebitis. Previous fracture, trauma or surgery. Family history of venous disease. Symptoms of venous insufficiency - for example, pains or heaviness in the legs, aching, itching, swelling, breakdown of the skin surface, pigmentation, eczema. Features (...) went to my doctor last Thursday wif a cough and slightly tight chest .. I was on 8 tabs a day and I'm sure... tammi31 Health Tools Feeling unwell? Assess your symptoms online with our free symptom checker. Article Information Last Reviewed 01 August 2016 Next Review 31 July 2021 Document ID 4099 (v26) Author Peer reviewer Prof Cathy Jackson The information on this page is written and peer reviewed by qualified clinicians. Disclaimer: This article is for information only and should not be used

2008 Mentor

1287. Blast Injury

. Epidemiology Frequency depends on both the political stability of the region, eg terrorism, and local factors such as occupational health and safety priorities. Presentation Lungs may show evidence of pulmonary trauma and . The clinical picture of dyspnoea, cough and hypoxia is referred to as blast lung syndrome and represents impaired gas exchange and vascular shunting with ventilation mismatching. [ ] Pulmonary can cause pleural tears or lacerations, which give rise to pneumothoraces, haemothoraces (...) sprain 8 days ago. no fracture. she has a boot and crutches and is very hesitant to put any weight on the foot even with the boot... marilyn38669 Health Tools Feeling unwell? Assess your symptoms online with our free symptom checker. Article Information Last Reviewed 22 June 2011 Next Review 20 June 2016 Document ID 1871 (v23) Author Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all

2008 Mentor

1288. Blackouts

both the risk of a serious underlying disorder and also the risk of recurrence and subsequent injury. [ ] Aetiology [ ] Neurally mediated syncope (NMS) - also called reflex syncope: Vasovagal syncope (common faint): Emotional - eg, fear, severe pain, blood phobia, sudden, unexpected sight, sound or smell. Orthostatic stress - eg, prolonged standing or when in crowded, hot places. Situational syncope - eg, cough, sneeze, gastrointestinal stimulation (swallowing, defecation, visceral pain (...) be due to strong P rovocation, associated with P rodromal symptoms and P osture, ie it is unlikely to occur while sitting or lying - the '3 Ps'. Greater restrictions apply if the situation is more complicated, such as cough syncope, or if diagnosis is less clear. If in doubt, contact the DVLA. Complications [ ] Recurrent syncope has serious effects on quality of life. The impairment due to syncope is comparable with chronic illnesses such as chronic arthritis, recurrent moderate depressive disorders

2008 Mentor

1289. Acute Exacerbations of COPD

Guidelines. You may find the article more useful, or one of our other . In this article In This Article Acute Exacerbations of COPD In this article See also the separate , and articles. Exacerbations of chronic obstructive pulmonary disease (COPD) are defined as a sustained worsening of the patient's symptoms from his or her usual stable state, which is beyond normal day-to-day variations and is acute in onset. Commonly reported symptoms are worsening breathlessness, cough, increased sputum production (...) breathlessness and cough, and increased sputum volume and/or a change in the colour of the sputum. Exacerbations of COPD can be associated with the following symptoms: Increased dyspnoea. Increased cough; increased sputum purulence and increased sputum volume. Upper airway symptoms (eg, colds and sore throats). Increased wheeze and chest tightness. Malaise. Reduced exercise tolerance. Fluid retention. Increased fatigue. Marked respiratory distress with dyspnoea and tachypnoea, acute confusion, increased

2008 Mentor

1290. Respiratory System - History and Exam

and based on research evidence, UK and European Guidelines. You may find the article more useful, or one of our other . In this article In This Article Respiratory System History and Examination In this article History Respiratory problems may be caused by disorders of other symptoms and so it may be appropriate to refer also to the separate and articles. History of presenting complaint The main respiratory symptoms are: Dyspnoea (see the separate article). Cough and sputum (see the separate (...) and articles). . . Wheeze (see the separate and articles). NB : may cause a silent chest with no wheeze. Other systems Loss of appetite is a common feature whenever people are unwell. It suggests that the disease is having a significant effect on well-being. Significant loss of weight may well be indicative of serious illness - eg, malignancy or tuberculosis. Upper gastrointestinal symptoms: gastro-oesophageal reflux is a common cause of chronic cough. Heart disease may cause respiratory symptoms

2008 Mentor

1291. Pulmonary Embolism

and travelled to the lungs via the venous system. Fat - following long bone fracture or orthopaedic surgery. Amniotic fluid [ ] . Air - following neck vein cannulation or bronchial trauma. The rest of this article deals with thrombotic PE. Epidemiology The incidence of venous thromboembolism (VTE) varies from 1-1.5 per 1,000 person-years [ ] . Risk factors Clots form when one or more of the following factors are present: increased blood coagulability, reduced mobility or blood vessel abnormalities (...) . These correspond to some of the risk factors for VTE (see below). A number of patients may not have any risk factors, making the diagnosis difficult. Risk factors for venous thromboembolism [ ] Major risk factors: relative risk of 5-20 Minor risk factors: relative risk of 2-4 Surgery: Major abdominal/pelvic surgery or hip/knee replacement (risk lower if prophylaxis used). Postoperative intensive care. Obstetrics: Late pregnancy. Puerperium. Caesarean section. Lower limb problems: Fracture. Varicose veins

2008 Mentor

1292. Prescribing in Terminal Care

effect). Cough [ ] Consideration of whether a cough is dry or moist and the effectiveness of the cough will affect the choice of symptomatic treatment. Treat the underlying cause if appropriate and possible; consider co-existing disease. Cough can be very distressing and may worsen pain. Humidify the room and try simple linctus. If this is inadequate, use the appropriate strength of opioid (plus laxative) with regular or prn antiemetic for the first week if necessary. Excessive respiratory secretions (...) acute pain (eg, biliary or ureteric colic, intrahepatic bleed, bladder spasm, acute vertebral collapse, pathological fracture of a long bone). Ethical and legal aspects to end of life prescribing Palliative sedation and the doctrine of double effect [ ] Prescribing for patients at the end of life is often full of ethical anxiety for the prescriber, particularly in situations where a person at the end of life faces refractory symptoms. Palliative sedation is the poorly defined practice of continuous

2008 Mentor

1293. Hydatid Disease

causes cough, haemoptysis, dyspnoea and pyrexia. Disease in the brain causes raised intracranial pressure and can cause epilepsy. Disease in the vertebrae can lead to compression of the spinal cord, causing paraplegia. In the long bones it may cause fractures and deformity. Polycystic echinococcosis Polycystic echinococcosis is the rarest type of echinococcosis, and may be caused by E. vogeli and E. oligarthrus , which are confined to Latin America. E. oligarthrus is only rarely found in humans (...) are larger than 5 cm in diameter. Symptoms can include vague pains, cough, low-grade pyrexia and abdominal fullness. Later, as the mass presses on surrounding organs, symptoms become more specific. In the abdomen, where there is less restriction on growth through pressure from other organs, cysts may grow to several litres. The liver is the most commonly affected organ. In the liver, symptoms of obstructive jaundice and abdominal pain can develop. Pressure of the cyst on the biliary tract can cause

2008 Mentor

1294. High Altitude Illness

of exercise and the absolute altitude. It has been recognised that some individuals are more susceptible. Usually it occurs 2-4 days after ascent: Symptoms and signs are typical of pulmonary oedema, including dyspnoea at rest, cough (initially dry from interstitial oedema and then productive of frothy sputum which may be bloodstained in later stages), chest tightness, poor exercise tolerance and eventually cyanosis. Pulmonary crepitations are found in at least one lung field, along with central cyanosis (...) illness: a randomized controlled trial for prevention of altitude illness with nonsteroidal anti-inflammatories. Ann Emerg Med. 2012 Jun59(6):484-90. doi: 10.1016/j.annemergmed.2012.01.019. Epub 2012 Mar 21. ; Adventure travel and type 1 diabetes: the complicating effects of high altitude. Diabetes Care. 2005 Oct28(10):2563-72. hi there, my 15-yr old daughter sprained was diagnosed with a grade 2 sprain 8 days ago. no fracture. she has a boot and crutches and is very hesitant to put any weight

2008 Mentor

1295. Foreign Body in the Eye

injury is suspected. Orbits and lids Look for lacerations, subcutaneous emphysema, bruising, deformity of the orbital rim, oedema. If fracture is suspected, measure the medial intercanthal distance (this should be 35-40 mm in adults). Where there is bilateral periorbital bruising, consider the possibility of a base of skull fracture rather than an eye injury. Evert the lids (unless lacerated) to look for FBs. Conjunctiva Look for haemorrhage and lacerations (small lacerations may show up on staining (...) it. Subconjunctival haemorrhage/conjunctival laceration: in the context of eye trauma, can indicate open globe injury, especially if there is severe or diffuse haemorrhage. If it tracks posteriorly, it may indicate fracture. Pupil, iris or fundal abnormalities: Hyphaema, irregular pupil or decreased IOP suggest that an object has gone at least into the anterior chamber. Hyphaema indicates significant eye injury. Teardrop-shaped pupil indicates open globe injury. Vitreous haemorrhage suggests injury

2008 Mentor

1296. Heavy Metal Poisoning

is an occupational illness due to exposure to fumes during welding). It presents with: Metallic taste and increased salivation. Nausea, vomiting and diarrhoea. Impaired sensation. Difficulty breathing, cough, chest pain. Complications include pneumonitis and pulmonary oedema. Chronic exposure may cause anaemia, emphysema or renal failure and cadmium may be a risk factor in the development of prostate or lung cancer. At present there is no effective therapy for cadmium poisoning; treatment is supportive (...) -93. Berlin M, Zalups RK, Fowler BA. Mercury. In: Nordberg GF, Fowler BA, Nordberg M, Friberg LT, editors; Handbook on the Toxicology of Metals. 3rd edition. Chapter 33. New York. Elsevier 2007. hi there, my 15-yr old daughter sprained was diagnosed with a grade 2 sprain 8 days ago. no fracture. she has a boot and crutches and is very hesitant to put any weight on the foot even with the boot... marilyn38669 Health Tools Feeling unwell? Assess your symptoms online with our free symptom checker

2008 Mentor

1297. Eye Trauma

. In this article In This Article Eye Injuries In this article Eye injuries are a common cause of emergency department attendances. Eye trauma should always be fully assessed, as penetrating injuries are otherwise easily missed but can rapidly lead to sight-threatening infections. This article covers the assessment of eye injury including blunt trauma, orbital fracture, lid laceration, glue in the eye, chemical and deterrent spray injuries and signs suggesting non-accidental injury (NAI). Specific practical (...) as your equipment allows. You may need local anaesthetic if the patient cannot open their eyes due to pain: Orbits and lids : lacerations, subcutaneous emphysema, bruising, deformity of the orbital rim, oedema. Evert lids: If you think there may be a fracture, measure the medial intercanthal distance (this should be 35-40 mm in adults). Consider whether bilateral bruising could actually be due to a base of skull fracture rather than an eye injury. (Conversely, rule out eye injury in the patient

2008 Mentor

1298. Endoscopic Suspension of the Vesical Neck for Urinary Incontinence in Females: Report on 203 Consecutive Patients Full Text available with Trip Pro

incontinence, and severe pelvic fractures. Between December 1973 and May 1979, 203 patients underwent 211 operations with a minimum of six months of follow-up study at final review (November 1979). Twenty per cent of the patients were totally incontinent on referral, and 60 per cent lost urine with minimal activity; only 20 per cent of the patients had typical stress urinary incontinence, requiring coughing or sneezing to lose urine. Among the 203 patients, there were 188 previous operations for urinary

1980 Annals of Surgery

1299. fracture (rib)

fracture (rib) fracture (rib) - General Practice Notebook This site is intended for healthcare professionals General Practice Notebook | Medical search fracture (rib) Fractured ribs are almost always a result of direct force although in osteoporotic patients something as small as a cough or sneeze can fracture a rib. The patient complains of a sharp pain in the chest which is made worse by deep breathing and coughing. On examination if the chest wall is compressed ('sprung (...) ') in the anteroposterior direction the pain is aggravated. X-ray shows the fracture(s), usually near the rib angle. Treatment in the majority of cases involves nothing more than the injection of a local anaesthetic and the encouragement of a normal pattern of breathing. In rare cases a bone fragment may puncture the lung resulting in a pneumothorax. Once the pneumothorax has been treated it should be remembered that the fracture is now a compound one and antibiotics should be given. Links: General Practice Notebook

2010 GP Notebook

1300. rib fracture

rib fracture rib fracture - General Practice Notebook This site is intended for healthcare professionals General Practice Notebook | Medical search rib fracture Fractured ribs are almost always a result of direct force although in osteoporotic patients something as small as a cough or sneeze can fracture a rib. The patient complains of a sharp pain in the chest which is made worse by deep breathing and coughing. On examination if the chest wall is compressed ('sprung') in the anteroposterior (...) direction the pain is aggravated. X-ray shows the fracture(s), usually near the rib angle. Treatment in the majority of cases involves nothing more than the injection of a local anaesthetic and the encouragement of a normal pattern of breathing. In rare cases a bone fragment may puncture the lung resulting in a pneumothorax. Once the pneumothorax has been treated it should be remembered that the fracture is now a compound one and antibiotics should be given. Links: General Practice Notebook General

2010 GP Notebook

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