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Fetal Foot Measurement

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641. Diabetes Mellitus, Type 1 (Follow-up)

of the foot ulcer because a revascularization procedure may be required to provide adequate blood flow for wound healing. Because ulcers and foot infections are difficult to cure, their prevention is extremely important. [ ] At one clinic, the rate of amputation was halved after patients were required to remove their shoes and socks at every visit. The emergency physician can facilitate this practice by briefly inspecting the feet of patients with diabetes and by educating them about the need for proper (...) daily before meals, in some cases 1-2 hours after meals, and at bedtime. In practice, however, patients often obtain 2-4 measurements each day, including fasting levels and levels checked at various other times (eg, preprandially and at bedtime). Instruct patients with type 1 DM in the method of testing for urine ketones with commercially available reagent strips. Advise patients to test for urine ketones whenever they develop any of the following: Symptoms of a cold, flu, or other intercurrent

2014 eMedicine Emergency Medicine

642. Ultrasonography, Abdominal (Follow-up)

sonography; however, pain management should not be delayed, and patients may experience some discomfort due to probe pressure. For improved patient comfort, consider using warmed ultrasound-conducting gel, if available. Ultrasound imaging does not use ionizing radiation and has not been shown to be associated with genetic damage or oncogenesis. Tissue damage secondary to heat production when using Doppler imaging is a theoretical risk, so high-energy modes are typically avoided with fetal ultrasonography (...) ultrasound by the European Federation of Societies for Ultrasound in Medicine and Biology include the following [ ] : For a complete examination of the bowel, both a low and high resolution probe are needed. A probe with a frequency above 5 MHz should be used when measuring wall thickness. Color Doppler imaging should be used to evaluate the vascularization of pathological bowel wall. Contrast-enhanced ultrasound of the bowel can be used to separate vascular from avascular intestinal or peri-intestinal

2014 eMedicine Emergency Medicine

643. Tick-Borne Diseases, Lyme (Overview)

the following image for examples of each stage). Only larvae, nymphs, and adult female ticks require blood meals, and only ticks in the nymphal and adult stages can transmit B burgdorferi. Magnified ticks at various stages of development. The life cycle of Ixodes ticks spans 2 years (see the image below). The adult lays eggs in the spring, and the larvae emerge in the summer. The larvae feed once, in late summer, on any of a wide variety of small animals (eg, the white-footed mouse) . The following spring (...) , the larvae emerge as nymphs. Nymphs feed once, in the spring and summer. The white-footed mouse is the preferred feeding source of nymphs, but other animals apparently suffice. Nymphs molt into adults the following fall and feed once on a larger animal, with the white-tailed deer being the preferred host. Life cycle of the Ixodes dammini tick. Courtesy of Elsevier. Ticks can acquire B burgdorferi from feeding on an infected animal host during any of the three life-cycle stages. Unless the tick has fed

2014 eMedicine Emergency Medicine

644. Diabetes Mellitus, Type 1 (Treatment)

of the foot ulcer because a revascularization procedure may be required to provide adequate blood flow for wound healing. Because ulcers and foot infections are difficult to cure, their prevention is extremely important. [ ] At one clinic, the rate of amputation was halved after patients were required to remove their shoes and socks at every visit. The emergency physician can facilitate this practice by briefly inspecting the feet of patients with diabetes and by educating them about the need for proper (...) daily before meals, in some cases 1-2 hours after meals, and at bedtime. In practice, however, patients often obtain 2-4 measurements each day, including fasting levels and levels checked at various other times (eg, preprandially and at bedtime). Instruct patients with type 1 DM in the method of testing for urine ketones with commercially available reagent strips. Advise patients to test for urine ketones whenever they develop any of the following: Symptoms of a cold, flu, or other intercurrent

2014 eMedicine Emergency Medicine

645. Pediatrics, Sickle Cell Disease (Overview)

by the onset of life-threatening anemia with rapid enlargement of the spleen and high reticulocyte count Infection: Organisms that pose the greatest danger include encapsulated respiratory bacteria, particularly Streptococcus pneumonia ; adult infections are predominately with gram-negative organisms, especially Salmonella Growth retardation, delayed sexual maturation, being underweight Hand-foot syndrome: This is a dactylitis presenting as bilateral painful and swollen hands and/or feet in children Acute (...) scanning: 99m Tc bone scanning detects early stages of osteonecrosis; 111 In WBC scanning is used for diagnosing osteomyelitis Transcranial Doppler ultrasonography: Can identify children with SCD at high risk for stroke Abdominal ultrasonography: May be used to rule out cholecystitis, cholelithiasis, or an ectopic pregnancy and to measure spleen and liver size Echocardiography: Identifies patients with pulmonary hypertension Transcranial near-infrared spectroscopy or cerebral oximetry: Can be used

2014 eMedicine Emergency Medicine

646. Electrical Injuries (Treatment)

of full neurovascular examination. The risks of electrical injury to the fetus in a pregnant patient are unknown. Pregnant women who are involved in electrical injuries should have a careful examination for traumatic injuries and obstetrical consultation. Women in the second half of pregnancy should be admitted for fetal monitoring in any cases of severe electrical injuries, high-voltage exposures, or minor electrical injuries with significant trauma. Previous Next: Further Inpatient Care and Transfer (...) sodium bicarbonate titrated to a serum pH of 7.5. Obtain adequate intravenous access for fluid resuscitation, whether peripheral or central. Initiate cardiac monitoring for all patients with anything more than trivial low-voltage exposures. Burn care should include tetanus immunization as indicated, wound care, measurement of compartment pressures as indicated, and it may include early fasciotomy. Extremities with severe burns should be splinted in a functional position after careful documentation

2014 eMedicine Emergency Medicine

647. Diabetes Mellitus, Type 2 (Overview)

their SMBG data, but they should also reevaluate the ongoing need for and frequency of SMBG at each routine visit. Approaches to prevention of diabetic complications include the following: HbA1c every 3-6 months Yearly dilated eye examinations Annual microalbumin checks Foot examinations at each visit Blood pressure < 130/80 mm Hg, lower in diabetic nephropathy Statin therapy to reduce low-density lipoprotein cholesterol See and for more detail. Next: Background Type 2 diabetes mellitus consists (...) measurements to confirm reduced pancreatic volume in individuals with a median 15-year history of diabetes mellitus (range, 5-26 years). [ ] This may also explain the associated exocrine deficiency seen in prolonged diabetes. Beta-cell dysfunction Beta-cell dysfunction is a major factor across the spectrum of prediabetes to diabetes. A study of obese adolescents by Bacha et al confirms what is increasingly being stressed in adults as well: Beta-cell dysfunction develops early in the pathologic process

2014 eMedicine Emergency Medicine

648. Arthritis, Rheumatoid (Overview)

and symptoms of RA may include the following: Persistent symmetric polyarthritis (synovitis) of hands and feet (hallmark feature) Progressive articular deterioration Extra-articular involvement Difficulty performing activities of daily living (ADLs) Constitutional symptoms The physical examination should address the following: Upper extremities (metacarpophalangeal joints, wrists, elbows, shoulders) Lower extremities (ankles, feet, knees, hips) Cervical spine During the physical examination (...) , it is important to assess the following: Stiffness Tenderness Pain on motion Swelling Deformity Limitation of motion Extra-articular manifestations Rheumatoid nodules Guidelines for evaluation 2010 American College of Rheumatology (ACR)/EULAR classification criteria [ ] 2012 ACR disease activity measures [ ] 2011 ACR/EULAR definitions of remission [ ] See for more detail. Diagnosis No test results are pathognomonic; instead, the diagnosis is made by using a combination of clinical, laboratory, and imaging

2014 eMedicine Emergency Medicine

649. Anemia, Sickle Cell (Overview)

-threatening anemia with rapid enlargement of the spleen and high reticulocyte count Infection: Organisms that pose the greatest danger include encapsulated respiratory bacteria, particularly Streptococcus pneumonia ; adult infections are predominately with gram-negative organisms, especially Salmonella Growth retardation, delayed sexual maturation, being underweight Hand-foot syndrome: This is a dactylitis presenting as bilateral painful and swollen hands and/or feet in children Acute chest syndrome (...) bone scanning detects early stages of osteonecrosis; 111 In WBC scanning is used for diagnosing osteomyelitis Transcranial Doppler ultrasonography: Can identify children with SCD at high risk for stroke Abdominal ultrasonography: May be used to rule out cholecystitis, cholelithiasis, or an ectopic pregnancy and to measure spleen and liver size Echocardiography: Identifies patients with pulmonary hypertension Transcranial near-infrared spectroscopy or cerebral oximetry: Can be used as a screening

2014 eMedicine Emergency Medicine

650. Anemia, Sickle Cell (Follow-up)

therapy is emerging as a possible cure for severe SCD. Experimental approaches include modification of autologous stem cells with lentiviral vectors to add normal globin genes, gene editing to correct the sickle cell disease mutation, and manipulations to enhance production of fetal hemoglobin. [ ] Successful results in individual patients has been reported, and clinical trials are planned or in progress. [ , ] Next: Hydroxyurea Therapy Although several pharmacological agents have been studied (...) for the treatment of SCD, the only drug currently approved by the US Food and Drug Administration (FDA) for the treatment of SCD is hydroxyurea. For frequent and severe pain, long-term hydroxyurea is currently the accepted treatment. [ ] Hydroxyurea increases total and fetal hemoglobin in children with SCD. [ ] The increase in fetal hemoglobin retards gelation and sickling of RBCs. Hydroxyurea also reduces levels of circulating leukocytes, which decreases the adherence of neutrophils to the vascular endothelium

2014 eMedicine Emergency Medicine

651. Ultrasonography, Abdominal (Diagnosis)

sonography; however, pain management should not be delayed, and patients may experience some discomfort due to probe pressure. For improved patient comfort, consider using warmed ultrasound-conducting gel, if available. Ultrasound imaging does not use ionizing radiation and has not been shown to be associated with genetic damage or oncogenesis. Tissue damage secondary to heat production when using Doppler imaging is a theoretical risk, so high-energy modes are typically avoided with fetal ultrasonography (...) ultrasound by the European Federation of Societies for Ultrasound in Medicine and Biology include the following [ ] : For a complete examination of the bowel, both a low and high resolution probe are needed. A probe with a frequency above 5 MHz should be used when measuring wall thickness. Color Doppler imaging should be used to evaluate the vascularization of pathological bowel wall. Contrast-enhanced ultrasound of the bowel can be used to separate vascular from avascular intestinal or peri-intestinal

2014 eMedicine Emergency Medicine

652. Anemia, Sickle Cell (Treatment)

therapy is emerging as a possible cure for severe SCD. Experimental approaches include modification of autologous stem cells with lentiviral vectors to add normal globin genes, gene editing to correct the sickle cell disease mutation, and manipulations to enhance production of fetal hemoglobin. [ ] Successful results in individual patients has been reported, and clinical trials are planned or in progress. [ , ] Next: Hydroxyurea Therapy Although several pharmacological agents have been studied (...) for the treatment of SCD, the only drug currently approved by the US Food and Drug Administration (FDA) for the treatment of SCD is hydroxyurea. For frequent and severe pain, long-term hydroxyurea is currently the accepted treatment. [ ] Hydroxyurea increases total and fetal hemoglobin in children with SCD. [ ] The increase in fetal hemoglobin retards gelation and sickling of RBCs. Hydroxyurea also reduces levels of circulating leukocytes, which decreases the adherence of neutrophils to the vascular endothelium

2014 eMedicine Emergency Medicine

653. Pediatrics, Bacteremia and Sepsis (Overview)

risks, [ ] —and thus may be at risk for the infections covered by these vaccines. On the other hand, recent vaccinations might have caused an elevation in the patient's temperature. Temperature measurement at home Some pediatric patients may have had a subjective determination of an elevated temperature by their caregivers before coming to the hospital but are afebrile when they present to the ED. Parents may report a temperature elevation in their child without having actually recorded (...) temperature measured at home had relatively high rates of serious bacterial infection. [ ] Home use of temporal artery thermometers have not been shown to be completely reliable indicators of febrile children. [ ] Fever phobia Parents may be overly concerned about possible outcomes of prolonged high temperature, or they may believe that every fever requires antibiotic therapy. [ , ] These usually unwarranted fears have been shown to vary by race and ethnicity, as well as by the age of the child

2014 eMedicine Emergency Medicine

654. Pediatrics, Fever (Overview)

be at risk for the infections covered by these vaccines. On the other hand, recent vaccinations might have caused an elevation in the patient's temperature. Temperature measurement at home Some pediatric patients may have had a subjective determination of an elevated temperature by their caregivers before coming to the hospital but are afebrile when they present to the ED. Parents may report a temperature elevation in their child without having actually recorded the temperature with a thermometer (...) . Parental reporting of fever on the basis of subjective information (eg, touching the child's torso or extremities or feeling his or her forehead) is a reliable indicator of a fever having been present. Studies have shown that the parental assessment of fever in this situation is usually accurate. [ ] On the other hand, one study found that the subjective history of fever in such infants may not correlate with subsequent fever, whereas those with an elevated rectal temperature measured at home had

2014 eMedicine Emergency Medicine

655. Erythrovirus B19

and reddening of the hands and feet that typically ends abruptly at the wrists and ankles. This condition usually resolves within a few weeks. Parvovirus can also be passed from a pregnant woman to her foetus and through blood and blood products. Sometimes, the infection can lead to more serious disease. Parvovirus B19 can cause major health problems in three types of patients: People with or a condition that affects or shortens the life of red blood cells (RBCs), such as or , may develop severe anaemia (...) during a parvovirus B19 infection. Parvovirus B19 targets cells in the bone marrow that become RBCs and disrupts the production of new RBCs, which may affect those with underlying blood disorders more severely. Women who are infected during can pass the infection to their baby. Most foetuses will be fine, but a small proportion will develop severe anaemia and a few may have an inflammation and infection of the heart muscle (myocarditis). These conditions can cause in the foetus, miscarriage, hydrops

2012 Lab Tests Online UK

656. Heavy Metals

: Abdominal pain, nausea, vomiting and diarrhoea Nervous system symptoms such as numbness, tingling of hands and feet, weakness Anaemia Kidney damage Liver damage In the lungs – irritation, Brain dysfunction, memory loss Mees lines (horizontal lines on nails) Changes in behaviour Malformed bones in children, weakened bones In pregnant women – miscarriage, premature labour People who may be exposed to metals in the workplace are usually monitored periodically. Safety measures minimise risk to employees (...) range if you do not have the lab report. For more information on reference ranges, please read . What is being tested? A heavy metals panel is a group of tests that measures the quantity of specific, potentially toxic metals in the blood, urine, or more rarely in the hair or other body or fluid. A laboratory may offer several different groupings of heavy metals panels as well as tests for individual metals. The most common combination includes , , and arsenic. Other panels may include one or more

2012 Lab Tests Online UK

657. Folate

consult your doctor or the laboratory that performed the test(s) to obtain the reference range if you do not have the lab report. For more information on reference ranges, please read . What is being tested? These tests measure the concentration of folate and vitamin B12 in the serum (liquid portion of the blood). Vitamin B12 and folate are both part of the B complex of vitamins. Folate is found in leafy green vegetables, citrus fruits, dry beans and peas, liver, and yeast. Vitamin B12 is found (...) in animal products such as red meat, fish, poultry, milk, and eggs. In recent years fortified cereals, breads, and other grain productshas also become an important dietary sources of folate (identified as "folic acid" on nutritional labels). Both vitamin B12 and folate are necessary for normal red cell formation, tissue and cellular repair, and synthesis. Vitamin B12 is also important for nerve health, while folate is necessary for cell division such as is seen in a foetus during pregnancy. A deficiency

2012 Lab Tests Online UK

658. Evaluating the impact of picture health warnings on cigarette packets

tested with interviewers prior to wave 1 fieldwork. • The questionnaire consisted of three core modules: smoking-related behaviour (measuring current behaviour and intended behaviour changes), knowledge about the health risks of smoking, and attitudes to and recall of the health warning messages. • All participants for this study were sampled from Health Survey for England informants who had agreed to be re-contacted and take part in future research. • For both waves of data collection, the issued (...) response to the health warning messages. • Depth of processing of the messages are measured by how often a participant reports noticing, reading and thinking about the health warnings messages. Among adult current cigarette smokers, there were no differences pre and post implementation of the picture health warnings for any of these measures. 8 Attitudes to the health warning messages: • All participants were asked a series of questions about their attitudes to the text health warning messages

2009 Public Health Research Consortium

659. Intrapartum Oxytocin Administration Affects Primitive Neonatal Reflexes

extrusion, arm circular motion, circular motion of the leg, flex foot / hand, 2) Antigravity: raise the head, 3) Motors: turn your head, nod, plantar pressure, Babinski, and 4) Rhythmic: suction, jaw movement and swallowing. An observer, blinded to the study group and the dose administered of Oxytocin, valued recordings, analyzing the state of consciousness at the beginning of the recording as Brazelton scale and form RNP dichotomous coding (achieved / not achieved). Secondary Outcome Measures (...) Not exposed to oxytocin Mother-child dyads in which Oxt had not been administered during the birth process Drug: Oxytocin Comparison of Primitive Newborn Reflexes between those exposed or not to Oxytocin Outcome Measures Go to Primary Outcome Measures : Expression of Neonatal Primitive Reflexes (RNP) are modified by administration of Oxytocin during delivery. [ Time Frame: 72 hours ] Neonatal Primitive Reflexes studied were: 1) Endogenous: hand to mouth, extension / flexion of fingers, mouth open, tongue

2013 Clinical Trials

660. Transcranial Direct Current Stimulation for Improving Gait Training in Stroke

sensory experience (30 seconds). Device: transcranial direct current stim (tDCS) During anodal tDCS, participants will receive 20 min at 2mA over motor cortex (with 30 seconds of ramp-up and ramp-down). During sham stimulation the stimulator is turned off. Outcome Measures Go to Primary Outcome Measures : Ankle Dorsiflexion Angle. Change From Baseline in Ankle Dorsiflexion Angle During the Swing Phase of Gait [ Time Frame: Study week 1, and study weeks 5(± 5 days) and 8 (± 10 days). ] Over ground (...) laboratory assessments of gait: 1) Gait velocity and spatiotemporal gait parameters will be measured with the GAITRite system (CIR Systems, Inc., Havertown, PA) 28-35. 2) Hip, ankle, and knee angles during gait will be measured using the Simi Aktisys gait analysis system (Simi Reality Motion Systems; Postfach, Unterschleissheim Germany). LED markers are placed on the participant's lower extremity. Ankle, knee, and hip angle data is obtained simultaneously to evaluate motor strategies for overcoming gait

2013 Clinical Trials

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