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Shifting Dullness Test

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1. Shifting Dullness Test

Shifting Dullness Test Shifting Dullness Test Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Shifting Dullness Test Shifting Dullness (...) Test Aka: Shifting Dullness Test II. Indication Confirming presence of III. Test Limitations False positive Test Mesenteric fat Feces in bowel Decreased sensitivity in Requires at least 500 cc of ascitic fluid IV. Technique Patient lies supine Percuss from tympanic bowel down to line of dullness Mark dullness line with a pen Patient turns onto side After 1 minute, re-mark line of dullness V. Interpretation Considerable shift in line of dullness suggests Images: Related links to external sites (from

2018 FP Notebook

2. Shifting Dullness Test

Shifting Dullness Test Shifting Dullness Test Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Shifting Dullness Test Shifting Dullness (...) Test Aka: Shifting Dullness Test II. Indication Confirming presence of III. Test Limitations False positive Test Mesenteric fat Feces in bowel Decreased sensitivity in Requires at least 500 cc of ascitic fluid IV. Technique Patient lies supine Percuss from tympanic bowel down to line of dullness Mark dullness line with a pen Patient turns onto side After 1 minute, re-mark line of dullness V. Interpretation Considerable shift in line of dullness suggests Images: Related links to external sites (from

2015 FP Notebook

3. Guidelines on Diabetes, Pre-Diabetes and Cardiovascular Diseases developed in collaboration with the EASD

-centred care 46 12.1 General aspects 46 13 ‘What to do’ and ‘what not to do’ messages from the Guidelines 48 14 Appendix 51 15 References 52 Recommendations Recommendations for the diagnosis of disorders of glucose metabolism 12 Recommendations for the use of laboratory, electrocardiogram, and imaging testing for cardiovascular risk assessment in asymptomatic patients with diabetes 16 Recommendations for lifestyle modifications for patients with diabetes mellitus and pre-diabetes 18 Recommendations (...) peptidase-4 DYNAMIT Do You Need to Assess Myocardial Ischemia in Type 2 Diabetes EACTS European Association for Cardio-Thoracic Surgery EAS European Atherosclerosis Society EASD European Association for the Study of Diabetes ECG Electrocardiogram EDIC Epidemiology of Diabetes Interventions and Complications EET Exercise electrocardiogram test eGFR Estimated glomerular filtration rate ELIXA Evaluation of Lixisenatide in Acute Coronary Syndrome EMPA-REG OUTCOME Empagliflozin Cardiovascular Outcome Event

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2019 European Society of Cardiology

5. Management of Stroke Rehabilitation

when clinicians take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice. Every healthcare professional making use of these guidelines is responsible for evaluating the appropriateness of applying them in the setting of any particular clinical situation. These guidelines are not intended to represent Department of Veterans Affairs or TRICARE policy. Further, inclusion of recommendations for specific testing

2019 VA/DoD Clinical Practice Guidelines

6. Erectile Dysfunction

, and psychosocial history; a physical examination; and selective laboratory testing. (Clinical Principle) For the man with ED, validated questionnaires are recommended to assess the severity of ED, to measure treatment effectiveness, and to guide future management. (Expert Opinion) Men should be counseled that ED is a risk marker for underlying cardiovascular disease (CVD) and other health conditions that may warrant evaluation and treatment. (Clinical Principle) In men with ED, morning serum total testosterone (...) levels should be measured. (Moderate Recommendation; Evidence Level: Grade C) For some men with ED, specialized testing and evaluation may be necessary to guide treatment. (Expert Opinion) Treatment : 6. For men being treated for ED, referral to a mental health professional should be considered to promote treatment adherence, reduce performance anxiety, and integrate treatments into a sexual relationship. (Moderate Recommendation; Evidence Level: Grade C) 7. Clinicians should counsel men with ED who

2018 American Urological Association

7. Erectile Dysfunction

touch and nociceptive nerve fibers may also be tested using the application of sharp versus dull and/or cool versus warm stimuli. Biothesiometry may be informative, but there are few data to suggest that it leads to substantive changes in management in most cases. Invasive testing. Cavernosometry quantifies intracorporal pressure after ICI and is useful primarily for establishing a diagnosis of veno-occlusive dysfunction. Typically, cavernosometry is performed in conjunction with cavernosography (...) ) Copyright © 2018 American Urological Association Education and Research, Inc.® Guideline Statements: Evaluation and Diagnosis: 1. Men presenting with symptoms of ED should undergo a thorough medical, sexual, and psychosocial history; a physical examination; and selective laboratory testing. (Clinical Principle) 2. For the man with ED, validated questionnaires are recommended to assess the severity of ED, to measure treat- ment effectiveness, and to guide future management. (Expert Opinion) 3. Men should

2018 American Urological Association

8. Exam Series: Guide to the Back Exam

. Pain characteristics : Identify the onset, location, quality, radiation, severity, and duration of the pain. Back pain presents as primarily back dominant (likely due from muscular or vertebral disease without nerve root involvement) or leg dominant (likely due from disc herniation or nerve root impingement). Benign back pain is typically dull, achy, and non-specific that worsens with movement and improves with rest. Pain that is associated with sensory changes, weakness, falls, and gait (...) and CVA tenderness may indicate renal pathology. Inspection : Examine the patient’s posture. Asymmetry in the shoulder height may indicate scoliosis, which becomes more pronounced during the Adam’s Forward Bend test where the patient bends forward at the hips with straight legs. A lateral view of the back reveals the four natural curves of the spine – cervical lordosis, thoracic kyphosis, lumbar lordosis, and coccygeal kyphosis. Examine the paraspinal muscles for swelling, atrophy, erythema, or other

2018 CandiEM

9. Relative effectiveness assessment of Femtosecond laser-assisted cataract surgery (FLACS) compared to standard ultrasound phacoemulsification cataract surgery

platforms 44 Table 8 Intended use for the five systems 50 Table 9 Technologies and procedures associated with cataract surgery (ref Alcon) 53 Table 10 Risk factors for age-related cataract (13) 58 Table 11 Diagnostic tests recommended in Europe and the US (13,77) 62 Table 12 Annual cataract surgical rates (per 1,000,000 people) in different years and countries. 64 Table 13 Age distribution of cataract surgeries in public hospitals in Austria, 2001, 2007, 2011 (81) 64 Table 14 Complications of cataract

2018 EUnetHTA

10. Management of chronic heart failure

pressure Peripheral oedema (ankle, sacral, scrotal) Hepatojugular reflux Pulmonary crepitations Third heart sound (gallop rhythm) Reduced air entry and dullness to percussion at lung bases (pleural effusion) Laterally displaced apical impulse Tachycardia Cardiac murmur Irregular pulse Tachypnoea (>16 breaths/min) Hepatomegaly Ascites Tissue wasting (cachexia) Reproduced from McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, et al. ESC guidelines for the diagnosis and treatment (...) are most useful rather than any of these in isolation. Basic early investigations are necessary to differentiate heart failure from other conditions and to provide prognostic information. Urinalysis, serum urea and creatinine tests may help to determine if there is kidney failure, since symptoms of kidney disease are similar to those of HF . Chest X-ray may indicate signs of HF such as cardiomegaly, pulmonary congestion or pleural effusion and also non-cardiac indications such as lung tumours which

2016 SIGN

11. Expert opinion on the introduction of the meningococcal B (4CMenB) vaccine in the EU/EEA

elucidated if a =4 hSBA cut-off is appropriate for other SgB IMD strains which cause disease in local areas [5], and it is not practical to predict vaccine strain coverage based on testing of many different meningococcal strains directly in hSBA. This has led to the development of MATS (meningococcal antigen typing system) as a typing system to predict the strain coverage for each of the four components in the 4CMenB vaccine [6]. 4CMenB vaccine safety Fever is a common adverse event, especially

2017 European Centre for Disease Prevention and Control - Expert Opinion

12. Management of Opioid Therapy (OT) for Chronic Pain

and appropriately occur when clinicians take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice. Every healthcare professional making use of these guidelines is responsible for evaluating the appropriateness of applying them in the setting of any particular clinical situation. These guidelines are not intended to represent TRICARE policy. Further, inclusion of recommendations for specific testing and/or therapeutic interventions (...) Therapy B. Module B: Treatment with Opioid Therapy C. Module C: Tapering or Discontinuation of Opioid Therapy D. Module D: Patients Currently on Opioid Therapy V. Background A. Opioid Epidemic B. Paradigm Shift in Pain and Its Treatment C. Prioritizing Safe Opioid Prescribing Practices and Use D. Taxonomy E. Epidemiology and Impact F. Chronic Pain and Co-occurring Conditions G. Risk Factors for Adverse Outcomes of Opioid Therapy VI. About this Clinical Practice Guideline A. Scope of this Clinical

2017 VA/DoD Clinical Practice Guidelines

13. Desk guide for diagnosis and management of TB in children - Africa

important part of assessment for child TB diagnosis and prevention Any child with suspected or confirmed TB should be tested for HIV infection Children with TB respond well to treatment and tolerate TB treatment All children (0-14 years) with TB should be routinely registered with and reported by the NTP Desk guide is for : 1. health worker who manages sick children in first level health facilities or outpa - tient settings at any level of care 2. NTP worker who manages children as part of NTP work (...) and young children Children with TB disease usually have poor weight gain, may lose weight or be malnourished The presentation and approach to diagnosis of pulmonary TB in older children (> 10 years) and adolescents is similar to that for adults Any child with suspected or confirmed TB should be tested for HIV TB-HIV co-infection is common in children in sub-Saharan Africa HIV-infected children are at greater risk for TB infection and for TB disease Diagnosis and management can be more challenging

2016 International Union Against TB and Lung Disease

14. Desk guide for diagnosis and management of TB in children - Asia

important part of assessment for child TB diagnosis and prevention Any child with suspected or confirmed TB should be tested for HIV infection Children with TB respond well to treatment and tolerate TB treatment All children (0-14 years) with TB should be routinely registered with and reported by the NTP Desk guide is for : 1. health worker who manages sick children in first level health facilities or outpa - tient settings at any level of care 2. NTP worker who manages children as part of NTP work (...) and young children Children with TB disease usually have poor weight gain, may lose weight or be malnourished The presentation and approach to diagnosis of pulmonary TB in older children (> 10 years) and adolescents is similar to that for adults Any child with suspected or confirmed TB should be tested for HIV TB-HIV co-infection is common in children in sub-Saharan Africa HIV-infected children are at greater risk for TB infection and for TB disease Diagnosis and management can be more challenging

2016 International Union Against TB and Lung Disease

15. Computed tomography to rule out suspected appendicitis in adults and reduce the negative appendectomy rate

associated with CT. One systematic review found CT in adults to be justified if radiation exposure is considered in the clinical decision pathway. Two of the non-randomised comparative studies supported a shift away from routine CT to diagnose appendicitis via the routine use of MRI or laparoscopy. This was, in part, owing to a reduction in the risks associated with abdominal and pelvic radiation (particularly in children and women of childbearing age). It is important to note that Choosing Wisely (...) begins with a gradual onset of dull cramping or aching throughout the abdomen (uncomplicated appendicitis). 4 As the condition progresses (over 48 to 72 hours), and the appendix becomes more inflamed, this turns to localised constant and severe sharp pain in the right lower abdomen (acute appendicitis). 4 Other symptoms that accompany pain may include fever, nausea and vomiting, loss of appetite and constipation or diarrhoea. 4 Acute appendicitis may become a clinical emergency if the infected

2016 COAG Health Council - Horizon Scanning Technology Briefs

16. Diagnosis of Right Lower Quadrant Pain and Suspected Acute Appendicitis

of laboratory or imaging tests, can be combined into multivariable diagnostic scores (sometimes referred to as “clinical prediction rules”) that synthesize the findings of different investigations to determine the most likely diagnosis. 22 In adults, the most commonly used diagnostic score for appendicitis is the Alvarado score, 23 which is based on eight items: pain migration, anorexia, nausea, RLQ tenderness, rebound pain, elevated temperature, leukocytosis, and shift of white blood cell count to the left (...) Medical Center Harvard Medical School Boston, MA Daniel Dante Yeh, M.D. Massachusetts General Hospital Division of Trauma, Emergency Surgery and Surgical Critical Care Boston, MA vii Diagnosis of Right Lower Quadrant Pain and Suspected Acute Appendicitis Structured Abstract Background. The reliable identification of patients with abdominal pain who need surgical intervention for acute appendicitis can improve clinical outcomes and reduce resource use. The test performance and impact on outcomes

2016 Effective Health Care Program (AHRQ)

17. Can We Reduce Lawsuits with Better Communication?

Can We Reduce Lawsuits with Better Communication? Can We Reduce Lawsuits with Better Communication? - CanadiEM Can We Reduce Lawsuits with Better Communication? In by Jesse Kellar July 12, 2016 One concern when practicing in the world of Emergency Medicine is fear of litigation. This fear often leads to defensive medicine practices and over-testing of our patients. 1 One of the main reasons patients seek legal recourse, however, is mis-communication, and not under-testing. 2–4 In primary care (...) about 1.5-2.5 patients per hour 6 , and research shows that only 28% of an EM physician’s time is spent on direct patient care. 7 This means that during a busy shift, you only have about 6-7 minutes per patient. Often in times of peak flow, you could see more than 3 patients per hour, lowering your face-to-face time to only a few minutes per patient. An EM physician’s time is extremely limited, and if we slow down to spend more time with our patients, the waiting room fills up and administrators get

2016 CandiEM

18. Management of Concussion-mild Traumatic Brain Injury (mTBI)

in practice will inevitably and appropriately occur when clinicians take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice. Every healthcare professional making use of these guidelines is responsible for evaluating the appropriateness of applying them in the setting of any particular clinical situation. These guidelines are not intended to represent TRICARE policy. Further, inclusion of recommendations for specific testing (...) present with symptoms or complaints potentially related to brain injury at initial presentation. Strong for Not Reviewed, Amended 3. Excluding patients with indicators for immediate referral, for patients identified by post-deployment screening or who present to care with symptoms or complaints potentially related to brain injury, we suggest against using the following tests to establish the diagnosis of mTBI or direct the care of patients with a history of mTBI: a. Neuroimaging b. Serum biomarkers

2016 VA/DoD Clinical Practice Guidelines

19. Newborn Nursing Care Pathway

months Parent education/ Anticipatory Guidance • Parent Education • Refer to >12 – 72 hr • No tears- tear ducts patent ~ 5 – 7 months Physiological Health: eyes Refer to: Healthy Families BC Website – www.healthyfamiliesbc.ca/parenting11 Newborn Guideline 13: Newborn Nursing Care Pathway Physiological Assessment 0 – 12 hours Period of Stability (POS) >12 – 24 hours >24 – 72 hours >72 hours – 7 days and beyond eyeS (Continued) Variance • Hazy, dull cornea • Pupils unequal, dilated constricted (...) mother’s/ family/supports understanding of newborn physiology and capacity to identify variances that may require further assessments Refer to: • elimination Norm and Normal Variations • Anus patent • Females Labia swollen Labia majora to midline Urethral open behind clitoris – in front of vaginal opening Clitoris maybe enlarged Hymenal tag is normally present Vernix caseosa present between labia Whitish mucoid or pseudomensus • Males Scrotum swollen – rugae present Testes descended palpable

2015 British Columbia Perinatal Health Program

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

obtained from case series, either post-test or pre-test and post-test Clinical practice points ? Recommended best practice based on clinical experience and expert opinion Key messages Key messages for each topic are given with the highest level of evidence available to support them, or with a symbol indicating that they are based on clinical experience or expert opinion. In the key messages, Level I evidence from the Cochrane Database is identified. Levels of evidence were documented according

2015 National Health and Medical Research Council

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