scholarly journals Mimics and chameleons of COVID-19: patient presentation and accuracy of triage during the first wave

2021 ◽  
Vol 151 (49-50) ◽  
Keyword(s):  
Patient Presentation

Nursing the uroabdomen patient

2021 ◽  
Vol 12 (3) ◽  
pp. 131-138
Author(s):  
Sam McGaw
Keyword(s):  
Metabolic Acidosis ◽  
Urinary Tract ◽  
Diagnostic Imaging ◽  
Urinary Diversion ◽  
Nursing Care ◽  
Postoperative Care ◽  
Surgical Intervention ◽  
Urinary Catheter ◽  
Abdominal Cavity ◽  
Patient Presentation

Uroabdomen, the presence of urine in the abdominal cavity, commonly occurs in dogs and cats, particularly following a trauma. Initial stabilisation of the patient is essential to treat the multisystemic effects of electrolyte and metabolic derangements, including hyperkalaemia, azotaemia and metabolic acidosis. Diagnosis is confirmed by comparing laboratory analysis of abdominal fluid and serum. Urinary diversion is required, often via placement of a urinary catheter, to prevent continuing urine accumulation. Once haemodynamically stable, diagnostic imaging may be performed to confirm the location of the urinary tract rupture, with several modes of imaging available. Surgical intervention may be necessary to repair the urinary leak, this is dependent on the location and severity of the trauma to the urinary tract. Registered veterinary nurses play an important role in the management of the uroabdomen patient, from initial triage and stabilisation, to assisting with imaging, anaesthetic monitoring and postoperative care. This article will discuss the aetiology of the uroabdomen, patient presentation and how to effectively treat the critical patient. Nursing care is vital for ensuring patient welfare and identifying complications that may arise.

Validation of a Belgian Prediction Model for Patient Encounters at Football Mass Gatherings

2021 ◽  
pp. 1-6
Author(s):  
Kris Spaepen ◽  
Door Lauwaert ◽  
Leonard Kaufman ◽  
Winne AP Haenen ◽  
Ives Hubloue
Keyword(s):  
Pearson Correlation ◽  
First Aid ◽  
Rank Test ◽  
Mean Deviation ◽  
Mass Gatherings ◽  
Actual Patient ◽  
Significant Difference ◽  
Correlation Tests ◽  
The Mean ◽  
Patient Presentation

Abstract Background: To validate the Belgian Plan Risk Manifestations (PRIMA) model, actual patient presentation rates (PPRs) from Belgium’s largest football stadium were compared with predictions provided by existing models and the Belgian PRIMA model. Methods: Actual patient presentations gathered from 41 football games (2010-2019) played at the King Baudouin Stadium (Brussels, Belgium) were compared with predictions by existing models and the PRIMA model. All attendees who sought medical help from in-event health services (IEHS) in the stadium or called 1-1-2 within the closed perimeter around the stadium were included. Data were analyzed by ANOVA, Pearson correlation tests, and Wilcoxon singed-rank test. Results: A total of 1,630,549 people attended the matches, with 626 people needing first aid. Both the PRIMA and the Hartman model over-estimated the number of patient encounters for each occasion. The Arbon model under-estimated patient encounters for 9.75% (95% CI, 0.49-19.01) of the events. When comparing deviations in predictions between the PRIMA model to the other models, there was a significant difference in the mean deviation (Arbon: Z = −5.566, P <.001, r = −.61; Hartman: Z = −4.245, P <.001, r = .47). Conclusion: When comparing the predicted patient encounters, only the Arbon model under-predicted patient presentations, but the Hartman and the PRIMA models consistently over-predicted. Because of continuous over-prediction, the PRIMA model showed significant differences in mean deviation of predicted PPR. The results of this study suggest that the PRIMA model can be used during planning for domestic and international football matches played at the King Baudouin Stadium, but more data and further research are needed.

Abstract P329: White Matter Score Does Not Predict Post-tPA Hemorrhage in Elderly Patients Evaluated Acutely via Telestroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Muhammad Bilal Tariq ◽  
Shekhar Khanpara ◽  
Eliana Bonfante Mejia ◽  
Liang Zhu ◽  
Christy T Ankrom ◽  
...  
Keyword(s):  
White Matter ◽  
Elderly Patients ◽  
The Elderly ◽  
Periventricular White Matter ◽  
Severe Stroke ◽  
Age Related ◽  
Increased Risk ◽  
Symptomatic Intracranial Hemorrhage ◽  
Relationship Of ◽  
Patient Presentation

Background: While tPA may be safe in the elderly, increasing age appears to augment risk of post-tPA symptomatic intracranial hemorrhage (sICH). Age-related white matter changes (ARWMC) are associated with increased sICH. Patients evaluated for acute ischemic stroke (AIS) via telestroke (TS) may not have access to MRI to allow incorporation of microbleeds in tPA decisions. We assessed if increased CT-based ARWMC was associated with increased sICH in elderly patients. Methods: Patients 80 years and older who received tPA for AIS at spoke hospitals were selected from our TS network registry from 9/2015 to 12/2018. TS spoke CT scans from patient presentation were reviewed by three of the authors for periventricular white matter (PWMC) and deep white matter (DWMC) changes. Total ARWMC score, based on the Fazekas score, was collected. Total ARWMC score was either mild (0-2), moderate (3-4), or severe (5-6). PWMC and DWMC were either mild (0-1) or moderate-severe (2-3). Logistic regression adjusted for age, sex, race, ethnicity, NIHSS and premorbid mRS was used to analyze relationship of ARWMC scores with sICH and patient-outcomes. Results: Of 241 patients, median age overall was 86 years (IQR 83-90), and 66% were female. The overall median ARWMC score was 3 (IQR 2-5). Regression analysis showed that more severe ARWMC scores did not lead to higher frequency of post-tPA ICH (moderate OR 0.57, CI 0.19-1.71; severe OR 1.32, CI 0.48-3.65) including sICH (moderate OR 0.78, CI 0.21-2.94; severe OR 2.09, CI 0.62-7.02). Similarly, severe PWMC and DWMC were not associated with increased risk of post-tPA ICH (PWMC OR 1.31, CI 0.51-3.38; DWMC OR 1.25, CI 0.52-3.01), including sICH (PWMC OR 1.61, CI 0.51-5.08; DWMC OR 1.81, CI 0.65-5.01). In our cohort, older patients had no difference in hemorrhage (ICH OR 0.93 CI 0.85-1.00: sICH OR 0.95 CI 0.86-1.04), and patients with less severe stroke were more likely to have hemorrhage (ICH OR 1.06 CI 1.02-1.10; sICH OR 1.08 CI 1.03-1.13). IRR among the CT scan readers was moderate (k=0.504). Conclusions: ARWMC scores were not associated with post-tPA ICH in the elderly. Our analysis lends support for the use of tPA despite severity of white matter disease. ARWMC should not be used to assist in tPA decision-making in elderly patients via telestroke.

scholarly journals Successful Antimicrobial Treatment of Phlegmonous Gastritis: A Case Report and Literature Review

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Madiha Iqbal ◽  
Rabia Saleem ◽  
Salman Ahmed ◽  
Prachi Jani ◽  
Salvador Alvarez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antimicrobial Treatment ◽  
Myelogenous Leukemia ◽  
Causative Organism ◽  
The Past ◽  
Phlegmonous Gastritis ◽  
Acute Myelogenous ◽  
Immunocompromised State ◽  
High Index Of Suspicion ◽  
Patient Presentation

Phlegmonous gastritis is an uncommon acute bacterial infection of the stomach that carries a fatal prognosis in spite of the advent of antibiotics. A high index of suspicion is required in patients with risk factors. An immunocompromised state is identified as one of the most important risk factors. We hereby report a case of successful antimicrobial treatment of phlegmonous gastritis in a patient who was receiving intensive chemotherapy for acute myelogenous leukemia. We have also carried out a review of literature over the past ten years. Streptococcus pyogenes is identified as the most common causative organism, and patient presentation is usually nonspecific. Conservative treatment with prompt institution of antibiotics can lead to rapid resolution in the majority of patients.

scholarly journals What Ifs and Multi-directional symptoms PBL cases: two simple and functional adjuncts to problem-based learning materials

2019 ◽  
Vol 27 (8) ◽  
Author(s):  
Jeff Schwartz
Keyword(s):  
Medical Education ◽  
Clinical Reasoning ◽  
Problem Based Learning ◽  
New Materials ◽  
Learning Materials ◽  
Case Based Learning ◽  
Patient Presentation ◽  
Case Based ◽  
Management Issues

Although problem-based learning (PBL) is widely used in medical education for its many virtues, a number of deficiencies exist. As means of enhancing the experience of PBL for students, two relatively simple adjuncts to PBL are presented. What Ifs are short hypothetical scenarios, appended to the end of a PBL case, that require students to revisit elements of the PBL case just completed and apply their newly acquired knowledge to clinical reasoning in an altered scenario or to explore anew another dimension of the PBL case. Multi-directional symptoms PBL cases are cases where a common presenting symptom, rather than a specific pathology, is the focus of the PBL case and, following a core narrative of the initial patient presentation, a series of independent continuation narratives with appropriate histories, examination findings and investigation results, lead students to divergent diagnoses and management issues. In addition to keeping the PBL process fresh by rotating new materials regularly, these adjuncts extend the PBL process in the direction of case-based learning.

scholarly journals Conservative treatment of a scoliosis patient after two heart surgeries in early childhood – A case report

2021 ◽  
Vol 77 (2) ◽  
Author(s):  
Hans-Rudolf Weiss ◽  
Manuel Lay ◽  
Tamisha Best-Gittens ◽  
Marc Moramarco ◽  
Mario Jimeranez
Keyword(s):  
Case Report ◽  
Conservative Treatment ◽  
Best Practice ◽  
Tanner Stage ◽  
Growth Spurt ◽  
Brace Treatment ◽  
Pubertal Growth Spurt ◽  
Patient Presentation ◽  
Main Curve

Introduction: This is a case report of a juvenile female patient with scoliosis following two heart surgeries for congenital heart disease (CHD).Patient presentation, management and outcome: Initially, the premenarchial female was 9 years old and had a Tanner stage 2–3 with a single thoracic curve of 65° Cobb. Because of the high risk for progression, immediate brace treatment was proposed as the father declined surgery. The patient received intensive treatment according to the Schroth Best Practice® programme and a Gensingen Brace® designed for large thoracic curves. Over the 18 months following the initial visit, she received two additional braces. As a result, the progression of the main curve was prevented. The patient continues to maintain an improved cosmetic result and is currently at a Risser 2.Conclusion: Surgery performed for CHD in rare cases may lead to stiff spinal deformity as a consequence of that surgery. Progression of a severe and stiff curve was prevented during the most vulnerable phase of the pubertal growth spurt with an improved clinical result. Therefore, we assume that the patient may have a normal life in adulthood with minor restrictions only. Supported by pattern-specific high correction exercises and braces, these typical single thoracic curves can be re-compensated to a more balanced appearance, less prone to progression in adulthood.Clinical implications: Because of the relative high risks of spinal fusion and the long-term unknowns of such an intervention, high-impact conservative treatment should be implemented first before surgical correction is considered.

Challenging Cases in Pediatric Ophthalmology

2005 ◽  
Author(s):  
David B. Granet ◽  
Shira L. Robbins ◽  
Leslie Julia Baber
Keyword(s):  
Case Reports ◽  
Final Outcome ◽  
Pediatric Ophthalmology ◽  
Learning Tool ◽  
High Interest ◽  
Patient Presentation

Developed by leading pediatric ophthalmologists, this all-new clinical and learning tool brings you 88 concise, high-interest case reports. From patient presentation to final outcome, you’ll see exactly how it’s done.

What a Pain in the Neck!

2020 ◽  
pp. 13-22
Author(s):  
Walter Wiswell ◽  
Bryan McCarty
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Cervical Spine ◽  
Neck Pain ◽  
Pediatric Patient ◽  
Ct Scans ◽  
X Rays ◽  
Pros And Cons ◽  
Current Guidelines ◽  
Patient Presentation

The chapter on cervical spine controversies in children describes what initial steps need to be taken in assessing a pediatric patient with neck pain after trauma, and discusses the decision-making process that goes into further evaluation and testing. Clinical actions and assessments of the patient on-scene, whether to pursue imaging once in the emergency department setting, and what imaging is most appropriate depending on the patient presentation are discussed. Indications and contraindications for cervical spine immobilization and spinal positioning, including proper techniques based on a patient’s age and whether or not such steps are necessary. It also discusses the pros and cons of x-rays, CT scans, and MRIs in the context of pediatric neck trauma, and current guidelines that should be followed when deciding to order such studies.

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