ThEmergency
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A simplify way for adequacy of a chest xray
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The new NSTEMI and Unstable angina
The new cpg for unstable angina and nstemi update 2011, for malaysian health service can be found at: www.acadmed.org.my
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Case 2# The Not So Common AUR ~ :)
11 years old malay girl, primary amenorrhea, presented multiple times to casualty for recurrent AUR which relieved after insertion of urinary catheterization. She had advised to be admitted on last presentation for further workup but her father requested AOR (at own risk) discharge in view of work problems. She presented again with acute urinary retention for the past 1/7. This is associated with abdominal pain and distension. Patient otherwise well, no fever, no altered bowel no recent history of fall or trauma.
O/E; well build,
Vital sign monitoring shows
- BP - 110/70
- PR - 100 Spo2- 100% under RA
- Pain Score 6/10
- Lungs : Clear, equal A/E CVS - S1S2 no murmur, no cardiac enlargement or signs of failure noted
- Abdomen soft, tender at the umbilical and suprapubic regions + Mass palpable at the umbilicus region, unable to palpate the lower border, mild tenderness on palpation
- PR - Bogginess at the anterior aspect of the rectum. Tender
US abdomen shows: Enlarged bladder up to the umbilicus CBD was inserted however urine out is only in tubing.
Repeat bedside ultrasound shoes CBD baloon is “outside” the “bladder”.
She was then referred to the gynaecology team where vaginal examinations reveal IMPERFORATED HYMEN She was then planned for elective operations in few days.
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The Cardioversion
This post is using ACLS 2010 (AHA) Guidelines recommendation:-
To make things simple, arrhythmia that originating from atrial need lesser power (joules) of cardioversion as to compared with those from the ventricular in origin.
How we differentiate this? simple. Look at the QRS complexes. If the QRS complexes are narrow, then it is atrial in origin, but if the QRS complexes are wide, (more then 0.12sec) then it is mostly a ventricular in origin. Got that? :)
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anyone knows how i can manage my archieve
- i really like to put all my writing in a proper way so everyone could find it more easily, anyone know how?
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Case 1#
40 y/asian/gentleman, NKMI presented to casualty department after had an MVA between a motorbike vs car. He is under the influence of alcohol. He was brought in by the passerby and no further history able to obtained at the point.
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Whats new in BLS?: ACLS 2010 Guidelines (AHA)
The new ACLS guidelines release somewhere in the mid 2010. There is a multiple changes in the BLS guidelines that i would like to bring in today so that we would see the changes in managing patient with cardiac arrest
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the beginning
This blog is purposely build to share knowledge in Emergency Medicine. This acute care management is build on multiple studies as well as cases that we encountered in our center so that the knowledge may be shared, comments, and hopefully to improve the outcome of the patient care.
It is understandable in each and every cases that we discussed in this blog page is change a bit so that the secrecy of the patient is well kept. Hopefully comments from all over the world will make what we have today, become better for a brighter future.
Thank you for coming and spend some time in commenting and reading the post that being made, hopefully to see you soon. Have fun! and have a great day! :D
