tailieunhanh - Sách: Clinical Problems in General Medicine and Surgery (part 2)

Clinical Problems in General Medicine and Surgery provides a succession of amazing clinical challenges for the reader. It's like a series of medical and surgical emergency shifts, where every patient has something substantial that's wrong with them. It is like real life - that is, the clinical problems are undiagnosed and they present with a series of symptoms, physical signs and abnormal investigations. And things often get worse before the patient improves. Scary stuff for the doctor in charge so best learned in advance, ideally in an armchair!. | Lower limb trauma in a young man You are on duty in the emergency department. The triage nurse asks you to assess a 24-year-old motorcyclist who has been brought in by ambulance. Witnesses reported that he was travelling at 70-80 kph when he lost control on a bend and crashed. You notice that his jeans are bloodstained and that he has a deformed left leg. He is moaning incoherently. QI What are the principles of early management of this patient He is still wearing his full-face motorcycle helmet Q2 What do you do You perform a primary survey and are reassured that his airway is clear and intact. His breathing is not hampered and his oxygen saturation by pulse oximeter is 98 . His blood pressure is 130 80 mm Hg and his heart rate is 100 bpm and of good volume. His helmet is removed. His initial score on the Glasgow Coma Scale is 12 E3 V3 M6 . A face mask is applied and oxygen delivered at 8 l min. A wide-bore catheter is inserted into a peripheral vein of his right arm and an infusion of isotonic saline started. His disorientation settles and his only injury appears to be to his left leg. His clothing is removed and his legs are shown in Figure . 182 Clinical problems PROBLEM 32 What do you see What will you particularly look for on examination Motor function sensation and blood supply to his foot are intact. The radiograph of his left leg is shown in Figure . Q4 What does the radiograph show and how should this problem be managed The orthopaedic surgeon treats his fracture and the next evening you come to see him on the ward to check on his progress. He complains bitterly that the pain in his left leg and foot is now worse than it was the night before and he is requesting more morphine. You note from the drug chart that he has been given a total of 50 mg morphine over the last 12 hours. You examine his legs and feet and note what is shown in the photograph Figure . Fig 183 PROBLEM 321 Lower limb trauma What do you see What is the explanation for .

• Y học thường thức
• postoperative fever
• Postoperative hypotension
• abdominal pain
• profuse diarrhoea
• leg ulcer
• Postoperative confusion
• acute scrotal
• scrotal swelling
• breast lump
• BMC Geriatrics
• Older people
• Chronic venous disease
• Short physical performance battery
• Muscle pump dysfunction