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18

Pulmonary Embolism

Say what?Virchow’s triad (stasis, endothelial injury, hypercoagulability) leads to thrombosis in your patient’s deep venous system. Part of the formed thrombus breaks loose, and gets stuck in your patient’s pulmonary vasculature.Your patient will report (in decreasing order of frequency)1:DyspneaPleuritic chest painCoughHemoptysisDiaphoresisNonpleuritic chest painSyncope (massive PE)Nothing (asymptomatic)You will see and hear (in decreasing order of frequency)1:Tachypnea…  
foamneedssoap.com
over 4 years ago
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Asthma in Adults

Say what? Chronic inflammation of your patient’s bronchi. Their bronchi are hypersensitive to environmental or intrinsic stimuli, leading to reversible episodes of bronchial constriction and mucosal edema. Your patient will report: Wheezing Cough Dyspnea Chest tightness Chest pain You will ask about: Comorbid diseases - you do not want to overlook another etiology to your…  
foamneedssoap.com
over 4 years ago
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Diagnose on Sight: "I feel like I am having a heart attack"

Diagnose on Sight: "I feel like I am having a heart attack". The chest radiograph provides the diagnostic clue.  
aliem.com
over 4 years ago
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18

Pigtail Insertion - Emergency Physicians Monthly

It’s a typical busy Saturday night in your ED. The next chart you pick up is a 15-year-old male with cough shortness of breath and chest pain for one day. He is tall, with normal vitals and in no distress, and you note decreased breath sounds on his right side. Chest X-ray confirms it: pneumothorax.  
epmonthly.com
over 4 years ago
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2

Imaging Case of the Week 149

The following frontal chest x-ray from a 80 year old was obtained as part of a pre-operative work up prior to lower limb surgery. What radiological sign can be noted?  
emergucate.com
over 4 years ago
Holly leaf sign 150x64
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Imaging Case of the Week 149 Answer

The chest x-ray shows pleural plaques more prominent on the right midzone, in the shape of a leaf. This is called the Holly leaf sign, seen in asbestosis. The bizarre plaques are bordered by calcified edges.  
emergucate.com
over 4 years ago
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Imaging Case of the Week 148 Answer

The chest x-rays show a thick walled cavity in the right middle lobe and an airspace opacity in the left upper lobe with cavity. There is a patchy opacity in the left lingular lobe. There is no pneumothorax or pleural effusion and the cardiomediastinal contour appears normal.  
emergucate.com
over 4 years ago
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Imaging Case of the Week 148

These chest x-rays are from a 21 year old presenting with a fever, cough and dyspnoea. He has no past medical illness and he is not an intravenous drug user. What can be discerned from the images?  
emergucate.com
over 4 years ago
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2

Pediatric Refractory Ventricular Fibrillation

Thank you to our own Ross Simcoe MD for submitting a case-report on which this is loosely based 16 year old M is struck in the chest by a baseball, falls to the  
jeffem.org
over 4 years ago
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CPR in Pectus Excavatum |

Some pectus excavatum patients have a metal ‘Nuss bar’ inserted below the sternum which can make chest compressions more difficult. In those without one, standard compression depths compress the left ventricle more than in non-pectus subjects, and might lead to myocardial injury.  
resus.me
over 4 years ago
Sinaiem dark
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3800

You are catching up on some charts in the resuscitation area of your ED when your triage nurse pushes in a 37 yo M with no PMHX, who presented to your ED complaining of sudden onset lightheadedness and L sided chest pain about 10 minutes PTA while at rest. No prior episodes. No CAD risk factors. No illicit drug use. No family risk factors. The patient appears uncomfortable, diaphoretic and is clutching his chest.  
sinaiem.org
over 4 years ago
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Treatments for unwanted male pattern hair growth in women | Cochrane

Background Up to 5% to 10% of women are hirsute (hair in areas where normally only men have hairs such as moustache, beard area, chest, belly, back etc). The most common cause is polycystic ovary syndrome. Hirsutism can lead to psychological distress, low self esteem, decreased self image, depression, feelings of shame and social difficulties.  
cochrane.org
over 4 years ago
Sinaiem dark
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bloated-and-upset

47 y/o female PMH appendectomy presents with three days of worsening abdominal pain and constipation. Over the past day she has had persistent vomiting. She appears ill and has a diffusely tender abdomen. You quickly order labs and an obstructive series with upright chest XR with concern for a perforated viscus. To your surprise the CXR shows no signs of air under the diaphragm. Are there other signs of pneumoperitoneum could you look for on abdominal films?  
sinaiem.org
over 4 years ago
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Imaging Case of the Week 152 Answer

The chest x-rays show  pneumomediastinum. The expiratory chest x-ray also shows a continuous diaphragm sign due to the mediastinal air. There is peri bronchial thickening. There is no pneumothorax or air space consolidation.  
emergucate.com
over 4 years ago
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Imaging Case of the Week 152

The following inspiratory and expiratory chest x-rays are from a 20 year old with an asthma exacerbation. What can be seen?  
emergucate.com
over 4 years ago
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51

Paediatric Respiratory Medicine

Paediatric Respiratory Medicine, second edition remains the first point of reference for those faced with treating acute or chronic respiratory problems. The handbook discusses the approach to clinical problems, specific conditions, supportive care and practical procedures, and includes vital appendices covering specific tests and statistics. Designed as a practical guide, it serves general and specialist paediatricians at both consultant and trainee level. The book is divided into five parts. Part I provides a practical approach to acute and non-acute clinical problems. Part II provides detailed information about common and more rare clinical conditions. Part III provides useful information on supportive care, including for example, use of non-invasive ventilation and the care of a child with a tracheotomy. Part IV gives details on how to perform several practical procedures, such as ciliary brush biopsy, flexible bronchoscopy, and inserting a chest drain. The appendices provide information on lung function testing and tables of age-corrected normal values for several respiratory parameters. Written by three consultants in paediatric respiratory medicine, their expertise in the subject provides all levels of paediatricians with practical guide on a subject that is increasingly relevant in paediatrics.  
books.google.co.uk
over 4 years ago
Www.bmj
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An unusual case of severe anaemia and lymphocytosis

An 83 year old man was referred to the haematology clinic with a three week history of fatigue and shortness of breath on exertion. His symptoms had progressively worsened and on the day of review he felt breathless at rest. He had noted that he bruised easily over his arms and had recently been admitted for recurrent chest infections that required intravenous antibiotics. He had also lost 5 kg in weight during the past month.  
feeds.bmj.com
over 4 years ago
Www.bmj
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A woman with upper and lower airway symptoms

A 65 year old woman presented with a four week history of lethargy, cough, and feeling generally unwell. She had recently been treated for an ear infection and had occasional epistaxis but had no other medical history. She had never smoked. On examination she was did not have a fever and had crepitations in the base of her right lung. A chest radiograph showed right basal consolidation. Her blood tests showed: white blood cell count 17.5×109 cells/L (reference range 4-11), C reactive protein 3171 nmol/L (<47.6), urea 9.8 mmol/L (2.5-7.8), and creatinine 98 µmol/L (62-124). A diagnosis of community acquired pneumonia was made.  
feeds.bmj.com
over 4 years ago
Www.bmj
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42

An unusual case of severe anaemia and lymphocytosis

An 83 year old man was referred to the haematology clinic with a three week history of fatigue and shortness of breath on exertion. His symptoms had progressively worsened and on the day of review he felt breathless at rest. He had noted that he bruised easily over his arms and had recently been admitted for recurrent chest infections that required intravenous antibiotics. He had also lost 5 kg in weight during the past month.  
feeds.bmj.com
over 4 years ago
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2

A woman with upper and lower airway symptoms

A 65 year old woman presented with a four week history of lethargy, cough, and feeling generally unwell. She had recently been treated for an ear infection and had occasional epistaxis but had no other medical history. She had never smoked. On examination she was did not have a fever and had crepitations in the base of her right lung. A chest radiograph showed right basal consolidation. Her blood tests showed: white blood cell count 17.5×109 cells/L (reference range 4-11), C reactive protein 3171 nmol/L (<47.6), urea 9.8 mmol/L (2.5-7.8), and creatinine 98 µmol/L (62-124). A diagnosis of community acquired pneumonia was made.  
feeds.bmj.com
over 4 years ago