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EMERGENCIES

Cardiac Tamponade

Introduction Cardiac tamponade is the result of compression of the myocardium by fluid, gas, pus, blood, or at combination of substances. It occurs in a physiologic continuum reflecting the amount of fluid, the rate of accumulation, and the nature of the heart. The result is increased pericardial pressure, which causes decreased ventricle compliance and decreased …

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Stridor

Introduction Stridor is an abnormal, high-pitched sound produced by turbulent airflow through a partially obstructed airway. Stridor is a dangerous finding and may indicate imminent airway obstruction. It can be inspiratory, expiratory or biphasic. Clinical presentation of stridor Hypoxia Respiratory distress Altered mental status Inability to speak Inability to swallow Differential diagnoses Infectious causes Croup, …

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Upper Gastrointestinal Bleeding

Introduction Upper gastrointestinal bleeding is a bleeding from the lower oesophagus, stomach or duodenum up to the level of ligament of Treitz. It occurs worldwide and is responsible for significant mortality and morbidity. Causes of upper gastrointestinal bleeding Major causes of upper GI bleeding include: Bleeding from Peptic ulcer disease Bleeding from oesophageal and gastric …

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Thyroid Storm (Thyrotoxic Crisis)

Introduction Thyroid storm also known as thyrotoxic crisis is a rare but life-threatening condition of hypermetabolic state induced by excessive release of thyroid hormones (THs) in individuals with thyrotoxicosis. Mortality rate is up to 30% even with treatment. Causes of death include cardiac failure, arrythmias and hyperthermia Precipitants of thyroid storm (thyrotoxic crisis) include the …

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Pulmonary thromboembolism

Introduction Pulmonary thromboembolism is a clinically significant obstruction of a part or the whole of the pulmonary arterial tree usually by thrombus that becomes detached from its sites of formation outside the lung. The emboli is swept downstream until it is arrested at points of intrapulmonary vascular narrowing. Predisposing factors for pulmonary thromboembolism The virchow\’s …

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Pneumothorax

Introduction Pneumothorax is the presence of air or gas in the pleural cavity which can impair oxygenation and/or ventilation. This occurs in apparently normal lung or in the presence of an underlying lung disease. Clinical results are dependent on the degree of collapse of the lung on the affected side. Classes of pneumothorax Pneumothorax is classified …

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Hypoglycemia

Introduction Hypoglycemia is a blood glucose level less than 2.5 mmol/L (45 mg/dL). It may occur in a fasting state or may be post prandial. Causes of hypoglycemia Hypoglycemia is commonly iatrogenic Antidiabetic drugs use Associated with quinine and salicylates use After overnight fast Missed meal(s)  Exercise Intensive insulin therapy May follow weight loss May …

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Myxoedema Coma

Introduction Myxoedema coma is a life-threatening complication of hypothyroidism. It follows a background of long-standing hypothyroidism. Clinical features of myxoedema coma Myxoedema coma may be precipitated by exposure to cold, infection, trauma and central nervous system suppressants Coma with extreme hypothermia, temperatures 24 – 32ºC Seizures Areflexia CO retention and respiratory depression due to decreased …

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Hypertensive Emergencies

Introduction Hypertensive emergency is a condition where there is a severely elevated blood pressure (>180/120 mmHg) with evidence of target organ damage such as: Neurologic (e.g. altered consciousness) Cardiovascular (myocardial ischeamia, left ventricular failure) Renal deterioration Fundoscopic abnormalities Presentations include: Aortic dissection Hypertensive encephalopathy Malignant hypertension Eclampsia Aetiology of hypertensive emergencies Improperly managed hypertension Renal …

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Hyponatremia

Introduction Hyponatraemia is a serum sodium level of less than 135 millimoles per litre. It is condition that occurs when the level of sodium in the blood is too low. Plasma Na+<135mmol/L = Hyponatraemia Aetiology There are different types of hyponatraemia with varied aetiologies Pseudo-hyponatraemia: With normal plasma osmolality as seen in hyperlipidaemia or hyper …

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Hypokalaemia

Introduction Hypokalaemia is a condition where there is a low Potassium level in the plasma. It is a plasma potassium less than 3.5 millimoles per Litre. Normal plasma potassium level is any value between 3.5-5 millimoles per litre. Hypokalaemia is the most common electrolyte abnormality in hospitalised patients; mostly caused by drugs and GI disease. …

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Hypernatraemia

Introduction A high concentration of sodium in the blood is known as hypernatraemia. It  is as plasma sodium of more than 145 Millimoles per liter. Majority of cases result from water loss in the absence of sodium loss, when the thirst mechanism is impaired, or (infrequently) due to primary sodium gain Clinical features Mainly neurologic: …

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Hyperkalemia

Introduction Hyperkalemia is a condition where the serum or plasma potassium level is above the upper limits of normal, usually greater than 5.0 mEq/L to 5.5 mEq/L. Actiology Hyperkalemia usually occurs as a result of potassium release from cells. Decreased renal excretion of K as in renal failure Decreased potassium secretion Impaired sodium reabsorption in …

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