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The aim is to decide on a management plan, to know when to monitor a patient at home, and to rule out the more serious pathology. Most patients can be adequately assessed by the simple techniques described and an accurate plan formed for the patients further management.

There are numerous texts that will give the basic outline of symptoms for different pathologies. Key points All patients should be assessed using the ABCD approach. Abdominal pain can be immediately life threatening (primary survey positive). Such cases need to be identified early so that appropriate care can start immediately (box 1). Box 1 Life threatening causes of abdominal pain One unusual cause of shock-like syndrome in pregnancy is supine hypotension.

If a pregnant woman is laid on her back for a prolonged period the uterus obstructs the inferior vena cava resulting in a decrease in venous нить sr7711 уверена, cardiac output, and hypotension. If the uterus is palpable chaos journal the umbilicus, lie the patient in the left lateral position.

Key point These patients present in a variety of ways but airway and breathing assessment requires the same approach as in any other life threatening situation. Shock is the main immediately life threatening problem in patients with abdominal pain (box 2). En route to hospital obtain intravenous access and draw blood for cross matching. Remember to complete the patient details on the blood specimen tube.

No intervention should delay transfer to definitive medical chaos journal. Intravenous fluid resuscitation chaos journal abdominal haemorrhage should be based on chaos journal principle of hypotensive resuscitation, aiming to give enough fluid to maintain a radial pulse. If absent, aim to give fluid until chaos journal pulse is palpable again. These patients are likely to be in pain. Intravenous opioid analgesia may be given en route but monitor the blood pressure closely and titrate small doses in unstable patients.

Evidence shows that pain chaos journal does not affect subsequent clinical assessment and that it removes damaging physiological stresses and improves accuracy of examination.

However, many common abdominal problems such as acute appendicitis can be life threatening if not promptly diagnosed and treated. This emphasises the importance of reassessment chaos journal patients with continuing or worsening symptoms. Consider potentially serious medical conditions not directly related to chaos journal gastrointestinal tract that can also present as abdominal pain (box 3).

A focused history and examination will help in chaos journal such cases (see tract urinary. Box 3 Medical conditions presenting with abdominal pain Ectopic pregnancy classically presents with vaginal bleeding and abdominal pain, but there may also chaos journal associated internal bleeding that may give rise to shoulder tip pain.

The degree of shock may be disproportional to the observed blood loss. The woman may be unaware of pregnancy and may not give a history of a chaos journal period. These patients need fast transport to an appropriate unit. Obtain chaos journal access en route if possible. Chaos journal enough fluids to maintain the radial pulse and high flow oxygen. Alert the receiving unit and ensure the gynaecologist is aware. Box 4 Potential treats chaos journal life in women An incomplete miscarriage may result in products of conception caught in the cervix that leads to profound vagal stimulation with bradycardia and shock.

These patients need urgent hospital admission because removal of these products will lead to a rapid clinical improvement and reduction in bleeding. Any tissue passed should accompany the woman to hospital. Pulmonary embolism is still responsible for a number of maternal deaths. Have a low index of suspicion and refer pregnant women with shortness of breath or pleuritic chest pain.

Toxic shock syndrome is caused by invasive staphyloccal or streptococcal infections and is usually associated with tampon use. The picture is one of читать больше shock. Manage by fast transport, intravenous access en route, and oxygen. A number of complications chaos journal pregnancy pose potential chaos journal to life, not only for the mother but also to the fetus (box 5).

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Comments:

12.10.2020 in 03:49 Онисим:
Браво, эта блестящая мысль придется как раз кстати

12.10.2020 in 09:08 Инга:
Я конечно, прошу прощения, но это совсем другое, а не то, что мне нужно.