1/10. Small ruptured abdominal aneurysm diagnosed by emergency physician ultrasound.Ruptured abdominal aortic aneurysms currently have a high rate of both mortality and misdiagnosis. Aneurysms smaller than 4 cm are not commonly considered for surgical repair. This report describes the case of a ruptured abdominal aneurysm measuring less than 4 cm diagnosed by the emergency physician utilizing bedside ultrasound. Within 30 minutes of arrival at the emergency department the patient's abdominal pain resolved spontaneously after defecation. If the bedside ultrasound had not been performed it is possible the patient would have been discharged from the hospital without surgical intervention. Bedside ultrasound by emergency physicians may improve the diagnosis of ruptured aortic aneurysms, particularly if the presentation is atypical.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/10. Aorto caval fistula--the "bursting heart syndrome".Aorto caval fistula is one of the less well recognised complications of abdominal aortic aneurysm seen in accident and emergency departments. It presents in a number of different ways the commonest of which is high output congestive cardiac failure with warm peripheries. Initial diagnosis is based on the index of suspicion of the clinician. However, early diagnosis by the emergency physician and early surgery can markedly improve the patients prognosis.- - - - - - - - - - ranking = 0.16666666666667keywords = physician (Clic here for more details about this article) |
3/10. back pain: a case study.Musculoskeletal complaints, especially back pain without trauma, are frequent health problems seen by nurse practitioners in community emergency centers and office settings. back pain can be a symptom of serious health problems. This article presents the case of a Caucasian male in his early sixties who reported sudden onset of back pain after pushing a heavy object. Careful clinical assessment led the nurse practitioner with the collaborating physician to pursue diagnostic tests, which revealed thoracic and abdominal aortic aneurysms.- - - - - - - - - - ranking = 0.16666666666667keywords = physician (Clic here for more details about this article) |
4/10. beta-Blockers and reduction of cardiac events in noncardiac surgery: clinical applications.Recent studies suggest that beta-blockers administered perioperatively may reduce the risk of adverse cardiac events and mortality in patients who have cardiac risk factors and undergo major noncardiac surgery. The objective of this article is to provide practicing physicians with examples of perioperative beta-blocker use in practice by using several hypothetical cases. Although current evidence describing the effectiveness of perioperative beta-blockade may not address all possible clinical situations, it is possible to formulate an evidence-based approach that will maximize benefit to patients. We describe how information from several sources can be used to guide management of patients with limited exercise tolerance, those at highest risk for perioperative cardiac events, patients who are taking beta-blockers long-term, and those with relative contraindications to beta-blockade. Even though fine points of their use remain to be elucidated, perioperative beta-blocker use is important and can be easily applied in practice by any physician involved with the care of patients perioperatively.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
5/10. Secondary aortoduodenal fistula.Secondary aortoenteric fistula (SAF) is now recognized as an uncommon but exceedingly important complication of abdominal aortic reconstruction. The complication often occurs months to years after the original surgery. The main clinical manifestation of the disease is always upper gastrointestinal bleeding. Treatment of the disease is early surgical intervention. The mortality is high if no prompt operation. We present a case of secondary aortoduodenal fistula (SADF) found 20 days after aortic reconstructive surgery, with the clinical presentation of upper gastrointestinal bleeding. Even immediate exploratory laparotomy was performed, the patient died 48 hrs after the surgical management. Because of the increasing number of elective aortic aneurysm repairs in the aging population, it is likely that more patients with SAF will present to the clinical physicians in the future. So, a high index of suspicion is necessary for prompt diagnosis and treatment of this actually life-threatening event.- - - - - - - - - - ranking = 0.16666666666667keywords = physician (Clic here for more details about this article) |
6/10. Percutaneous drainage and explanation of an infected aortic endoluminal stent graft.Endoluminal repair of abdominal aortic aneurysms (AAAs) has undergone explosive growth in the last decade. Although immediate benefits are attractive to both the patient and the treating physician, concerns regarding long-term success have dampened sustained enthusiasm for this technique. A rare but catastrophic complication is stent graft infection. This case report describes an early infection of an endoluminal aortic stent graft treated initially with percutaneous drainage and ultimately with staged extraanatomic bypass and graft explantation.- - - - - - - - - - ranking = 0.16666666666667keywords = physician (Clic here for more details about this article) |
7/10. Ultrasound by emergency physicians to detect abdominal aortic aneurysms: a UK case series.Early identification of abdominal aortic aneurysms in some patients can be difficult and the diagnosis is missed in up to 30% of patients. Ultrasound cannot be used to identify a leak, but the presence of an aneurysm in an unstable patient is conclusive. With minimal training emergency physicians can easily identify the aorta and thus in the early phase of resuscitation an aneurysm can be confidently excluded. The purpose of the examination is not to delineate the extent of the aneurysm, but to identify those patients that will need emergency surgery. A series of patients presented to the department in an unstable condition with equivocal abdominal signs. An ultrasound scan in the resuscitation room by members of the emergency department revealed an aneurysm, which was enough to convince the vascular surgeons to take the patient straight to theatre with good results. In patients who are stable, computed tomography will continue to be used to evaluate the extent of the aneurysm and identify a leak.- - - - - - - - - - ranking = 0.83333333333333keywords = physician (Clic here for more details about this article) |
8/10. Aortic pseudoaneurysm after penetration by a Simon nitinol inferior vena cava filter.This report describes an unusual complication related to inferior vena cava (IVC) filter placement. A 50-year-old woman undergoing long-term anticoagulation presented to her primary care physician with abdominal pain after a motor vehicle accident. An IVC filter had been placed 7 years earlier. Computed tomography of the abdomen demonstrated a moderate perisplenic hematoma and a fragmented IVC filter penetrating the aorta. A small infrarenal aortic pseudoaneurysm had developed at the penetration site. Wallgraft placement successfully sealed the aneurysm.- - - - - - - - - - ranking = 0.16666666666667keywords = physician (Clic here for more details about this article) |
9/10. Inflammatory abdominal aortic aneurysm.Inflammatory abdominal aortic aneurysm (AAA) accounts for 5% to 10% of all cases of AAA and differs from typical atherosclerotic AAA in many important ways. Although both inflammatory and atherosclerotic AAA most commonly affect the infrarenal portion of the abdominal aorta, patients with the inflammatory variant are younger and usually symptomatic, chiefly from back or abdominal pain. Unlike patients with atherosclerotic AAA, most with the inflammatory variant have an elevated erythrocyte sedimentation rate or abnormalities of other serum inflammatory markers. Computed tomography and magnetic resonance imaging are both sensitive for demonstrating the cuff of soft tissue inflammation surrounding the aneurysm that is characteristic of inflammatory AAA. In contrast to atherosclerotic AAA, the inflammatory variant is characterized pathologically by marked thickening of the aneurysm wall, fibrosis of the adjacent retroperitoneum, and rigid adherence of the adjacent structures to the anterior aneurysm wall. An extraordinary expansion of the adventitia due to inflammation also distinguishes inflammatory from atherosclerotic AAA. Although the pathogenesis of inflammatory AAA appears to involve an immune response localized to the vessel wall, the etiology of the inflammatory reaction is unknown. Inflammatory AAA is almost never associated with inflammation of other arteries. male sex and smoking, the main risk factors for atherosclerotic AAA, are even stronger risk factors for the inflammatory variant. smoking cessation is the first step of medical therapy. Corticosteroids or immunosuppressive therapies may also have roles. Although inflammatory AAA appears less likely to rupture than atherosclerotic AAA, surgical intervention appears prudent once the diameter of the aneurysm exceeds 5.5 cm. Knowing the features of inflammatory AAA should allow physicians to distinguish it from atherosclerotic AAA or from systemic vasculitis and to treat it with the appropriate combination of medical and surgical therapies.- - - - - - - - - - ranking = 0.16666666666667keywords = physician (Clic here for more details about this article) |
10/10. emergency medicine physicians saving time with ultrasound.In an attempt to provide comprehensive and timely patient care, emergency physicians have begun to use ultrasonography to perform and interpret goal-oriented examinations. Reducing time to diagnosis can potentially have a major impact on the treatment of patients with ruptured ectopic pregnancy, leaking aortic aneurysm, and cardiac tamponade, who require time-sensitive surgical intervention. A review of three cases reveals how ultrasonography performed by emergency physicians can rapidly provide valuable diagnostic information and expedite patient care in three different clinical scenarios.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
| | Next -> |