Suicide is the 14th global cause of death (uptodate.com). Even though we try, screening doesn’t seem to reduce mortality. We can still do things to identify those patients in high or in the highest risk of committing suicide. Even though we must take every suicide threat from patients seriously, not all patients who claim they…
Acute calculous cholecystitis / Colecistitis aguda calculosa.
Acute cholecystitis (inflammation of the gallbladder) results from injury from a gallstone, like impactation or cystic duct obstruction. Sometimes inflammation occurs without gallstone disease due to infection of bile (acalculous cholecystitis). The main difference between a patient who complains from abdominal pain and suffers from uncomplicated gallstone disease and acute cholecystitis is the evidence of…
Gallstone disease in adults / Cólico biliar en el adulto.
Abdominal pain is very common in the emergency department. Plenty of times patients complain of pain, but the physical examination results completely normal. Because of WHERE it hurts (upper right quadrant), suspicion of gallstone diseases rises. Things get tricky when lab results are normal, and the possibility of a final diagnosis in the ED disappears…
Cardiac tamponade / Taponamiento cardiaco.
A major complication of trauma and pericarditis, and a feared cause of hypotension and obstructive shock, cardiac tamponade occurs when there’s fluid in the pericardial space. This may be from effusion (pericarditis, serositis) or blood, such as in thoracic trauma. As the heart is “imprisoned” within its own pericardium, diastole is restricted, and ultimately systole…
Pericardial disease: 2015 ESC guidelines / Pericarditis, diagnóstico según la ESC, 2015.
The following illustration summarizes both clinical presentation and diagnostic procedure and criteria of pericardial disease, as well as one of the worst complications: constriction and arrest (due to obstructive shock). Remember the following: you will start suspecting it after seeing, listening and talking to your patient. You will use ECG, bio-markers and imaging to confirm…
Abdominal pain in the ED / Dolor abdominal en urgencias.
While very common in the emergency department, abdominal pain can be challenging, since the causes range from functional disorders, non severe organic diseases up to bad acute abdomen real life threatening emergencies. Women and elderly patients represent an even more challenging population due to an expanded list of possible diseases and higher frequency of atypical…
Atrial fibrillation and increased stroke risk / Fibrilación auricular y riesgo elevado de ictus.
Atrial fibrillation is the most common arrhythmia. As sinus rhythm fails and an irregular pace is established, turbulence in atria increases the risk of thrombus formation, embolism and ischemic stroke. It also increases the risk of tachyarrhythmia, altering end diastolic volume, causing heart failure. In order to prevent stroke, depending on certain risk factors and…
“Do not do” and “Do” recomendations in the elderly patient.
From SEMFYC’s “Recomendaciones no hacer y hacer en el anciano” (https://www.semfyc.es/biblioteca/recomendaciones-no-hacer-y-hacer-en-el-anciano/) The following illustration is a summary of some of things we must be aware of when treating and prescribing medication for an elderly patient. Different chronic conditions present, lots of medication and higher risk for adverse effects, much more sensibility and less glomerular filtrate,…
Management of COPD exacerbations
Patients with a chronic pulmonary obstructive disease will suffer exacerbations from time to time. It’s defined as an increase in symptoms beyond the normal day to day variability that then leads to a change in medication. It may also be defined as a worsening of the usual dyspnea, wheezing, tight chest feeling, coughing and expectoration…
Heart failure with preserved ejection fraction pathophysiology.
Also known as “diastolic heart failure”. Heart failure is one of the most important causes of dyspnea and fatigue in patients who attend to the ED with this chief complaint. Dyspnea is mostly on exertion, along with orthopnea, increased nocturia (urination at night, having to wake up) and possible progressive lower extremity edema, specially at…
