ABSTRACT
Breathlessness, also known as dyspnoea, is a common presenting complaint in the outpatient family physician clinic. It is most commonly caused by respiratory and cardiac disorders, but there are lots of other important aetiologies that need to be considered. The initial goal of assessment is to determine the severity of the dyspnoea, considering the need for oxygen therapy and intubation. Unstable patients usually present with abnormal vital signs, hypoxia, diaphoresis, and/or altered mental states, and require urgent management. Ongoing care depends on the differential diagnosis established by an adequate history and physical examination, and investigations, if available, can aid definitive diagnosis. The family physicians must be equipped to initiate appropriate therapy, conduct continuous monitoring and stabilise an acutely dyspnoeic patient before determining the final disposition of the patient.
ABSTRACT
@#BACKGROUND: Closed loop bowel obstruction is a specific type of mechanical obstruction with a high risk of strangulation and bowel infarction, especially in the small bowel. It is associated with a high mortality rate. Hence, it is important for emergency physicians to identify the presence of strangulation, while making the diagnosis of closed loop small bowel obstruction. METHODS: We reported three patients with strangulated closed loop small bowel obstruction associated with severe abdominal pain, who had been treated at the emergency department. Urgent computerized tomography was performed in the patients. RESULTS: Two patients were discharged with stable conditions, and one patient died after hemodialysis. CONCLUSION: Urgent computerized tomography of the abdomen serves as an important diagnostic tool in view of its ability to detect the site, level and cause of obstruction along with the distinctive CT appearance of closed loop small bowel obstruction and signs of ischemia. Early definitive diagnosis will guide subsequent management and improve outcomes.
ABSTRACT
OBJECTIVE: Outcomes of primary angioplasty can be improved by achieving better pre/post PCI TIMI flows. Earlier administration of antithrombotic and antiplatelet agents may help in achieving better TIMI flows. We evaluated the role of intravenous bolus of enoxaparin administered immediately after the diagnosis of STEMI in the emergency room. METHODOLOGY: We compared the data of 100 consecutive patients in the emergency room, administered intravenous enoxaparin immediately after the diagnosis of STEMI (within 12 hours from the onset of pain). The patients had undergone primary PCI with 100 patients receiving unfractionated heparin administered during primary PCI. All patients received 325 mg Aspirin, 300 mg Clopidogrel on admission and platelet IIb/IIIa antagonist during and after PCI. Enoxaparin group received 0.6 ml IV enoxaparin (0.8 ml if weight > 80 kg). TIMI flows on pre/post PCI angiograms were studied. Clinical end points included death and MACE rates at 30 days. RESULTS: Both the groups were demographically similar. Pre PCI TIMI 2/3 flow increased from 18%-24% (p = 0.385). TIMI 3 flow increased from 8%-17% (p = 0.087). Post PCI TIMI 3 flow increased from 91%-96% (p = 0.251). There was absolute improvement of 9% in pre PCI TIMI 3 flow and 5% in post PCI TIMI 3 flow. There was no significant difference in the mortality and MACE rates at 30 days. CONCLUSION: Enoxaparin administered early in the emergency room after the diagnosis of STEMI improved pre and post PCI TIMI 3 flows with an absolute improvement of 9% in pre PCI TIMI 3 flow. Death and MACE rates showed trends towards improvement although they were not statistically significant.