Emergency medicine : the principles of practice by Gordian W. O. Fulde

By Gordian W. O. Fulde

The last word emergency drugs textbook from the popular Professor Gordian Fulde now in a brand new version. Emergency medication 6e provides evidence-based medical administration and remedy recommendation for emergency medication scholars and practitioners in Australasia. The large diversity of themes contain paediatric, geriatric, gynaecology, psychiatric, dental, rural and Indigenous shows, making sure readers are good prepared  Read more...

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G. 1 unit of pH → ↓ ionised Ca2+ by 3–8% Causes of hypocalcaemia 9 Factitious Hypoalbuminaemia ↓ PTH Hypoparathyroidism Pseudohypoparathyroidism Parathyroid/thyroid surgery Radical neck dissection Radiation therapy for head/neck ca ↓ Vitamin D Nutritional malabsorption ↓ Intake Renal disease Pronounced hypophosphataemia ↑ Calcitonin Medullary thyroid ca ↑ Phosphate Tumour lysis syndrome Rhabdomyolysis CRF ↑ Citrate in serum Massive blood transfusion Plasmapheresis ↑ Bone formation/ turnover Medications Malignancy (prostate, breast, lung, chondrosarcoma) Osteomalacia Others Sepsis Severe burns Pancreatitis (calcium complex formation) QR48 Phenytoin Phenobarbitone Colchicine Cisplatin Metabolic equations and electrolytes Symptoms and signs of hypocalcaemia Symptoms dependent on the absolute value and rate of fall in Ca2+.

P waves: • Relationship of P waves to QRS complex: is each P wave followed by a QRS complex? • Is the PR interval the same duration for all complexes? • If all P waves and QRS complexes are completely unrelated = AV dissociation. QRS complex: Look at the: • axis • amplitude • duration—short (narrow complex), normal or widened (broad complex)? Broad complexes = possible bundle branch block (BBB), drug toxicity, electrolyte abnormalities. ST segment: Is the ST segment: • isoelectric (lies horizontally on the baseline)—normal?

Axis: • Is the average direction of the spread of depolarisation through the ventricles when looking at the front of the patient. • Leads aVR and II look at the heart from opposite directions. , deflections are mainly negative in aVR and positive in II). • Normal axis is a positive deflection in I, II, III as the depolarising wave is spreading towards these leads. 2 Normal QRS axis and axis deviation Most ECGs show either a normal axis or left or right axis deviation. Occasionally, the QRS axis is between −90° and 180°.

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