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Example text

Management Assuming that the history and examination are consistent with the diagnosis of an acute exacerbation of asthma, then oxygen, bronchodilators and steroids are the first-line treatments. • Oxygen: maximum inspired oxygen by face mask should be administered. This is best achieved by using a mask with a reservoir bag that can deliver inspired oxygen concentrations of 85% at a flow rate of 15 L/min. Do not be concerned about high-flow oxygen in this situation: it will not cause progressive hypoventilation and hypercapnia, although these might occur if the patient becomes exhausted.

Give intravenous colloid (500 mL) swiftly and reassess. Close haemodynamic monitoring is required, ideally in the high-dependency unit or intensive care unit, so that deterioration can be spotted promptly and thrombolysis administered. Repeated embolic events despite adequate anticoagulation may require mechanical intervention, eg insertion of a filter device into the inferior vena cava. 11 Chest infection/ pneumonia Scenario A 68-year-old woman with no significant past medical history is sent to the Medical Assessment Unit with a 48-hour history of Important points to remember about PE • Common and potentially lifethreatening condition.

ECG: in PE the ECG is commonly normal but it may show sinus tachycardia; T-wave inversion in V1–V3; an ‘S1Q3T3’ pattern, commonly described in the medical literature and reflecting axis change as a result of sudden increase in right ventricular D-dimer is very helpful if used wisely, but it should not be used as a routine screening test for PE. • Blood gases: these typically show hypocapnia in PE because of hyperventilation. Hypoxia may or may not be present. If there is a base deficit, your concerns should be heightened because it indicates secondary cardiovascular compromise.

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Acute medicine by Coll.


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