Case Files: Emergency Medicine, 4e. Author(s): Eugene C. Toy; Adam J. Rosh; Barry C. Simon; Katrin Y. Takenaka; Terrence H. Liu. View by: Case Topic Case. CASE FILES EMERGENCY MEDICINE 3RD EDITION. Free download and install Case Files Emergency Medicine, 3rd Edition for iOS(iPhone iPad) without jailbreak on vShare.
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The point of maximal impulse PMI should be ascertained, and the heart auscultated at the apex as well as the base.
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- Case Files Emergency Medicine, Third Edition
It is important to note whether the case files emergency medicine 3rd rhythm is regular or irregular. Heart sounds including S3 and S4murmurs, clicks, and rubs should be characterized.
Systolic flow mur- murs are fairly common in pregnant women because of the increased cardiac output, but significant diastolic murmurs are unusual. The lung fields should be examined systematically and thoroughly.
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Stridor, wheezes, rales, and rhonchi should be recorded. The clini- cian should also search for evidence of consolidation bronchial breath case files emergency medicine 3rd, egophony and increased work of breathing retractions, abdominal breathing, accessory muscle use.
The abdomen should be inspected for scars, disten- sion, masses, and discoloration. For instance, the Grey-Turner sign of bruising at the flank areas may indicate intraabdominal or retroperitoneal hemorrhage.
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Auscultation should identify normal versus high-pitched and case files emergency medicine 3rd ver- sus hypoactive bowel sounds. The abdomen should be percussed for the pres- ence of shifting dullness indicating ascites.
Then careful palpation should begin away from the area of pain and progress to include the whole abdomen to assess for tenderness, masses, organomegaly ie, spleen or liverand peritoneal signs.
Guarding and whether it is voluntary or involuntary should be noted. Back and spine examination: The back should be assessed for symmetry, case files emergency medicine 3rd ness, or masses. The flank regions particularly are important to assess for pain on percussion that may indicate renal disease.
The external genitalia should be inspected, then the speculum used to visualize the cervix and vagina.
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A bimanual examination should attempt to elicit cervical motion tenderness, uterine size, and ovarian masses or tenderness. The penis should be examined for hypospadias, lesions, and discharge. The scrotum should be palpated for tenderness and masses.
If a mass is pres- ent, it can be transilluminated to distinguish between solid and cystic masses. The groin region should be carefully palpated for bulging hernias upon rest and provocation coughing, standing.
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A rectal examination will reveal masses in the poste- rior pelvis and may identify gross or occult blood in the stool. In females, nodularity and tenderness in the uterosacral ligament may be signs of endo- metriosis. The posterior uterus and palpable masses in the cul-de-sac may be identified by rectal examination.