Medical emergencies physical examination

DW, a 78-year-old Caucasian man, presents to the emergency room with complaints of a headache persisting over the last 3 days. Repeated blood pressure measurements average 200/11 0 mm Hg. He reports no other symptoms and physical examination and laboratory tests are unremarkable as is his past medical history with the exception of hypertension diagnosed in his early 60s. DW reports that he is struggling on a fixed retirement income with no prescription coverage and takes "what I can afford." Blood pressure medications are carvedilol 25 mg twice daily, amlodipine 10 mg once daily, torsemide (Demadex )... 

Julie Singer is a 55-year-old white woman who was admitted to the emergency department in acute distress. A previous physical examination showed hypertension and diabetes mellitus type 2. The patient s present medications include enalapril 40 mg, nifedipine 60 mg, and 100 U insulin. A physical examination revealed prominent ankle edema, a palpable spleen, and hepatomegaly. Chest radiography revealed diffuse cardiac enlargement and left ventricular hypertrophy. Based upon the history and clinical hndings, what is your diagnosis and what treatment do you recommend ... 

A 25-year-old woman presents to the emergency department complaining of acute onset of shortness of breath and pleuritic pain. She had been in her usual state of health until 2 days prior when she noted that her left leg was swollen and red. Her only medication was oral contraceptives. Family history was significant for a history of "blood clots" in multiple members of the maternal side of her family. Physical examination demonstrates an anxious woman with stable vital signs. The left lower extremity demonstrates erythema and edema and is tender to touch. Ultrasound reveals a deep vein thrombosis in the left lower extremity chest computed tomography scan confirms the presence of pulmonary emboli. What are the likely risk factors in this woman—hereditary, acquired, or both What therapy is indicated acutely What are the long-term therapy options How long should she be treated Should this individual use oral contraceptives ... 

Preventive Medicine Activity (MIRADCOM). This operation surveys all processes and procedures for medical safety. They review (and approve in selected instances) standard operating procedures. Laboratories are surveyed for toxic chemical levels. Also, chemical procedures are monitored to determine the level of exposure to toxic substances. They perform annual physical examinations on all personnel involved in hazardous operations or exposed to hazardous chemicals. Medical histories are maintained. Techniques of emergency treatment for both standard and unusual incidents are kept updated. 

Section 4.6 consolidates the requirements for medical support for chemical emergencies. It includes requirements for medical plarming and treatment for mass casualty situations immediate medical consultation and surveillance baseline physical examinations for hazardous materials response team members and hazardous materials specialists specifications for the treatment of emergency response employees and other detailed requirements for emergency response personnel and other employee medical programs and records. 

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