Saturday, April 14, 2012

The Clinical Approach to the Acutely Ill Patient- diagnosis

The Clinical Approach to the Acutely Ill Patient- diagnosis 

The Use of Guidelines and Algorithms 
The Emergency Setting 
Physical Examination 
Primary Survey 
Secondary Survey 
Laboratory Testing 
Plain Abdominal Films 
Intravenous Pyelography 
Computed Tomography 
Magnetic Resonance Imaging 
Chest X-Ray 

The Use of Guidelines and Algorithms
One must distinguish among genuinely life-threatening problems such as urosepsis or kidney rupture, urgent problems such as testicular torsion, and merely troublesome conditions such as cystitis in a healthy young woman.

For example, a patient with a long history of renal colic may present with acute flank pain, tachycardia, tachypnea, and hypotension. If renal ultrasound is normal (lack of upper tract dilatation) and urinalysis reveals no microhematuria, abdominal ultrasonography and/or computed tomography (CT), as indicated in a diagnostic algorithm, will lead to the correct diagnosis of ruptured abdominal aneurysm.

Most preferable are guidelines classified by the level of evidence: S1 guidelines representing an informal consensus of experts, S2 a formal consensus, and S3 a formal consensus adhering to evidenced-based medicine, with the elaboration of clinical algorithms. Guidelines in this form are widely used in other fields such as emergency medicine (e.g., cardiovascular resuscitation, initial management of trauma patients) and are increasingly used in urology.

The Emergency Setting
Repeated checks of the patient and of the working hypothesis are warranted. It is also important to evaluate the results of each step in the therapeutic process.
The current availability of high-tech diagnostic tools does not supplant the need for a urologist who is able to identify the salient البارزة facts in the history and findings on physical examination, as these are the bases for the correct management choice. The urologist must also be skilled in extracting the relevant results from technical or laboratory tests and in integrating these into the given management pathway.



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