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The Gist of Emergency Medicine - part 7

thử nghiệm mang thai / dự phòng prn (ovral ® prn), soi cổ tử cung / pháp y kiểm tra prn (ảnh prn), bảo vệ trẻ em, báo cáo thích hợp, tư vấn, thừa nhận prn. → postscript → xã hội tiếp tục phải trả một mức giá ngày càng tăng | The Gist of Emergency Medicine 115 shaken baby syndrome coma seizures retinal hemorrhages new or healing rib extremity fractures other injuries. Munchausen s by proxy e.g. apnea spells sepsis poisoning. bruises red-blue 1 day old green 5 days yellow 7 days brown 10 days remember that mongolian spots or folk remedies may simulate bruises. coagulation studies skeletal survey CT scan MRI parent caretaker volunteers that they were abused as a child L ACBC s supportive care rule out legitimate injuries illness e.g. accidental burns leukemia treat other problems e.g. injuries STD sexually transmitted disease pregnancy test prophylaxis prn ovral prn colposcopy forensic examination prn photos prn child protection appropriate reporting counseling admit prn. postscript society continues to pay an ever increasing price e.g. violence substance abuse family discord and other dysfunctional behaviours for the inappropriate care neglect and abuse of its children my impression . 16 Seventeen beware of entrapment tourniquet injuries of the penis and digits in infants e.g. hair clothing material . Pediatrics second of two sections The Gist of Emergency Medicine 116 XI. Endocrinology and Hematology 1 Unexplained hypoglycemia Pancreatic or other tumors drugs e.g. alcohol endocrine disorder e.g. myxedema surreptitious administration of insulin or oral hypoglycemic agents seizures coma confusion or bizarre behaviour do a serum glucose a serum insulin insulin antibodies and c-peptide levels prn. L ABC s I.V. dextrose prn 5 10 25 or 50 prn glucagon 1-5mg I.V. prn Solu-cortef 250mg I.V. prn and diazoxide 300mg I.V. prn over 30minutes. Treat other problems e.g. hypothyroidism. Alcoholics require thiamine 100mg I.M. I.V. hypoglycemia may simulate a CVA especially in the elderly including focal deficits . ketotic hypoglycemia can occur in children 1-5 years of age. Oral hypoglycemic agents beware of prolonged hypoglycemic effect hours days . 2 Diabetic ketoacidosis DKA undiagnosed diabetic .