Tricky Diagnosis of Appendicitis: Blood Tests and Urinalysis
- Learn about the diagnosis process for appendicitis and the importance of blood tests and urinalysis.
- Understand the significance of different colored tubes used in blood tests and their additives.
- Discover the role of emergency physicians and surgeons in diagnosing and treating appendicitis.
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When the tricky diagnosis of appendicitis is considered, blood tests and a urinalysis are required. The patient's blood is put into different colored tubes, each with its own additive depending on the test being performed: •A purple-top tube is used for a complete blood count (CBC). A CBC measures: 1) The adequacy of your red blood cells, to see if you are anemic. 2) The number and type of white blood cells (WBCs), to determine the presence of infection. 3) A platelet count (platelets are a blood component necessary for clotting) •A red-top tube is used to test the serum (the liquid or non-cellular half of your blood). •A blue-top tube is used to test your blood's clotting. The tests in your case indicate that you have an elevated WBC count. This is a sign of a bacterial infection, and bacterial infections are commonly associated with appendicitis. At this point, the emergency physician may request that you not eat or drink anything. The reason is that appendicitis is treated by surgery, and an empty stomach is desirable to prevent some complications of anesthesia. When the emergency physician has all the information he can obtain, he makes a determination of the most likely diagnosis from his differential diagnosis. Alternately, he may decide that he does not have enough information to make a decision and may require more tests. At this point, he speaks to a general surgeon -- the appropriate consultant in this case. The surgeon comes to see you and performs a thorough history, physical exam, and review of your lab data. She examines your symptoms: pain and tenderness in the right, lower abdomen, vomiting, low-grade fever and elevated WBC count. These symptoms all point to appendicitis. The treatment of appendicitis is removal of the appendix, or an appendectomy. The surgeon explains the procedure, including the risks and benefits. You then sign a consent form to document this and permit her to operate on you. The vast array of people caring for patients in an emergency department can be quite confusing to the average health care consumer -- as confusing as if you were watching your first baseball game ever and no one was around to explain all those players. Additionally, most people are uncertain of the training and background necessary to become a member of the emergency-department team. Well, here's the scorecard. The emergency physician comes to the team after spending four years in college studying hard to get as high a GPA (grade point average) as possible in order to get accepted into medical school. Medical school is a four-year course of study covering all the essentials of becoming a physician. It generally includes two years of classroom time, followed by two years rotating through all the different specialties of medicine. Toward the end of medical school, each medical student must select a particular specialty (emergency medicine, family practice, internal medicine, surgery, pediatrics, etc.). The medical student then completes an internship (one year) and residency (two to three additional years) in order to be a specialist in emergency medicine. Physicians must pass an all-day written exam and an all-day oral exam to become board certified in emergency medicine. As of 2001, there were approximately 32,000 emergency physicians practicing in the United States, of which 17,000 were certified by the American Board of Emergency Medicine.
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以下のとおりお答えします。 虫垂炎の疑いのある診断が考えられる時には、血液検査と尿検査が必要になります。 患者の血液は、それぞれ実行されるテストに応じて添加剤が加えられ、種々の色つきの試験管に入れられます： ・頂点部が紫色の試験管は、完全な血球数測定（CBC）のために使われます。CBCでは次のような測定がなされます。1) 貧血であるか否かを見るための、赤血球の個人別適正量。2) 感染の有無を決定する白血球（WBCs）の数と型。3) 血小板計算（血小板は凝固に必要な血液組成です）。 ・頂点部が赤色の試験管は、血清をテストするために使用されます（血液の液性部分または無細胞部分）。 ・頂点部が青色の試験管は、血液の凝固をテストするために使用されます。 あなたの場合のテストでは、WBC数値の高いことが示されています。これは細菌感染の兆候であり、細菌の感染は一般的に虫垂炎と関連します。 この時点で、救急医はあなたに飲食を控えるように要請するかも知れません。理由は、虫垂炎は外科によって扱われるので、空の胃は麻酔による合併症を防止するのに望ましいのです。 救急医は、入手できるすべての情報を持っている時には、自分の鑑別診断から最もありそうな診断を確定します。 代って、彼が自分で決定するための情報を十分持ち合わせないので、さらなるテストが必要であるとの判断を下すこともあります。この時彼は、一般外科医－このケースに適する相談役－と話し合いをします。外科医があなたに会いに来て、あなたの完全な病歴や身体の検査、実験データの閲覧などを行います。 彼女（外科医）は、あなたの徴候を調査します。すなわち、右下腹部の痛みや柔らかさ、嘔吐、熱、およびWBC計算での数値高の状況です。これらの徴候すべてが虫垂炎を示唆します。虫垂炎の取り扱い（手術）は、虫垂または虫垂炎部位の切除です。 外科医は手続を説明しますが、それにはリスクと利点が含まれます。あなたがこの文書に署名すると、彼女があなたに手術することへの同意の表示となります。 救急部門の患者を世話する人々の膨大な陣営は、平均的な医療受診者にとっては実に紛らわしい－まるで、選手の説明をしてくれる者もないまま、初めて野球の試合を観戦するように紛らわしいものかも知れません。 さらに、ほとんどの人は、救急部門チームの成員となるのに必要な訓練や背景については不案内です。それではここで、選手一覧表を見てみましょう。 救急医師は、医学校に入るためにできる限り高いGPA（平均成績評価点）を得るべく、熱心に4年間大学での研究に費やした後、チームに参加します。 医学校は、医師になるための全必須事項をカバーしている4年間の学習課程です。それは一般に2年の教室時間を含み、それに医学の全専門分野を巡回経験する2年が続きます。 医学校の終わり頃に、個々の医学生は特定の専門（救急医療、開業医、内科医学、外科、小児科学など）を選ばなければなりません。医学生が救急医療の専門家になるためには、それからインターンシップ（1年）、および研修（さらに2, 3年）を満たすことになります。 医師が救急医療の認定部局員になるためには、丸１日の筆記試験と丸１日の口頭試験を通らなければなりません。2001年現在、米国では約32,000人の救急医師が実習中であり、そのうち17,000人が米国救急医療の部局員に認定されています。 以上、ご回答まで。
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Millions of Americans visit an emergency room each year. Millions more have seen the hit TV show "ER." This has sparked an almost insatiable interest in the fascinating, 24-hour-a-day, non-stop world of emergency medicine.A visit to the emergency room can be a stressful, scary event. Why is it so scary? First of all, there is the fear of not knowing what is wrong with you. There is the fear of having to visit an unfamiliar place filled with people you have never met. Also, you may have to undergo tests that you do not understand at a pace that discourages questions and comprehension. In this article, Dr. Carl Bianco leads you through a complete behind-the-scenes tour of a typical emergency room. You will learn about the normal flow of traffic in an emergency room, the people involved and the special techniques used to respond to life-or-death situations. If you yourself find the need to visit an emergency room, this article will make it less stressful by revealing what will happen and why things happen the way they do in an emergency. One of the most amazing aspects of emergency medicine is the huge range of conditions that arrive on a daily basis. No other speciality in medicine sees the variety of conditions that an emergency room physician sees in a typical week. Some of the conditions that bring people to the emergency room include: •Car accidents •Sports injuries •Broken bones and cuts from accidents and falls •Burns •Uncontrolled bleeding •Heart attacks, chest pain •Difficulty breathing, asthma attacks, pneumonia •Strokes, loss of function and/or numbness in arms or legs •Loss of vision, hearing •Unconsciousness •Confusion, altered level of consciousness, fainting •Suicidal or homicidal thoughts •Overdoses •Severe abdominal pain, persistent vomiting •Food poisoning •Blood when vomiting, coughing, urinating, or in bowel movements •Severe allergic reactions from insect bites, foods or medications •Complications from diseases, high fevers The classic emergency room scene involves an ambulance screeching to a halt, a gurney hurtling through the hallway and five people frantically working to save a person's life with only seconds to spare. This does happen and is not uncommon, but the majority of cases seen in a typical emergency department aren't quite this dramatic. Let's look at a typical case to see how the normal flow of an emergency room works. Imagine that it's 2 a.m., and you're dreaming about whatever it is that you dream about. Suddenly you wake up because your abdomen hurts -- a lot. This seems like something out of the ordinary, so you call your regular doctor. He tells you to go to your local hospital's emergency department: He is concerned about appendicitis because your pain is located in the right, lower abdomen. When you arrive at the Emergency Department, your first stop is triage. This is the place where each patient's condition is prioritized, typically by a nurse, into three general categories. The categories are: •Immediately life threatening •Urgent, but not immediately life threatening •Less urgent This categorization is necessary so that someone with a life-threatening condition is not kept waiting because they arrive a few minutes later than someone with a more routine problem. The triage nurse records your vital signs (temperature, pulse, respiratory rate and blood pressure). She also gets a brief history of your current medical complaints, past medical problems, medications and allergies so that she can determine the appropriate triage category. Here you find out that your temperature is 101 degrees F.
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Millions of Americans visit an emergency room each year. Millions more have seen the hit TV show "ER." This has sparked an almost insatiable interest in the fascinating, 24-hour-a-day, non-stop world of emergency medicine.A visit to the emergency room can be a stressful, scary event. Why is it so scary? First of all, there is the fear of not knowing what is wrong with you. There is the fear of having to visit an unfamiliar place filled with people you have never met. Also, you may have to undergo tests that you do not understand at a pace that discourages questions and comprehension. In this article, Dr. Carl Bianco leads you through a complete behind-the-scenes tour of a typical emergency room. You will learn about the normal flow of traffic in an emergency room, the people involved and the special techniques used to respond to life-or-death situations. If you yourself find the need to visit an emergency room, this article will make it less stressful by revealing what will happen and why things happen the way they do in an emergency. One of the most amazing aspects of emergency medicine is the huge range of conditions that arrive on a daily basis. No other speciality in medicine sees the variety of conditions that an emergency room physician sees in a typical week. Some of the conditions that bring people to the emergency room include: •Car accidents •Sports injuries •Broken bones and cuts from accidents and falls •Burns •Uncontrolled bleeding •Heart attacks, chest pain •Difficulty breathing, asthma attacks, pneumonia •Strokes, loss of function and/or numbness in arms or legs •Loss of vision, hearing •Unconsciousness •Confusion, altered level of consciousness, fainting •Suicidal or homicidal thoughts •Overdoses •Severe abdominal pain, persistent vomiting •Food poisoning •Blood when vomiting, coughing, urinating, or in bowel movements •Severe allergic reactions from insect bites, foods or medications •Complications from diseases, high fevers The classic emergency room scene involves an ambulance screeching to a halt, a gurney hurtling through the hallway and five people frantically working to save a person's life with only seconds to spare. This does happen and is not uncommon, but the majority of cases seen in a typical emergency department aren't quite this dramatic. Let's look at a typical case to see how the normal flow of an emergency room works. Imagine that it's 2 a.m., and you're dreaming about whatever it is that you dream about. Suddenly you wake up because your abdomen hurts -- a lot. This seems like something out of the ordinary, so you call your regular doctor. He tells you to go to your local hospital's emergency department: He is concerned about appendicitis because your pain is located in the right, lower abdomen. When you arrive at the Emergency Department, your first stop is triage. This is the place where each patient's condition is prioritized, typically by a nurse, into three general categories. The categories are: •Immediately life threatening •Urgent, but not immediately life threatening •Less urgent This categorization is necessary so that someone with a life-threatening condition is not kept waiting because they arrive a few minutes later than someone with a more routine problem. The triage nurse records your vital signs (temperature, pulse, respiratory rate and blood pressure). She also gets a brief history of your current medical complaints, past medical problems, medications and allergies so that she can determine the appropriate triage category. Here you find out that your temperature is 101 degrees F.
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In almost every TV show about an emergency room you probably see an ambulance screeching to a stop with its lights flashing , a gurney being rushed through the corridors and emergency staff racing against time to save a person's kife with only seconds to spare. This scene is possible and occasionally happends , but most of he cases that a typical emergency department sees aren't so dramatic. Let's look at how an ordinary case goes through the normal flow of an emergency room. When patients arrive at the Emergency Department , they go to triage first. In triage , each patient's condition is prioritized , typically by a nurse. She puts the patient into one of three general categories. The categories are: ・Immediately life-threatening ・Urgent , but not immediately life-threatening ・Less urgent Categorizing patients is necessary so that someone with a life-threatening condition doesn't have to wait to get care. The triage nurse records the vital sugns (temperature , pulse , respiratory rate , and blood pressure). She also takes a brief history of the patient's current medical complaints , past medical problems , medications and allergies. From this information , the nurse can decide which triage category is suitable. Registration is the next stage in the ER process. A TV show rarely lets us see this part. It's not exciting , but it is very important. This is where the hospital collexts the patient's personal details and insurance information. Registration is needed to create a clear medical record so that the patient's medical history , lab tests , X-rays , etc. , will all be put on his or her medical chart. That chart can then be checked by doctors , nurses and other medical staff when necessary. Also , this information will be important for creating the hospital bill. If the patient has a life-threatening situation or arrives by ambulance , the registration stage might be done later at the beside. Finally , the patient comes to the exam room. The nurse has the person put on a patient gown so that an examination can be done properly. She might also collect a urine specimen at this time. After the nurse's tasks are fished , the emergency-medicine physician meets with the patient. The physician asks questions t create a more detailed medical history about the present illness , past medical problems , family history , social history , and also takes a close look at all the patient's physical systems. The physician then formulates a list of possible causes of the patient's symptoms. This is called a differential diagnosis. The most likely diagnosis is then determined by th patient's symptoms and the physical examination. If this stage is not enough to create a clear diagnosis , then further diagnostic testa are done.
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In almost every TV show about an emergency room you probably see an ambulance screeching to a stop with its lights flashing , a gurney being rushed through the corridors and emergency staff racing against time to save a person's kife with only seconds to spare. This scene is possible and occasionally happends , but most of he cases that a typical emergency department sees aren't so dramatic. Let's look at how an ordinary case goes through the normal flow of an emergency room. When patients arrive at the Emergency Department , they go to triage first. In triage , each patient's condition is prioritized , typically by a nurse. She puts the patient into one of three general categories. The categories are: ・Immediately life-threatening ・Urgent , but not immediately life-threatening ・Less urgent Categorizing patients is necessary so that someone with a life-threatening condition doesn't have to wait to get care. The triage nurse records the vital sugns (temperature , pulse , respiratory rate , and blood pressure). She also takes a brief history of the patient's current medical complaints , past medical problems , medications and allergies. From this information , the nurse can decide which triage category is suitable. Registration is the next stage in the ER process. A TV show rarely lets us see this part. It's not exciting , but it is very important. This is where the hospital collexts the patient's personal details and insurance information. Registration is needed to create a clear medical record so that the patient's medical history , lab tests , X-rays , etc. , will all be put on his or her medical chart. That chart can then be checked by doctors , nurses and other medical staff when necessary. Also , this information will be important for creating the hospital bill. If the patient has a life-threatening situation or arrives by ambulance , the registration stage might be done later at the beside. Finally , the patient comes to the exam room. The nurse has the person put on a patient gown so that an examination can be done properly. She might also collect a urine specimen at this time. After the nurse's tasks are fished , the emergency-medicine physician meets with the patient. The physician asks questions t create a more detailed medical history about the present illness , past medical problems , family history , social history , and also takes a close look at all the patient's physical systems. The physician then formulates a list of possible causes of the patient's symptoms. This is called a differential diagnosis. The most likely diagnosis is then determined by th patient's symptoms and the physical examination. If this stage is not enough to create a clear diagnosis , then further diagnostic testa are done.
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Depending on a patient's specific medical condition, physicians will either admit the patient to the hospital, discharge the patient, or transfer the patient to a more appropriate medical facility. If you are discharged, you will receive discharge instructions (either written specifically for you or pre-printed) that explain your medications and other treatments. If medications are prescribed, you may receive a beginning dose if there are no pharmacies open in your area at that particular time. You will also be referred for follow-up care should your condition continue or worsen. You may need to be transferred if your condition is better treated at another institution. You may have to sign a consent form if your condition or mental state allows. The modern emergency department performs an important role in our society. It really is a marvelous invention that has saved countless lives. Hopefully, the information in this article will help ease your fears should you need the services of an emergency department in the future. For more information on emergency departments, medical conditions and related topics, check out the links on the next page.
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下部のExcept when~~~ からの一文がどう訳してよいか分からないので、そちっらだけでもよろしかったらお願いします。 The freezing point of normal human plasma averages -0.54℃,which corresponds to an osmolal concentration in plasma of 290 mOsm/l. This is equivalent to an osmotic pressure against pure water of 7.3 atm. The osmolality might be expected to be higher than this, because the sum of all the cation and anion equivalents in plasma is over 300.It is not this high because plasma is not an ideal solution and ionic interactions reduce the number of particles free to exert an osmotic effect. Except when there has been insufficient time after a sudden change in composition for equilibrium to occur, all fluid compartments of the body are in (or nearly in) osmotic equilibrium. The term tonicity is used to describe the osmolality of a solution relative to plasma.
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アンジェリーナジョリーがMy Medical ChoiceとしてNY Times に出した英文です 部分的で話のつながりがわかりにくい部分があると思いますが和訳よろしくお願いします。 Only a fraction of breast cancers result from an inherited gene mutation. 'nipple delay' rules out diseasa in the breast ducts behind the nipple and draws extra blood flow to the area. You wake up with drain tubes and expanders in your breasts. The final surgery is completed with the reconstruction of the breasts with an implant. I want to encourage every woman. Life comes with many challenges. The one that should not scare us are the ones we can take on and take control of.
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Welcome to your future life! You get up in the morning and look into the mirror. Your face is firm and young-looking. In 2035, medical science is better than ever. Many people your age could live to be 150, so at 40, you're not old at all. And your parents just had an anti-aging nanotechnology treatment. Now, all three of you look the same age!
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Unlike regular defibrillators, an automated external defibrillator requires minimal training to use. It automatically diagnoses the heart rhythm and determines if a shock is needed. Automatic models will administer the shock without the user's command. Semi-automatic models will tell the user that a shock is needed, but the user must tell the machine to do so, usually by pressing a button. In most circumstances, the user cannot override a "no shock" advisory by an AED. Some AEDs may be used on children - those under 55 lbs (25 kg) in weight or under age 8. If a particular model of AED is approved for pediatric use, all that is required is the use of more appropriate pads. All AEDs approved for use in the United States use an electronic voice to prompt users through each step. Because the user of an AED may be hearing impaired, many AEDs now include visual prompts as well. Most units are designed for use by non-medical operators. Their ease of use has given rise to the notion of public access defibrillation (PAD), which experts agree has the potential to be the single greatest advance in the treatment of out-of-hospital cardiac arrest since the invention of CPR. Automated external defibrillators are now easy enough to use that most states in the United States include the "good faith" use of an AED by any person under Good Samaritan laws. "Good faith" protection under a Good Samaritan law means that a volunteer responder (not acting as a part of one's occupation) cannot be held civilly liable for the harm or death of a victim by providing improper or inadequate care, given that the harm or death was not intentional and the responder was acting within the limits of their training and in good faith. In the United States, Good Samaritan laws provide some protection for the use of AEDs by trained and untrained responders. AEDs create little liability if used correctly; NREMT-B and many state Emergency Medical Technician (EMT) training and many CPR classes incorporate or offer AED education as a part of their program. In addition to Good Samaritan laws, Ontario, Canada also has the "Chase McEachern Act (Heart Defibrillator Civil Liability), 2007 (Bill 171 – Subsection N)", passed in June, 2007, which protects individuals from liability for damages that may occur from their use of an AED to save someone's life at the immediate scene of an emergency unless damages are caused by gross negligence. Automated external defibrillators are under recent scrutiny by the U.S. Food and Drug Administration (FDA) which is now considering reclassifying AEDs as class III premarket approval devices. The major reason for this appears to be technical malfunctions, which likely contributed to more than 750 deaths in the 5-year period between 2004 and 2009, in most cases by component failures or design errors. During the same period, up to 70 types of AEDs have been recalled, including recalls from every AED manufacturer in the world.
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Automated external defibrillators are generally either held by trained personnel who will attend events or are public access units which can be found in places including corporate and government offices, shopping centres, airports, airplanes, restaurants, casinos, hotels, sports stadium, schools and universities, community centers, fitness centers, health clubs, theme parks, workplaces and any other location where people may congregate. The location of a public access AED should take into account where large groups of people gather, regardless of age or activity. Children as well as adults may fall victim to sudden cardiac arrest (SCA). In many areas, emergency vehicles are likely to carry AEDs, with some ambulances carrying an AED in addition to manual defibrillators. Police or fire vehicles often carry an AED for use by first responders. Some areas have dedicated community first responders, who are volunteers tasked with keeping an AED and taking it to any victims in their area. AEDs are also increasingly common on commercial airliners, cruise ships, and other transportation facilities. High-rise buildings are densely populated, but are more difficult to access by emergency crews facing heavy traffic and security barriers. It has been suggested that AEDs carried on elevators could save critical minutes for cardiac arrest victims, and reduce their deployment cost. In order to make them highly visible, public access AEDs are often brightly colored, and are mounted in protective cases near the entrance of a building. When these protective cases are opened or the defibrillator is removed, some will sound a buzzer to alert nearby staff to their removal, though this does not necessarily summon emergency services; trained AED operators should know to phone for an ambulance when sending for or using an AED. In September 2008, the International Liaison Committee on Resuscitation issued a 'universal AED sign' to be adopted throughout the world to indicate the presence of an AED, and this is shown on the right. A trend that is developing is the purchase of AEDs to be used in the home, particularly by those with known existing heart conditions. The number of devices in the community has grown as prices have fallen to affordable levels. There has been some concern among medical professionals that these home users do not necessarily have appropriate training, and many advocate the more widespread use of community responders, who can be appropriately trained and managed. Typically, an AED kit will contain a face shield for providing a barrier between patient and first aider during rescue breathing; a pair of nitrile rubber gloves; a pair of trauma shears for cutting through a patient's clothing to expose the chest; a small towel for wiping away any moisture on the chest, and a razor for shaving those with very hairy chests. Most manufacturers recommend checking the AED before every period of duty or on a regular basis for fixed units. Some units need to be switched on in order to perform a self check; other models have a self check system built in with a visible indicator.[citation needed] All manufacturers mark their electrode pads with an expiration date, and it is important to ensure that the pads are in date. This is usually marked on the outside of the pads. Some models are designed to make this date visible through a 'window', although others will require the opening of the case to find the date stamp.[citation needed] It is also important to ensure that the AED unit's batteries have not expired. The AED manufacturer will specify how often the batteries should be replaced. Each AED has a different recommended maintenance schedule outlined in the user manual. Common checkpoints on every checklist, however, also include a monthly check of the battery power by checking the green indicator light when powered on, condition and cleanliness of all cables and the unit, and check for the adequate supplies.
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