Disease and conditions 

Anxiety is a common psychiatric symptom characterized by feelings of uneasiness or dread, ranging from mild discomfort to severe, life-threatening conditions. It can result from physical illness, psychological disorders, or external factors, and requires careful evaluation to identify underlying causes and provide appropriate management.

Aphasia is a language disorder caused by damage to the brain's language centers, affecting speech comprehension and expression, with various types including Broca’s, Wernicke’s, anomic, and global aphasia. It often results from conditions like stroke, head trauma, brain tumors, or infections, and requires careful clinical assessment and supportive communication strategies.

Apnea is the temporary or permanent cessation of spontaneous breathing, often caused by airway obstruction, brainstem dysfunction, or neuromuscular failure, and requires immediate intervention to maintain airway patency and support ventilation. Prompt recognition and management are critical to prevent respiratory arrest and death.

Apneustic respirations are prolonged, gasping inspirations caused by severe pontine damage disrupting normal breathing regulation. Immediate airway management and neurological assessment are critical for patient survival.

This clinical guide provides a comprehensive overview of arm pain, covering causes from musculoskeletal to cardiovascular origins, with detailed assessment and management strategies. It includes special considerations for pediatric and geriatric populations, along with key red flags and references.

Asterixis is a clinical sign of negative myoclonus characterized by brief lapses in muscle tone, often seen as a flapping tremor during sustained posture. It commonly indicates metabolic encephalopathies such as hepatic, uremic, or hypercapnic conditions.

Ataxia is a neurological condition characterized by uncoordinated voluntary movements due to cerebellar or sensory pathway dysfunction. It may present acutely or chronically, requiring prompt evaluation to identify reversible or life-threatening causes.

Aura is a brief neurological phenomenon that often precedes seizures or migraines, presenting as sensory, cognitive, or emotional changes. Recognizing aura aids in early diagnosis, timely intervention, and localization of underlying brain activity.

Babinski’s reflex is an abnormal upward movement of the big toe with fanning of the other toes upon sole stimulation, indicating corticospinal tract dysfunction. It is normal in infants up to 24 months but signifies neurological pathology in older children and adults.

Back pain is a common clinical complaint with diverse causes ranging from musculoskeletal strain to serious underlying conditions requiring prompt identification of red flags. Proper history, physical examination, and timely intervention are critical to effective management and prevention of complications.

Battle’s sign, bruising behind the ear, is a key clinical indicator of a basilar skull fracture and may be the only visible sign. Prompt recognition, neurologic assessment, and imaging are critical to prevent complications.

Biot’s respirations are irregular, unpredictable breathing patterns indicating severe brain stem dysfunction, often due to increased intracranial pressure. They are a medical emergency requiring urgent airway management and neuroimaging to identify and relieve the underlying cause.

Bladder distention is the abnormal enlargement of the bladder due to urine retention, often caused by obstruction, neurologic disorders, or medications. It presents with suprapubic pain, difficulty urinating, and may require emergency catheterization to prevent complications.

Hypotension is a condition where blood pressure drops below normal, leading to inadequate perfusion of vital organs. It can result from dehydration, blood loss, sepsis, or heart failure, and requires prompt identification and treatment to prevent shock and organ damage.

Elevated blood pressure (hypertension) is a common but often unnoticed condition caused by various factors like kidney or hormonal disorders, requiring careful diagnosis to prevent life-threatening complications. Management includes identifying underlying causes, monitoring, and emergency interventions for hypertensive crises.

Absent bowel sounds signal serious intestinal dysfunction from obstruction, ischemia, or paralysis, requiring urgent evaluation. Prompt intervention is vital to prevent life-threatening complications like perforation and sepsis.

Hyperactive bowel sounds are loud, frequent intestinal noises indicating increased motility, often caused by infections, inflammation, or bowel obstruction. Prompt assessment and intervention are crucial to address potentially serious underlying conditions.

Hypoactive bowel sounds indicate decreased intestinal motility often caused by obstruction, surgery, medications, or ischemia. While not always urgent, they require close monitoring to prevent progression to life-threatening conditions like paralytic ileus or bowel obstruction.

Bradycardia is a slower-than-normal heart rate (below 60 bpm) that can be physiological or indicate serious underlying conditions requiring prompt evaluation. Symptoms like dizziness, chest pain, or syncope alongside bradycardia necessitate urgent medical assessment and treatment.

Bradypnea is abnormally slow breathing (less than 10 breaths per minute), often signaling life-threatening conditions like drug overdose, increased intracranial pressure, or metabolic failure. Immediate assessment and airway support are critical to prevent respiratory arrest.

Breast dimpling is a late warning sign often linked to breast cancer, caused by skin retraction over an underlying mass. It requires thorough clinical evaluation, as it may also result from infections, trauma, or fat necrosis.

Fecal breath odor, typically seen in conditions like intestinal obstruction or gastrojejunocolic fistula, signals a potentially life-threatening GI disorder. Immediate evaluation and emergency interventions, including possible surgery, are crucial for managing this condition.

Ammonia-scented breath, common in end-stage chronic kidney disease, is caused by metabolic disturbances and the breakdown of urea into ammonia. Regular oral care and dietary adjustments are important in managing this symptom.

A breast ulcer, often a late sign of cancer, can result from trauma, infection, or radiation. It requires careful evaluation of patient history, physical examination, and appropriate diagnostic tests to determine the underlying cause and guide treatment.

Breast pain is usually due to benign conditions like fibrocystic changes, infections, or hormonal shifts, rather than cancer. It can be cyclic or constant, affecting one or both breasts, and may radiate to the arms, back, or neck.

Hypertension can develop gradually or suddenly and may signal serious underlying conditions. It is more common in women using hormonal contraceptives, especially those over 35 who smoke.

Breast nodules are lumps in the breast that may be benign or malignant and require thorough evaluation. Most are caused by benign conditions like fibrocystic changes, but cancer must always be ruled out.

This rhythm does not require treatment, unless they are causing symptoms, i.e. syncope, dizziness, tiredness and poor effort tolerance. Sinus bradycardia < 50/minute or sinus arrest with slow escape rhythm, accompanied by hypotension, strongly suggests a treatable underlying cause:

Most cases occur in patients over 60 years and is idiopathic, with an excellent long-term prognosis, provided a permanent pacemaker is implanted.

Has a twisting pattern to the QRS complexes and a prolonged QT interval in sinus rhythm It is usually due to a QT–prolonging drug, ± hypokalaemia

Chronic pulmonary emboli are mainly a consequence of incomplete resolution of acute pulmonary thromboembolism. Clinically symptoms and signs may be preceded by Acute PE for more than two weeks

An acute pulmonary embolism, or embolus, is a blockage of a pulmonary (lung) artery. Most often, the condition results from a blood clot that forms in the legs or another part of the body (deep vein thrombosis, or DVT) and travels to the lungs.

These are chronic acquired sequelae of Acute Rheumatic Fever or Acute Sequelae of Infective Endorcaditis or Ischaemic Heart Disease, consisting of valvular damage, usually left heart valves, with varied progression of severity and complications.

It is a non–suppurative sequela of a group A ß haemolytic streptococcal (GABHS) pharyngeal infection.

The infective process of endocardial layer of the heart can involve native or prosthetic valve and congenital defects/shunts.

Pulmonary oedema or pulmonary congestion is a broad descriptive term and is usually defined as an abnormal accumulation of fluid in the extravascular compartments of the lung

Patients who have had HF as defined above for some time are often said to have ‘Chronic Heart Failure’. A treated patient with symptoms and signs that have remained generally unchanged for at least 1 month is said to be ‘Stable chronic heart failure’

Heart Failure is a clinical syndrome characterized by typical symptoms that may be accompanied by signs caused by a structural and/or functional cardiac abnormality, resulting in a reduced cardiac output and/or elevated intracardiac pressures at rest or during stress.

Acute heart failure

AHF is defined as rapid or gradual onset of signs and symptoms of heart failure that results in urgent unplanned hospitalization or Emergency Medicine Department visits. The clinical signs and symptoms are significantly life threatening if the above features occur in patients with established diagnosis with structurally heart disease categorized as Acute Decompensated Heart Failure (ADHF). The cause and immediate precipitating factor(s) of the AHF must be identified and treated to prevent further damage to the heart.

Treatment Goals

To improve clinical symptoms and outcome, management strategy should be based on clinical, laboratory and haemodynamic findings. All patient with AHF should be cared and admitted to a high care dependent unit or Intensive Care Unit.

Consider oral vasodilators in case intravenous vasodilator not available or unavailability of intensive care or high dependent unit care
• Isosorbide mononitrate 10–20mg (PO) 12 hourly
OR
• Hydralazine 25 mg (PO) 6–8 hourly. Maximum dose: 200 mg/day

Inotropes (Inotropic agents)

Indicated in patients with hypotension (SBP <90 mmHg or mean arterial BP < 60mmHg) and peripheral hypoperfusion. Dosage see in image number 2 above.

Vasopressor (norepinephrine preferably) Indicated in patients with cardiogenic shock, despite treatment with another inotrope, to increase blood pressure and vital organ perfusion

Hypertension is elevation of Blood Pressure (BP) measured on at least three separate occasions. There is strong association between hypertension and CAD.

STEMI/AMI is a medical emergency caused by the complete or partial occlusion of a coronary artery and requires prompt hospitalization and intensive care intervention management.