Revue médicale suisse
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Revue médicale suisse · Aug 2010
[When should a patient with low back pain/sciatica be referred to the emergency ward?].
Low back pain and sciatica are common causes of medical consultation. The medical history and the physical examination are essential in their management. ⋯ These include hyperalgic sciatica, sciatica with motor deficits and the cauda equina syndrome. Sciatica with sensory deficits do not require emergency department referral.
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Revue médicale suisse · Aug 2010
[When should a patient with musculoskeletal trauma be referred to emergency ward?].
Standardized clinical examination can obviate the need for osteoarticular radiographs for trauma. This paper summarizes a number of decision rules that allow clinical exclusion of significant fracture of the cervical spine, elbow, knee or ankle, making radiographs unnecessary. These criteria were all derived from large cohort studies (Nexus, Ottawa, CCS, etc..., and have been prospectively validated. The rigorous use of these criteria in daily practice improves treatment times and costs with no adverse effect on treatment quality.
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Revue médicale suisse · Aug 2010
[When should a patient with abdominal pain be referred to the emergency ward?].
When should a patient with abdominal pain be referred to the emergency ward? The following goals must be achieved upon managing patients with acute abdominal pain: 1) identify vital emergency situations; 2) detect surgical conditions that require emergency referral without further diagnostic procedures; 3) in "non surgical acute abdomen patients" perform appropriate diagnostic procedures, or in selected cases delay tests and reevaluate the patient after an observation period, after which a referral decision is made. Clues from the history and physical examination are critical to perform this evaluation. A good knowledge of the most frequent acute abdominal conditions, and identifying potential severity criteria allow an appropriate management and decision about emergency referral.