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Dizziness - pathogenesis, diagnosis and treatment

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Dizziness is a symptom of many diseases. Patients very frequently come with such ailment to the hospital emergency department. It is a state which may last a few seconds or minutes and increase or recede with time. Therefore, the admitted patients frequently cannot assess their own illness in a precise and objective way. The dizziness definition is also quite ambiguous. Dizziness is defined as the sensation of one own’s body movement or spinning and movement of the surrounding. It is very important to record the patient’s medical history since the diagnostic procedure may depend on the symptoms’ character. Dizziness may be a symptom of a serious disease, although it is not easy to find its cause. It appears not only in case of the labyrinth and nervous system disorders, but also in the systemic and functional diseases. Dizziness and balance disorder are the direct cause of admitting one in every thirty patients. The symptom indicated the directly life-threatening disease only within the 3-8.5% of patients (cerebral circulation insufficiency - 6%, cardiac dysrhythmia – 1.5%, brain tumour < 1%). Analyzing the data concerning the problem of dizziness occurrence within the general population, it has been noticed that this symptom has been reported two or three times more frequent by women than by men. Dizzinesses are classified pathogenetically and clinically into labyrinthine and non-labyrinthine, paroxysmal and permanent, acute and chronic. Dizziness is hard to diagnose because the symptoms reported by patients are only their own subjective sensations. The data presented in the article implicate the increasing number of patients with such disorders. Apart from dizziness, the patients complain also about the hearing disorders and nausea, which make their proper functioning impossible. It is inappropriate to start the treatment without knowing the cause. Establishing, on the basis of patient’s medical history and physical examination, whether the dizziness is of peripheral or central origin, is essential for the further diagnosis. After establishing the main diagnosis, the casual and symptomatic treatment is implemented, in some cases - there is a vestibular rehabilitation or even a surgical treatment.
The ability of fast response in case of increasing health problems of a child which lead directly to life-threatening situations is a necessary condition for creating opportunity of child’s survival until it will be transported to intensive care unit, where it will be provided with care by a specialist. In case of healthy children the most common cause of acute respiratory failure is obstruction of upper respiratory tract. There is an enormous variety of causes of upper airway obstruction, but the most important are the result of congenital defects, acute inflammation, anaphylactic reactions, foreign body aspiration and injuries. Consequence of the hypoventilation resulting from significant impediment of airflow through the obstructed airways is impaired gas exchange in the lungs. This leads to the increasing hypoxemia (PaO 2 <60 mmHg) and hypercapnia (PaCO2> 45 mmHg). This condition is called the total respiratory failure. The persistence of hypoventilation leads to hypoxia of vital organs (heart muscle, brain), increased anaerobic metabolism, acidosis, and inevitably to cardiac arrest as a result of homeostasis disorders. Respiratory failure is defined as acute when developing suddenly and is potentially reversible. We can find such a situation in the fast-increasing stenosis of the larynx. Symptoms of severe dyspnoea occur in a short time, but can be interrupted by an effective airway patency. Acute respiratory failure is a state of direct threat to life, which is why it is crucial to give a prompt aid to the sick child. The aim of this paper is to discuss the signs and symptoms, knowledge of which is essential for rapid identification and initial differentiation of the causes of acute upper airway obstruction in children. The principles of first-aid for children with acute respiratory failure and above all the description of life-saving procedures will be presented.
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