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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

During the 1986 World's Exposition held in Vancouver, British Columbia, the types and frequencies of emergency medical problems were assessed. The average number of patients seeking care was 3.93 +/- 0.95 per 1,000 visitors (daily range, 1.94 to 6.8). Patient loads were linearly related to gate attendance, but the correlation was imperfect (P less than .001, r = .63). Only 4.4% of patients evaluated on site by nurses and paramedics were referred for additional testing and treatment: of these patients, 30% had suspected serious musculoskeletal injury, 16% had abdominal pain, and 25% had complaints of chest pain, dizziness, or loss of consciousness. Lay employees (security personnel) were trained to use automatic external defibrillators. There were six cardiac arrests (0.3 per million visitors). Two patients collapsed with ventricular fibrillation, were defibrillated by lay personnel, quickly regained consciousness, and survived. The other arrests were associated with asystole or electromechanical dissociation; no shocks were inappropriately given, and all four died. We conclude that four of every 1,000 persons at this assembly sought emergency medical care, that 95% of the problems seen were minor with few requiring physician skills, and that the automatic external defibrillator was suited for this setting and could be used by lay responders to provide early definitive treatment.
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PMID:Emergency medical care requirements for large public assemblies and a new strategy for managing cardiac arrest in this setting. 291 79

Three hundred fifty patients in an observation unit attached to an emergency department received diagnostic workup of nine critical diagnostic syndromes (abdominal pain, flank pain, headache, possible cerebrovascular accident, chest pain, dizziness or syncope, head injury, seizure, multiple trauma). The decision to hospitalize for acute care after observation for 11.1 +/- 3.9 hours was examined. The objective diagnosis-related group (DRG) criteria for admission were compared retrospectively with the physician's clinical judgment of need for hospitalization. Clinical outcome was used to establish the correctness of the decision to hospitalize. Clinical judgment was compared with objective DRG criteria for reliability in predicting the presence of serious pathology necessitating acute care hospitalization; respective values were sensitivity, 100% vs 76%; specificity, 86% vs 80%; positive predictive value, 75% vs 62%; and negative predictive value, 100% vs 89%. The difference between the sensitivity of the two admission criteria was highly significant (P less than 10(-8); chi 2, 26.12). We conclude that the physician's clinical judgment outperforms DRG objective criteria in identifying which patients with critical diagnostic syndromes need acute care hospitalization for emergency medical or surgical therapy.
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PMID:Decision to hospitalize: objective diagnosis-related group criteria versus clinical judgment. 313 51

Medical emergencies at a major metropolitan airport have a significant impact on prehospital care capabilities for the rest of the community in which the airport is located. Stapleton International Airport in Denver, Colorado, is a facility that in 1985 had 14.4 million passengers and a static employee population of 12,000 to 15,000. In 1981, there were 1,182 ambulance trips to the airport, 40.4% of which did not result in the transport of a patient. The expense of sending an ambulance and fire engine out on such calls was great, and paramedics were out of service for approximately 300 hours on these nontransport cases. In order to improve prehospital services to the airport and the city, a paramedic has been stationed in the concourse at the airport 16 hours a day since 1982. The records for airport paramedic services for the 12 months ending September 1985 were reviewed. Paramedic services were requested for 1,952 patients. Of these, 696 (35.7%) were transported to hospital by ambulance; 115 (5.9%) went by private car; 284 (14.6%) refused any paramedic care or transport; and 857 (43.9%) were released, after base station contact, with instructions to seek definitive care at the final destination. Presenting complaints were classified into 55 categories and the frequencies and dispositions are described. The most common presentations resulting in transport were chest pain, 110 (5.6%); syncope, 60 (3.1%); psychiatric, 57 (2.9%); abdominal pain, 49 (2.5%); seizure, 36 (1.8%); fracture, 31 (1.6%); and cardiac arrest, 29 (1.5%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prehospital care at a major international airport. 210 61

Many childhood and adolescent stress-related symptoms have a psychophysiological component that involves muscular tension and/or autonomic nervous system dysfunction. Examples of this include recurrent headache, chest pain, abdominal pain, syncope, and dizziness. After a careful medical and psychosocial evaluation, the clinician may identify many patients who are appropriate for the application of stress reduction techniques such as progressive muscular relaxation, meditation, biofeedback, and relaxation/mental imagery (self-hypnosis). This review describes these techniques and their application with selected children and adolescents.
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PMID:Stress management techniques in childhood and adolescence. Relaxation training, meditation, hypnosis, and biofeedback: appropriate clinical applications. 331 33

Malignant mesothelioma has been rare in the general population. In recent decades its incidence has risen dramatically, parallel to the increasing use of asbestos in industry since 1930. Altogether 17,800 asbestos insulation workers, members of the International Association of Heat and Frost Insulators and Asbestos Workers (AFL-CIO-CLC) in the United States and Canada, were enrolled for prospective study on 1 January 1967 and followed up to the present. Every death that occurs is investigated by our laboratory. One hundred and seventy five deaths from mesothelioma occurred among the 2221 men who died in 1967-76 and 181 more such deaths in the next eight years. Altogether, 356 workers had died of malignant mesothelioma (pleural or peritoneal) by 1984. Diagnosis of mesothelioma was accepted only after all available clinical, radiological, and pathological material was reviewed by our laboratory and histopathological confirmation by the pathology unit made in each case. One hundred and thirty four workers died of pleural and 222 of peritoneal mesothelioma. Age at onset of exposure, age at onset of the disease, and age at death were similar in both groups of patients. Significant difference was noted only in the time elapsed from onset of exposure to the development of first symptoms, which was longer in the group with peritoneal mesothelioma. Shortness of breath, either new or recently increased, and chest pain were the most frequent presenting symptoms in the group with pleural mesothelioma; abdominal pain and distension were frequent in the patients with peritoneal mesothelioma. Pleural effusion or ascites were found in most patients. The most effective approach to the diagnosis of malignant pleural mesothelioma in these cases was by open lung biopsy; exploratory laparotomy was best for diagnosing peritoneal mesothelioma. Patients with pleural mesothelioma died principally from pulmonary insufficiency whereas those with peritoneal mesothelioma succumbed after a period of pronounced wasting.
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PMID:Malignant mesothelioma in a cohort of asbestos insulation workers: clinical presentation, diagnosis, and causes of death. 334 94

A survey concerning common pain conditions and psychological distress was carried out among a probability sample of the adult enrollees of a large health maintenance organization in Seattle. The prevalence of pain in the prior six months was 41% for back pain; 26% for headache; 17% for abdominal pain; 12% for chest pain; and 12% for facial pain. Headache, abdominal and facial pain were less prevalent among older persons and more prevalent among females. We examined the temporal dimensions of these pain conditions, as well as intensity, treatment seeking, and activity limitation. The pain conditions were typically long standing, recurrent, of mild to moderate intensity, and usually did not limit activities. However, depending on the pain condition, 9-40% reported one or more days in the prior six months when they were unable to carry out their usual activities due to the pain problem. On average, persons with a pain condition had higher levels of anxiety, depression, and non-pain somatic symptoms as measured by the scales of the Symptom Checklist (SCL); poorer self-rating of health status; and more family stress compared to persons without a pain condition. Of these alternative measures of distress, the SCL somatization scale had the strongest independent association with pain. The increments in measures of anxiety, depression, and family stress with the presence of pain were greatest among persons with higher levels of non-pain somatic symptoms.
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PMID:An epidemiologic comparison of pain complaints. 336 55

While recurrent somatic complaints are commonly encountered in children and adolescents, occult organic disease is rarely found in patients with these complaints. Recent studies have confirmed the clinical impression that a relationship exists between functional somatic complaints and negative life events in adolescents. Our goal was to investigate additional psychosocial characteristics that may be associated with functional complaints. One hundred fifteen adolescents coming for the first time to an adolescent medicine clinic completed standard measures of negative life events, psychophysiologic symptoms, self-esteem, peer social comparison, and family functioning before an independent evaluation by a physician. Patients with functional somatic complaints (chest pain, recurrent abdominal pain, limb pain, and hyperventilation syndrome) reported significantly more negative life events, lower self-esteem, more psychophysiologic symptoms and a lower self-evaluation than did patients coming for physical examination or routine health maintenance. Functional somatic complaints in adolescents may be associated with poor psychosocial adjustment and reaction to negative life events. In addition to ruling out organic disease, physicians dealing with these patients should evaluate other areas, including stressful life events, peer relations, and self-esteem.
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PMID:Functional somatic complaints in adolescents: relationship to negative life events, self-concept, and family characteristics. 341 8

Little is known about how the care received in emergency departments (ED) by the elderly population differs from that received by younger people. We prospectively abstracted ED records of 1620 consecutive patients visiting a large community hospital ED over a 22-day period in 1984 for demographic and medical variables. Charts of patients presenting with five specific complaints (dyspnea, chest pain, abdominal pain, syncope, and motor vehicle accidents) were also analyzed for process of care variables and, for patients hospitalized, the accuracy of the ED diagnosis. Older people (ie, those greater than or equal to 65 years of age) do not seem to be overutilizers of the ED for minor complaints, in fact, they tend to be more acutely ill on presentation than younger people. Older people were more likely to be hospitalized (46% v 10%, P less than .001), to arrive by ambulance (35% v 10%, P less than .001), and to have an identified source of primary care (95% v 64%, P less than .01). Older people stayed longer in the ED than younger people if they were eventually released home but shorter if admitted to the hospital. Test ordering patterns for specific complaints varied by patient age (eg, older patients had more electrocardiograms performed for chest pain and fewer urinalyses for abdominal pain than younger patients). Therapy for specific complaints showed less age effect. Although generally more diagnostic tests were performed on older patients, the ED diagnosis tended to be more accurate for younger patients. Our data indicate that the process of ED care may be substantially different for the elderly population and have implications for future planning and financing of medical care.
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PMID:Old people in the emergency room: age-related differences in emergency department use and care. 357 88

Prescription of oral contraceptives is reviewed by giving practical tips on the absolute contraindications, timing of the first dose, dose of estrogen, choice of type of progestin, reasons for changing the combination, and a list of benefits of oral contraceptives. The major risk in taking orals is cardiovascular disease, but actual risks are clustered in subsets of women. Those at high risk are women over 45, smokers over 35, and smokers of any age with cardiovascular risk factors. Generally women should start with a 30 or 35 mcg estrogen combined pill, and perhaps consider taking a higher estrogen dose if they experience breakthrough bleeding or amenorrhea. The 1st cycle can be started at any time up to 6 days after Cycle Day 1 or after spontaneous or induced abortion. Women taking bromocriptine should also begin contraception soon after delivery. Signs of potential major complications are abdominal pain, chest pain or dyspnea, headache or neurologic symptoms, visual or speech problems, or leg pain or weakness. Benefits of oral contraception include menstrual regulation, decreased menstrual flow, prevention of functional ovarian cysts, protection against ovarian and endometrial cancer by half, against benign breast disease, and possibly against pelvic inflammatory disease.
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PMID:Oral contraceptives. Who, which, when, and why? 362 38

A 65 year old woman with gall stones presented with crushing chest pain after an attack of biliary colic. The electrocardiogram showed ST segment elevation in leads I, aVL, and V1-V3 while leads II, III, and aVF showed ST segment depression. Cardiac enzyme activity remained within the normal range. During the next three weeks attacks of epigastric and right hypochondrial pain preceded by crushing chest pain with identical electrocardiogram changes occurred with decreasing frequency. Coronary arteriography showed 60% obstruction of the left anterior descending coronary artery and good left ventricular function. During the next three years the patient complained both of mild abdominal pain, probably biliary colic, and mild effort related angina pectoris without a relation between the two symptoms. It is suggested that the attack of variant angina was triggered by biliary colic through sympathoadrenal discharge causing vasospasm.
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PMID:Variant angina induced by biliary colic. 367 31


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