Birinci Basamakta Gözden Kaçırılmaması Gereken Acil Durumlar: Aile Hekimi İçin Kırmızı Bayrak Belirtileri
Synopsis
Many life-threatening conditions present to primary care with common and nonspecific complaints, and the absence of a typical clinical picture may lead to a missed diagnosis. This chapter discusses selected adult emergencies with serious consequences if not recognized in time, organized around the patient’s presenting complaint. Acute coronary syndrome, acute aortic syndrome and pulmonary embolism are covered under chest pain and dyspnea. Subarachnoid hemorrhage, stroke and transient ischemic attack, and hypertensive emergency are covered under headache and neurological complaints. Mesenteric ischemia, ruptured abdominal aortic aneurysm, small bowel obstruction, ectopic pregnancy and diabetic ketoacidosis are covered under abdominal pain, and sepsis under fever and general deterioration. For each condition, red flag features, misleading presentations and the urgency of referral are summarized on the basis of current guidelines and studies. The chapter also notes the patient populations in which clinical decision tools were evaluated and the situations in which they are not sufficient on their own. Sources of diagnostic error, safety-netting and the information to be communicated at referral are also discussed. The aim is to help family physicians decide how urgently a patient needs referral without waiting for a definitive diagnosis.
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