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Acute epiglottitis: A very rapidly progressive infection causing inflammation of the epiglottis (the flap that covers the trachea) and tissues around the epiglottis that may lead to abrupt blockage of the upper airway and death. These above are some more important works of kidney, which keeps our body safe from various diseases, and it controls the amount of calcium present in our body. Acute renal failure ( ARF ) or acute kidney injury both terms are same, in this condition kidney cannot perform its function properly. This disease can be diagnosed if person is suffering from these symptoms – breath odor, decrease appetite, fatigue, high blood pressure, flank pain, nausea, excessive urination and seizures.
This is a steady and fast deterioration of the kidney functioning, this happens when the kidney fails to pull out the wastes, this disease is caused when the volume of the blood is low. MAHBOOB RAHMAN, MD, MS, Case Western Reserve University School of Medicine, Cleveland, OhioFARIHA SHAD, MD, Kaiser Permanente, Cleveland, OhioMICHAEL C. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Severe Acute Respiratory Syndrome (SARS) : Treatment and prophylaxis with Reactive Oxidizers Species preparations.
As populations continue to grow and age, there will be increasing demand for acute curative services responsive to life-threatening emergencies, acute exacerbation of chronic illnesses and many routine health problems that nevertheless require prompt action. Clear definitions of health systems and services are required to create a common language to encourage discussion and help focus system development efforts. In 2007, WHO highlighted the need to strengthen health systems, but precise definitions and objectives, especially with regard to the delivery of health services, often remain elusive.4 Priority health problems are on consensus lists that countries normally develop with input from international organizations.
As a clinical service, acute care responds to immediately life- or limb-threatening health conditions, regardless of their ultimate cause.
The predominant conceptual framework divides health problems into communicable diseases, noncommunicable diseases and injuries. Many simple, effective and inexpensive acute care interventions can be life-saving, often within the first 24 hours.
Creating an acute care service delivery model for low- and middle-income countries that will function in parallel with preventive and primary services. Improving coordination between deliverers of acute care services, such as emergency physicians, surgeons and obstetricians, to deliver critical acute care services efficiently and effectively. Developing research methods to quantify the burden of acute care diseases and injuries, including health economics and cost-effectiveness components, to justify integrating acute care within health systems.
Holding national and international discussions to encourage better integration of acute care within local and national health systems. This paper is a call to action for leaders, policy-makers and academics to acknowledge the key contribution of acute care systems towards the care of patients with communicable and non-communicable conditions and injuries.
JM Hirshon received funding from the National Institutes of Health Fogarty International Center (Grant 5D43TW007296). Report of the Secretary-General on the prevention and control of non-communicable diseases.
Prevention and control of noncommunicable diseases: guidelines for primary health care in low resource settings. Peritonitis, acute: Sudden inflammation of the peritoneum, the membrane lining the inner wall of the abdomen and pelvis, resulting in abrupt abdominal pain (an acute abdomen).
This organ performs several essential functions to save our body from the various diseases; this organ also serves as natural filter of the blood. Kidney removes wastes from our body by this process- foods and drinks enters from the esophagus to the stomach and broken into nutrients, nutrients enter into blood stream and used by the body for growth, energy and maintenance of body. If any people suffer from this disease must contact the doctor and should go for these medical tests like – Erythrocyte Sedimentation Rate, Urinalysis, Elood Electrolyte etc. Acute renal failure creates many other problems like – change in the balance of body fluid, increase in the potassium level in the blood. The spectrum of injury ranges from mild to advanced, sometimes requiring renal replacement therapy. Most patients with mild to moderate acute kidney injury are asymptomatic and are identified on laboratory testing. The history should identify use of nephrotoxic medications or systemic illnesses that might cause poor renal perfusion or directly impair renal function. A value less than 1 percent indicates a prerenal cause of acute kidney injury, whereas a value greater than 2 percent indicates an intrinsic renal cause. After acute kidney injury is established, management is primarily supportive.Patients with acute kidney injury generally should be hospitalized unless the condition is mild and clearly resulting from an easily reversible cause. It is caused by a virus that was first identified in 2003.Infection with the SARS virus causes acute respiratory distress (severe breathing difficulty) and sometimes death.
Hikers, skiers and adventurers who travel to high altitudes can sometimes develop acute mountain sickness, also referred to as altitude sickness or high altitude pulmonary edema. Department of Emergency Medicine, University of Maryland School of Medicine, 10 South Paca Street, Room 4S-127, Baltimore MD 21201, United States of America (USA).b. Emergency interventions and services should be integrated with primary care and public health measures to complete and strengthen health systems. Standard medical definitions for acuity emphasize the singular attribute of time pressure.3 Acute services therefore include all promotive, preventive, curative, rehabilitative or palliative actions, whether oriented towards individuals or populations, whose primary purpose is to improve health and whose effectiveness largely depends on time-sensitive and, frequently, rapid intervention. As a group, acute curative services are the most time-sensitive, regardless of disease entity.
Examples include administering intravenous fluids to a critically injured patient before transfer to an operating room. Examples include delivery of care by ambulance personnel or evaluation of acute health problems by local health-care providers. Examples are patients with severe respiratory problems requiring endotracheal intubation and patients with seizures caused by cerebral malaria. Health services are then oriented towards preventing and controlling these priority health problems. Thus, acute care necessarily supports progress towards strong health systems (horizontal approach) rather than from patchwork efforts that may improve outcomes for specific conditions but not the overall functioning of the health system (vertical programmes).
The current global discussion concerning noncommunicable diseases illustrates how care can be fragmented when the time sensitivity of curative interventions is ignored. These acute care services will address both life-threatening and limb-threatening problems as well as exacerbations of priority noncommunicable diseases. However, the creation of such acute care systems should not be used as a pretext for diverting resources to the construction of poorly-resourced and ill-managed health facilities.

Kidney is a very important organ of the body because it is responsible for the re-absorption of water, glucose and amino acids.
Extra nutrients, which are not absorbed by the body are removed by the kidney and waste products and material moves from kidney to bladder and ultimately it is disposed. The diagnostic evaluation can be used to classify acute kidney injury as prerenal, intrinsic renal, or postrenal. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Patients with severe cases, however, may be symptomatic and present with listlessness, confusion, fatigue, anorexia, nausea, vomiting, weight gain, or edema.15 Patients can also present with oliguria (urine output less than 400 mL per day), anuria (urine output less than 100 mL per day), or normal volumes of urine (nonoliguric acute kidney injury).
Physical examination should assess intravascular volume status and any skin rashes indicative of systemic illness.
In patients on diuretic therapy, however, a FENa higher than 1 percent may be caused by natriuresis induced by the diuretic, and is a less reliable measure of a prerenal state. The key to management is assuring adequate renal perfusion by achieving and maintaining hemodynamic stability and avoiding hypovolemia. Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.c. However, to date, acute care has been poorly defined and inadequately supported in most developing health systems. One important component that has yet to be adequately elucidated within these processes is the influence of time on the implementation and success of interventions.
Notably, many of the material, consumable and human resources required to implement acute care platforms are the same as those needed in traditional a€?disease-centreda€? programmes. Within health systems, acute care also serves as an entry point to health care for individuals with emergent and urgent conditions.
Aligning key players, both within countries and across them, to support the development of the best mix of acute and preventive services needed to address the growing disease burden is an urgent priority for health systems and society.
Peritonitis is an inflammation of the membrane which lines the inside of the abdomen and all of the internal organs. The initial workup includes a patient history to identify the use of nephrotoxic medications or systemic illnesses that might cause poor renal perfusion or directly impair renal function.
The initial laboratory evaluation should include urinalysis, complete blood count, and measurement of serum creatinine level and fractional excretion of sodium (FENa). In such cases, fractional excretion of urea may be helpful, with values less than 35 percent indicating a prerenal cause. Dizziness, nausea, headaches, and shortness of breath are a few symptoms of this condition. R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, USA.d. First, we draw on standard World Health Organization (WHO) terminology to propose working terms to define a€?acute carea€?.
A reasonable working definition of acute care would include the most time-sensitive, individually-oriented diagnostic and curative actions whose primary purpose is to improve health.
Preventive strategies primarily focus on reducing the probability of incident cases through interventions that decrease the risk of developing a disease. Additionally, it is important to dispel common misperceptions about acute care, such as believing it to be the same as ambulance transport or fundamentally reliant on high technology. A strict definition of acute care will allow the development of metrics for the evaluation of acute care services, the assessment of the disease burden addressed by these services, and the articulation of goals for the advancement of acute care in low- and middle-income countries.8 The separate and currently fragmented specialty areas grouped under acute care have been largely unable to spark growth in their respective clinical domains at the international level. These factors may result in fatal asphyxia within a few hours. The onset of this disease is typically acute and the course is frequently fulminant. An injury or any infection called sepsis can decrease the amount of blood flow from hearth to kidney.
Patient must acquire diet which is low in protein, potassium and salt but high in carbohydrates. Physical examination should assess intravascular volume status and identify skin rashes indicative of systemic illness. Second, we highlight the fragmentation of service delivery that results from not adopting the proposed definition.
A proposed definition of acute care includes the health system components, or care delivery platforms, used to treat sudden, often unexpected, urgent or emergent episodes of injury and illness that can lead to death or disability without rapid intervention. The essential contribution of acute care towards reducing the growing burden of disease and injuries has been woefully underestimated.
This is partly because of lack of appropriate metrics and coordination of health service delivery.
Sore throat, hoarseness, and, frequently, high fever develop abruptly in a previously well child. The initial laboratory evaluation should include measurement of serum creatinine level, complete blood count, urinalysis, and fractional excretion of sodium.
The definition of acute kidney injury indicates that a rise in creatinine has occurred within 48 hours, although in the outpatient setting, it may be hard to ascertain when the rise actually happened.
In severe hyperkalemia, 5 to 10 units of regular insulin and dextrose 50% given intravenously can shift potassium out of circulation and into the cells.
In rare cases, however, altitude sickness can become severe, causing complications with the lungs or brain. Third, we show the potential contribution of acute care to integrated health systems designed to reduce all-cause morbidity and mortality. On the other hand, curative strategies reduce the probability of disability or death among existing cases. Understanding acute care as an integrated care platform allows these splintered areas to move forward with a single agenda as a unified front. Dysphagia (trouble swallowing) and respiratory distress characterized by drooling, dyspnea (difficulty breathing), tachypnea (fast breathing), and inspiratory stridor (noisy inspiration) develop rapidly, often causing the child to lean forward and hyperextend the neck to enhance air exchange. Acute Renal Failure is the very dangerous disease, nowadays many people are suffering from this disease.
Ultrasonography of the kidneys should be performed in most patients, particularly in older men, to rule out obstruction.
A high serum creatinine level in a patient with a previously normal documented level suggests an acute process, whereas a rise over weeks to months represents a subacute or chronic process.URINALYSISUrinalysis is the most important noninvasive test in the initial workup of acute kidney injury. Calcium gluconate (10 mL of 10% solution infused intravenously over five minutes) is also used to stabilize the membrane and reduce the risk of arrhythmias when there are electrocardiographic changes showing hyperkalemia.

Finally, we propose key steps to further the development of acute care that leaders, researchers and health workers, who are the people responsible for maintaining strong national health systems, should consider taking.
The relative priority assigned to curative interventions is driven by how time-sensitive and effective the interventions are, as well as by cost.
The integration of acute care with preventive and primary care completes a health-care system paradigm that fully encompasses all essential aspects of health care delivery.
Management of acute kidney injury involves fluid resuscitation, avoidance of nephrotoxic medications and contrast media exposure, and correction of electrolyte imbalances.
Renal biopsy may need to be performed urgently in patients with oliguria who have rapidly worsening acute kidney injury, hematuria, and red blood cell casts. In patients without electrocardiographic evidence of hyperkalemia, calcium gluconate is not necessary, but sodium polystyrene sulfonate (Kayexalate) can be given to lower potassium levels gradually, and loop diuretics can be used in patients who are responsive to diuretics.
However, in the case of curative services, the relationship between time and effectiveness varies, which makes it important to get the patient to the right place at the right time for the right intervention. Dietary intake of potassium should be restricted.The main indication for use of diuretics is management of volume overload. Failure to consider the time component of curative services produces fragmentation through poor coordination of care and the imprecise application of clinical interventions, such as delays in treating sepsis with antibiotics leading to death or disability. Visualization of the epiglottis should be done only by designated trained personnel using equipment to establish an airway if necessary. Intravenous loop diuretics, as a bolus or continuous infusion, can be helpful for this purpose.
Fragmented care reduces the number of disability-adjusted life years (DALYs) that can be averted with a given set of resources. If direct examination of the larynx confirms the diagnosis by revealing a beefy red, stiff, and edematous (swollen) epiglottis, an artificial airway should be placed immediately. Team-based approaches for prevention, early diagnosis, and aggressive management are critical for improving outcomes. However, it is important to note that diuretics do not improve morbidity, mortality, or renal outcomes, and should not be used to prevent or treat acute kidney injury in the absence of volume overload.22All medications that may potentially affect renal function by direct toxicity or by hemodynamic mechanisms should be discontinued, if possible. When you travel in a plane, drive or hike up a mountain, or go skiing, your body may not have enough time to adjust, resulting in altitude sickness.
The causative organism may then be cultured from the upper respiratory tract and, usually, from the blood. Epiglottitis caused by H. For example, metformin (Glucophage) should not be given to patients with diabetes mellitus who develop acute kidney injury. Autoregulatory mechanisms often can compensate for some degree of reduced renal perfusion in an attempt to maintain the glomerular filtration rate.
The dosages of essential medications should be adjusted for the lower level of kidney function. Pushing yourself to quickly hike up a mountain, for example, may cause acute mountain sickness. In patients with preexisting chronic kidney disease, however, these mechanisms are impaired, and the susceptibility to develop acute-on-chronic renal failure is higher.11Several medications can cause prerenal acute kidney injury. Notably, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers can impair renal perfusion by causing dilation of the efferent arteriole and reduce intraglomerular pressure.
In patients with rapidly progressive glomerulonephritis, treatment with pulse steroids, cytotoxic therapy, or a combination may be considered, often after confirmation of the diagnosis by kidney biopsy.23 In some patients, the metabolic consequences of acute kidney injury cannot be adequately controlled with conservative management, and renal replacement therapy will be required.
These drugs and others limit the normal homeostatic responses to volume depletion and can be associated with a decline in renal function.
Other risk factors include: quick movement to high altitudes physical exertion while traveling to a higher altitude traveling to extreme heights (for example, anything above 14,000 feet) a low red blood cell count due to anemia heart or lung disease past bouts of acute mountain sickness What are the Symptoms of Acute Mountain Sickness?
The cause is usually ischemic (from prolonged hypotension) or nephrotoxic (from an agent that is toxic to the tubular cells). In contrast to a prerenal etiology, acute kidney injury caused by acute tubular necrosis does not improve with adequate repletion of intravascular volume and blood flow to the kidneys.
Both ischemic and nephrotoxic acute tubular necrosis can resolve over time, although temporary renal replacement therapy may be required, depending on the degree of renal injury and the presence of preexisting chronic kidney disease.Glomerular causes of acute kidney injury are the result of acute inflammation of blood vessels and glomeruli. If you have a mild case, you may experience: dizziness headache muscle aches insomnia nausea and vomiting irritability loss of appetite swelling of the hands, feet, and face rapid heartbeat shortness of breath with physical exertion Severe cases of acute mountain sickness can cause more intense symptoms, affecting your heart, lungs, muscles, and nervous system.
History, physical examination, and urinalysis are crucial for diagnosing glomerulonephritis (Table 39 and Figure 112). During the exam, your doctor will most likely use a stethoscope to listen for fluid in your lungs.
Hospitlization is required if your doctor determines that there is brain swelling or fluid in your lungs. However, if your condition is severe and there is little access to treatment, complications can lead to swelling in the brain and lungs, resulting in coma or death. In about one-third of cases, there is a history of maculopapular erythematous rash, fever, arthralgias, or a combination of these symptoms.13 Eosinophiluria may be found in patients with acute interstitial nephritis, but it is not pathognomonic of this disease. A kidney biopsy may be needed to distinguish between allergic interstitial nephritis and other renal causes of acute kidney injury. In addition to discontinuing offending agents, steroids may be beneficial if given early in the course of disease.14Acute events involving renal arteries or veins can also lead to intrinsic acute kidney injury.
Renal atheroembolic disease is the most common cause and is suspected with a recent history of arterial catheterization, the presence of a condition requiring anticoagulation, or after vascular surgery. Vascular causes of acute kidney injury usually require imaging to confirm the diagnosis.POSTRENAL CAUSESPostrenal causes typically result from obstruction of urinary flow, and prostatic hypertrophy is the most common cause of obstruction in older men. Instead of moving from zero to 8,000 feet all in one day, rest for a day after every 2,000 feet. Having anemia causes a low red blood cell count, which reduces the amount of oxygen in your blood. Ask your doctor about taking an iron supplement, and treat the issue before going to high altitudes.
If you have either heart or lung disease, the combination of high altitudes and low oxygen can be difficult to endure. If you take medications like sleeping pills, narcotic pain relievers and tranquilizers, check with your doctor before climbing to high altitudes.

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