Monday, July 7, 2008

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high blood pressure spiral

A common sight, a typical constellation: Well-kept apartment, elderly lady alone. On the table: An electronic blood pressure meter, a few boxes with blood pressure medicine and a meticulously-managed blood pressure protocol, closely written in the last hours.

The older woman is troubled, excited. Flushed face, rapid breathing, nervous walking around. The reason: Your blood pressure is out of control. Alarmingly high values it has measured in the last hours and written. And with each measurement, the values were increased. As nifedipine neither helped nor nitro spray.

Whether the meter is broken, perhaps? No, the doctor quite similarly high values measured with the old Riva-Rocci blood pressure measurement.

The meter is not broken. But it contributes to this "high blood pressure spiral" essential to: Any high measurement value increases the anxiety of the patient. Any increase in the patient's anxiety increases blood pressure. And over again. The doctor prescribed

a blood pressure medicines and prohibits the blood pressure measurement, at least for the next few hours. It calms and entdramatisiert. Clear instructions, clear and calm instruction times and transport pass leave some. And behold: it works.

Conclusion: Not all patients have these modern, precise, simple and inexpensive measuring devices at home really useful.

(see also "If you do not take a temperature you can not find a fever")

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fever?

"If you do not take a temperature you can not find a fever" (Rule # 10, " House of God "by Samuel Shem). This tenth

Act Shems classic is as simple as true: If you measure any temperature, you will notice a fever. In this country, it can also be formulated as follows: "A healthy man is only human who has not been studied thoroughly enough"

course, the fever-law meant in a figurative sense. The doctor is one especially at the beginning of training, often face the question of what tests for situations in which complaints and really useful. The greater the uncertainty of school-leavers more instrument examinations will take it. Shotgun diagnostics: Somewhere something has to be seen. Failing this, the young doctor is on the safe side and must be mentioned in his letter of release all the complicated procedure remained inconclusive. Last but this approach also serves the legal protection. Finally, we are all always "one foot in jail."

The experienced physician, however, is used sparingly and targeted investigations. Not only because it's experience, many differential diagnoses Exclude leaves. But also because he knows that many findings in the individual case would have no consequences.

But the fever-law also has a literal accuracy: How often was called the doctor already in retirement or nursing homes because a resident "was not good"? Somehow. Very diffuse. No appetite, very tired, did not want to get up. Or even more blatantly: vomiting, restlessness, delirium. Sometimes even the whole body trembling, teeth chattering. This is sometimes interpreted even as a "seizure".

nurses then measure usually blood pressure and blood sugar, with disastrous results. By then the ambulance is called. Him a jumble of observations are described and some measurements. "The residents are not going well." "The residents may have a fever?" (Feel the back of the hand to the cheek of the person concerned) "No." "Did you check?" "No." Or "I must go and see in the curve."

Recently the doctor a temporal thermometer in the box (10 € at Aldi) added. And lo and behold: the resident but has a fever. Often even really high. It then explains all the anomalies of recent days. Just clarify the cause of fever (mostly bronchial or urinary tract) and can begin a causal therapy.

Twelve years ago, when the doctor began his emergency services, he hoped that the fever knife before the emergency call would soon become a matter of course. All too often, a visit to the nursing home has since expired by the above-described pattern. Today is hoping the doctor any more.

But even in the home, the temperature measurement is forgotten. Straight male patients from south-eastern countries refuse the rectal temperature measurement (gold standard) often with indignation. Apart from this, many households in a fever thermometer is more present, even if several small children living there.

And the conclusion? Unclear deterioration in general health status are often associated with fever. And fever can be stated precisely only if one measures the temperature.