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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.

Eyes Yoo Close Together

Dangerous?

Can home visits for home medical emergency are dangerous? Can you send out small doctors at night? Why the doctor is sometimes uneasy?

There was, for example, the home visit last week. Shabby Building, fifth floor, the apartment door ajar. No response from inside. Chaos, disorder and decay already in the hallway of the apartment. Empty two-liter bottles of wine anywhere. Really everywhere. Filthy dishes piled up in the kitchen. Half empty pizza boxes. Moldy carpets. The powerful Russian was delirious in the next room. But before the doctor took care of him, he searched the rest of the apartment. Ready for anything, there was still lurking could.

There was, for example, the Fixer couple with the dog. Dilapidated apartment without furniture. Cold, old tobacco smoke. Greasy, hazy windows. He was seriously ill and on withdrawal. Wanted to benzodiazepines. The two were brash and demanding than the doctor did not believe them. Wanted to see for myself what was in the suitcase. Had the prescription forms certainly like to put in themselves. Like a scuffle would have ended? Had been threatened with infected needles? For example, there were

repeatedly southern men who wanted to spray their malaise but only got good advice. They do not understand. The were already demanding. Especially if they also ten have to pay €. For example, there are

repeatedly called on members of nursing care, which the doctor can not do the favor of hospitalization.

And there are always large dogs, dilapidated buildings, dark corridors, dissatisfied patients or relatives, violent alcoholic.

sure, the rescue service will always put dangerous situations on highways, construction sites, in factories. But the primary care emergency service is accessible for alone. Down the street waiting for a taxi driver. And a doctor's bag filled to the brim, which form thick binder with recipes and practice fees collected could one day Desires awaken.

Yes, home visits can be dangerous. Yes, small doctors are vulnerable at night.

The doctor takes the following precautions: Always light with you. Always remember the way back. Never follow a request to take off their shoes at the door. Never enter a dwelling in which a larger dog is moving freely.

But above all, be sure to do the right thing.

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paracetamol

paracetamol? Is a painkiller. Many patients believe pain but not its effect. At any effect. "Fever suppositories for children?" they say incredulously "to help me?"

But paracetamol acts. Sometimes it works even deadly.

She was a nurse, young, early 20 She had lower abdominal pain. As each month. However, they took a paracetamol tablet. Soon she felt sick and dizzy. It collapsed when the emergency bell rang at the door. Before losing consciousness, she could explain. The blood pressure sagged. Anaphylactic shock. Ventilation, cardiac massage, catecholamines, cortisol. From her apartment door to the ambulance. She was so unstable that the resuscitation was continued in RTW. Almost three hours. Unsuccessful. She died in the late afternoon, four hours after paracetamol ingestion.

What she told the emergency physician had? That she was allergic to paracetamol. That was even in their allergy identification. A few months ago it was you ever been so similar to a paracetamol. Since they had had to test it. They had hoped, anyway, the tablet is well tolerated for?

Since then the doctor prescribes medication or a bit more reserved.

Even paracetamol.