Rapid Emergency and Unscheduled Care

Oliver Phipps, Jason Lugg

• Publisher: Wiley-Blackwell
• Year: 2016
• Print ISBN: 9781119035855
• eBook ISBN: 9781119035879
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

Rapid Emergency and Unscheduled Care outlines the fundamental skills and knowledge necessary to work in the emergency and unscheduled care setting, including pre-hospital care.

• Highlights key history/assessment knowledge, identifying red-flags, and defining and assisting with making a diagnosis
• Explores over 140 presenting ailments, with core information on definition, aetiology, epidemiology, history, examination, investigations and management.

Incorporating words of wisdom and advice from experienced practitioners, this A-Z reference book is essential for all those working in emergency care settings, including doctors, nurse practitioners, nurses, paramedics, and allied health professionals.

Musculoskeletal

Achilles tendon injuries

Definition

Achilles tendon rupture (partial or complete) refers to tearing of the Achilles tendon. The Achilles is the tendon that connects the calf muscles to the calcanium. Achilles tendinopathy (preferred term to tendonitis) is a broad term used to describe a degenerative condition that causes pain, swelling, weakness and stiffness of the Achilles tendon.

Aetiology

Achilles tendinopathy is believed to result from repeated micro trauma to the tendon that fails to heal. The mechanism of repeated tendon overloading causes degeneration. Achilles tendon rupture occurs when the tendon is overstretched. Rupture can be secondary to tendinopathy or occur in individuals who have suddenly increased their sporting activity.

Epidemiology

Achilles tendinopathy has an estimated lifetime incidence of around 6% in inactive people, but this increases to around 50% in elite athletes. Men are more likely to be affected particularly between 30 and 40 years of age. Achilles tendon rupture has an incidence of 6–18 ruptures per 100 000 people. Rupture is also more common in men, with complete rupture affecting three times more men than women.

History

• In tendinopathy the patient often describes a gradual onset of pain and swelling to the Achilles tendon with reduced range of movement due to stiffness. Pain is often in the middle third of the tendon and worse in the morning.
• In rupture the patient often describes a sudden and sometimes audible popping sensation to the back of the ankle (patients often initially think they were kicked), followed by pain, swelling and lack of function. Weight bearing can be difficult.

Examination

• Look for swelling or bruising along the tendon.
• Feel for the presence of a palpable gap or loss of contour indicating rupture.
• Assess active and resisted ankle plantar flexion.
• Perform a calf squeeze (Simmonds or Thompson test) and compare to the other leg.

Investigations

• Achilles tendinopathy is a clinical diagnosis, and imaging is not routinely required.
• X-ray is not usually of value unless suspecting other injuries, that is, calcanium avulsion.
• Ultrasound scanning or MRI is useful in secondary care to confirm diagnosis.

Management

Achilles tendinopathy	Achilles tendon rupture
Advise rest in particular from high-impact activ...

Table of contents

• Cover
• Title Page
• Table of Contents
• List of contributors
• Preface
• Acknowledgements
• List of abbreviations
• Cardiovascular
• Ear, nose and throat (ENT)
• Endocrine
• Gastroenterology
• Genitourinary
• Infections, sepsis and infectious diseases
• Mental health emergencies
• Musculoskeletal
• Neurology
• Obstetrics and gynaecology
• Ophthalmology
• Overdose and poisoning
• Respiratory
• Skin
• The electrocardiogram
• Index
• End User License Agreement