Further Reading
274 Surgical Emergencies
4 Neurogenic origin
(i) Herpes zoster.
(ii) Radiculitis from spinal cord degeneration or malignancy.
(iii) Tabes dorsalis.
5 Thoracolumbar spine origin
Collapsed vertebra due to osteoporosis, neoplasm or infection, e.g. tuberculosis
(see p. 332).
6 Psychiatric
Münchausen’s syndrome or ‘hospital hopper’:
(i) Be suspicious of a patient presenting with acute abdominal pain
or renal colic, who usually does not live locally, and with no GP,
who may have multiple abdominal scars from operations ‘at
another hospital’.
(ii) Their aim is to gain narcotic analgesia or hospital admission by
feigning illness.
(iii) Ask for a previous hospital number or admission details, so you
can ‘go and verify their story’.
(iv) Seek advice from the senior ED doctor.
7 Take a careful history in every case, do a thorough examination, and send
blood for FBC, U&Es, LFTs, blood sugar and lipase/amylase.
8 Request a urinalysis, perform an ECG and request a CXR and AXR to avoid
missing the more serious diagnoses.MANAGEMENT1 Discuss the case with the senior ED doctor. Admit the patient as appropriate
according to the underlying diagnosis.FURTHER READING
National Institute for Health and Clinical Excellence, NHS UK. http://www.nice.
org.uk/Guidance/CG/Published
National Institute of Clinical Studies (Australia). http://www.nhmrc.gov.au/nics/
index.htm
Scottish Intercollegiate Guidelines Network. http://www.sign.ac.uk/
Trauma.org http://www.trauma.org/ (trauma education and management).