The Rational Clinical Examination
David L. Simel, Drummond Rennie
Hypovolemia, Adult
Steven McGee, William B. Abernethy III, David L. Simel
Clinical Scenarios
Topics Discussed:
fecal occult blood test, hearing impairment, hypovolemia, nausea and vomiting, vertigo
Excerpt:
"In each of the following clinical scenarios, clinicians need
to identify which physical signs reliably and accurately indicate
volume depletion or dehydration.A 54-year-old man, taking ibuprofen for knee arthritis, presents
with a 1-day history of melena. Physical examination reveals a pulse
of 80/min and blood pressure (BP) of 140/82 mm
Hg when supine and 115 and 132/86 mm Hg when standing. There
is mild epigastric tenderness and a positive result on a guaiac
test for occult blood in the stool. The hematocrit level is 39%. ..."
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