NZREX Clinical key terms

Sudden severe abdominal pain of less than about a week's duration that often signals a condition needing urgent surgical assessment, such as appendicitis, perforation, or ischaemic bowel.

Rebound tenderness and guarding caused by inflammation of the peritoneum, typically indicating blood, pus, or bowel contents in the peritoneal cavity and prompting urgent surgical review.

Free gas within the peritoneal cavity, usually from a perforated hollow viscus, shown as free air under the diaphragm on an erect chest X-ray or on CT.

Blockage of the small or large intestine causing colicky pain, vomiting, distension, and absolute constipation, with adhesions and malignancy among the commonest causes in adults.

Irreversible trapping of a hernia's contents within its sac, which threatens strangulation of the bowel and usually requires emergency surgical repair.

Compromise of the blood supply to a herniated or obstructed segment of bowel, leading to ischaemia, gangrene, and perforation if not relieved urgently.

A systematic framework for classifying causes of a surgical symptom into categories such as congenital, inflammatory, traumatic, neoplastic, and vascular, used to build a complete differential diagnosis.

The package of assessment and management delivered before, during, and after an operation, including risk stratification, thromboprophylaxis, antibiotic prophylaxis, and enhanced recovery planning.

A three-phase team checklist used at sign-in, time-out, and sign-out around an operation to confirm patient identity, site, allergies, equipment, and specimen handling, reducing avoidable harm.

A patient's voluntary agreement to an intervention after receiving and understanding information about its purpose, benefits, material risks, alternatives, and the consequences of declining.

A person's ability to make a particular decision at a particular time, assessed by whether they can understand, retain, weigh, and communicate relevant information.

A structured clinical record organised into subjective findings, objective findings, an assessment or problem list, and a management plan, widely used in New Zealand hospital documentation.

A ranked list of possible conditions that could explain a patient's presentation, ordered by likelihood and by how urgently each must be excluded or treated.

A concise register of a patient's active and significant past medical issues, used to keep the clinical record organised and to guide handover and ongoing management.

A structured verbal handover covering identify, situation, background, assessment, and recommendation, used to transfer care safely between clinicians and teams.

The process of promptly informing a more senior clinician or rapid response team when a patient's condition deteriorates or exceeds the agreed plan, using objective triggers such as early warning scores.

Life-threatening organ dysfunction caused by a dysregulated host response to infection, recognised by signs such as altered mentation, low blood pressure, and raised respiratory rate, requiring urgent antibiotics and fluids.

A bedside screening score for sepsis using three items: respiratory rate of 22 or more, altered mentation, and systolic blood pressure of 100 mmHg or less; two or more prompt urgent review.

A spectrum of myocardial ischaemia from unstable angina through non-ST-elevation and ST-elevation myocardial infarction, diagnosed with serial troponin testing and ECG and treated with antiplatelet therapy and reperfusion.

Upward displacement of the ST segment on an ECG, which in the appropriate clinical setting indicates acute transmural myocardial injury and triggers emergency reperfusion.

Accumulation of fluid in the lung interstitium and alveoli, commonly from left ventricular failure, causing breathlessness, orthopnoea, basal crackles, and a frothy cough.

Jugular venous pressure, estimated at the bedside from the height of the internal jugular pulsation, giving a guide to right atrial pressure and volume status.

Systematic reading of an arterial blood gas for pH, carbon dioxide, bicarbonate, oxygen, and base excess to classify respiratory or metabolic acidosis and alkalosis and detect compensation.

New hypertension after 20 weeks' gestation with proteinuria or maternal organ dysfunction, which can progress to seizures, liver and kidney injury, and fetal growth restriction.

New-onset generalised seizures in a woman with pre-eclampsia, in the absence of another cause, managed with magnesium sulphate and urgent delivery.

A severe variant of pre-eclampsia marked by haemolysis, elevated liver enzymes, and low platelets, causing right upper quadrant pain and requiring urgent obstetric review and delivery.

Bleeding from the genital tract after 20 weeks' gestation and before birth, with placenta praevia and placental abruption as the key causes needing urgent assessment.

Premature separation of a normally implanted placenta, causing painful vaginal bleeding, a tense uterus, and fetal compromise, with concealed bleeding possible.

Implantation of the placenta over or near the cervical os, causing painless vaginal bleeding late in pregnancy and requiring caesarean delivery in most cases.

Blood loss of 500 mL or more after vaginal birth or 1000 mL or more after caesarean, most often from uterine atony, managed with uterine massage, uterotonics, and escalation.

Simultaneous recording of fetal heart rate and uterine contractions, interpreted for baseline rate, variability, accelerations, and decelerations to detect fetal compromise in labour.

Failure of the shoulders to deliver after the head in a vaginal birth, an obstetric emergency managed with manoeuvres to free the anterior shoulder and prevent brachial plexus injury.

Structured support of a newborn's breathing and circulation at birth, beginning with warmth, drying, and stimulation, then airway positioning and positive pressure ventilation if breathing is inadequate.

A rapid assessment at one and five minutes after birth of appearance, pulse, grimace, activity, and respiration, used to describe newborn condition and guide the need for resuscitation.

Monitoring of fetal wellbeing before and during labour using methods such as auscultation, cardiotocography, and fetal scalp sampling, interpreted alongside maternal observations.

A viral lower respiratory infection of infants, most often from respiratory syncytial virus, causing coryza, cough, wheeze, and crackles, managed mainly with supportive oxygen and feeding support.

Viral inflammation of the larynx and subglottis in young children, producing a barking cough, hoarse voice, and inspiratory stridor, treated with a single dose of oral corticosteroid.

A harsh inspiratory sound from turbulent airflow through a narrowed upper airway, signalling obstruction that may need urgent airway assessment and senior help.

A deficit of body water and electrolytes in a child, usually from gastroenteritis, graded clinically by reduced skin turgor, delayed capillary refill, sunken eyes, and reduced urine output.

Replacement of fluid and electrolyte losses by frequent small drinks of an appropriate solution, the first-line treatment for mild to moderate dehydration in children.

A structured assessment of appearance, behaviour, speech, mood, thought form and content, perception, cognition, insight, and risk, forming the core psychiatric clinical record.

Systematic evaluation of a person's risk of harm to self or others, including suicidal ideation, self-harm history, and protective factors, documented with a clear management plan.

An acute fluctuating disturbance of attention and awareness, often from infection, drugs, or metabolic upset, which is frequently mistaken for dementia or a primary psychiatric illness.

In New Zealand, a compulsory psychiatric assessment under the Mental Health (Compulsory Assessment and Treatment) Act 1992, requested when serious mental illness is suspected and community assessment is unsafe.

A potentially fatal toxidrome from serotonergic drugs causing agitation, tremor, clonus, hyperreflexia, and hyperthermia, requiring drug cessation and supportive treatment.