American family physician
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American family physician · Apr 1991
ReviewPediatric advanced life support: Part I. Airway, circulation and intravascular access.
Effective management of life-threatening emergencies in infants and children demands a high level of technical skill. The Pediatric Advanced Life Support (PALS) provider course, developed jointly by the American Academy of Pediatrics and the American Heart Association, is highly recommended to help physicians prepare for pediatric emergencies. Equipment, cardiopulmonary assessment, airway maintenance, circulation maintenance and intravascular access are discussed in this article. The description of pediatric emergency management follows that of the PALS course.
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Shoulder entrapment during delivery is a true obstetric emergency that can result in significant maternal and infant trauma. Fetal macrosomia, maternal obesity, maternal diabetes and prolonged second stage of labor are associated risk factors. ⋯ With fetal shoulder entrapment, the mother may have significant hemorrhage, fourth-degree perineal lacerations and endometritis. Maneuvers to release the shoulder include closed-fist suprapubic pressure, downward pressure on the posterior shoulder, rotation of the anterior shoulder to the oblique position, rotation of the posterior shoulder beneath the pubic symphysis, release of the posterior arm and anterior rotation of the fetal body.
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American family physician · Nov 1990
ReviewPatient profiling: individualization of hypertension therapy.
Although the stepped-care approach remains the cornerstone of antihypertensive therapy, the patient's profile must also be considered. Important issues include the patient's age, race and activity level, potential for hypertensive complications, presence of other diseases, cost of medications and probability of adherence to the recommended drug regimen. Nonpharmacologic treatment based on lifestyle changes is a useful adjunct to drug therapy, but it is not sufficient to control hypertension in most patients. Selection of pharmacologic therapy must be based on a knowledge of each drug's mode of action and side effects, as well as the characteristics of special patient populations.
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Major depression is a syndrome that can be triggered by numerous physical and psychosocial factors. Concurrent somatic complaints can complicate the diagnosis. Patient evaluation requires a comprehensive history, physical and mental status examinations, and a number of laboratory studies. Effective treatment of depression enhances the quality of life, reduces the probability of secondary alcoholism or suicide, frequently improves coexisting medical problems and reduces the high rate of health care use by these patients.
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Regarded by many as a delicacy, puffer fish can be the source of lethal food poisoning in humans. The syndrome is caused by tetrodotoxin, one of the most potent poisons known. ⋯ Life support may be required. In some series, the mortality rate has approached 60 percent.