The Journal of family practice
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This is a report of the results of a study of all patients who received cardiopulmonary resuscitation (CPR) for an in-hospital cardiac arrest in a community hospital from July 1983 through June 1984. Out of 121 patients, 46 survived the initial arrest, but only 13 (11 percent) survived to leave the hospital. The patient's age or sex were not predictors of survival to leave the hospital. ⋯ Patients with acute myocardial infarctions or cardiac arrhythmias had better survival rates (26 percent and 19 percent, respectively) than with other diagnosis (5 percent), but this difference did not reach statistical significance. Patients who survived to leave the hospital did not suffer any mental loss from the arrest. General guidelines for withholding CPR based on the present study and a review of the literature are presented.
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Ectopic pregnancies are common, are increasing in incidence, and are preventable causes of reproductive morbidity and death. They are also frequently misdiagnosed, and are one of the most common causes for malpractice claims made against primary care physicians. The classic description of the presenting signs and symptoms of ectopic pregnancy was derived from a series of ruptured ectopic pregnancies. ⋯ The study confirmed the expected frequency of this condition in this population but findings disclosed that the classic presentation was, in fact, uncommon. Implications for decision making derived from these case reports are discussed. A high level of clinical suspicion for this problem must be maintained.
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A chart review of 37 hospitalized patients with diabetes mellitus who received burn therapy showed that ten (27 percent) had preventable lower-extremity burns related to sensory loss. Most of these ten burns occurred from heat applied for self-care of diabetes, namely, from hot tap water, a hot moist compress, or a heating pad. These ten patients, compared with the other 27 diabetic burn patients, were more likely to be men younger than 45 years old, to have insulin-dependent diabetes, and to have been burned during self-treatment. These findings underscore the importance of injury-prevention educational efforts by physicians in cautioning their diabetic patients, especially those with lower-extremity sensory losses, about potential burns from heat applied to the lower extremities for self-care.
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Randomized Controlled Trial Comparative Study Clinical Trial
Treatment of mild to moderate pain of acute soft tissue injury: diflunisal vs acetaminophen with codeine.
Acute soft tissue injuries create pain and limitation of function. Treatment requires analgesia and time for full recovery. Acetaminophen with codeine (650 mg plus 60 mg, respectively, every 4 to 6 hours) is used frequently as the analgesic of choice. ⋯ However, 65 percent of acetaminophen with codeine patients experienced side effects, with 35 percent of these patients stopping the medication because of intolerable side effects. In the diflunisal group, 28 percent of the patients experienced side effects and 5 percent had to stop the medication early. Diflunisal was found to be an effective analgesic in mild to moderate pain of acute soft tissue injuries, and caused fewer and more tolerable side effects than did acetaminophen with codeine.