Cleveland Clinic journal of medicine
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The adult respiratory distress syndrome, marked by severe, refractory hypoxemia, noncardiogenic pulmonary edema, and stiff, noncompliant lungs, demands quick recognition and intensive care. This article reviews the disease process and current and experimental treatments for it.
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Lyme disease has taken hold in the imagination of the general public and physicians alike. Although the disease is real, the diagnosis is often false. Patients demanding an explanation for feeling out of sorts, and physicians too willing to oblige them with improper use of serologic tests and useless therapies both foster a mythology that conscientious physicians should try to combat. This article debunks the myths and presents the facts.
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The use of conscious sedation instead of general anesthesia is increasing with the development of less-invasive alternatives to surgery and the shift to outpatient care. Yet, conscious sedation can pose its own special dangers. Common pitfalls include failure to recognize hypoxemia, inadequate analgesia, inappropriate dosing with respect to individual variability, and lack of appropriate backup support.
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The limitations of current therapies for atrial fibrillation are forcing a rethinking of how they should be used. Questions are being raised about the use of antiarrhythmic drugs, and new nonpharmacologic procedures are promising alternatives. Most patients with atrial fibrillation still require warfarin therapy, but some low-risk patients can forego it. ⋯ Certain antiarrhythmic drugs should be avoided in patients with congestive heart failure, in whom the risks may exceed the benefits. The maze procedure is emerging as an option to restore and maintain sinus rhythm. Radiofrequency atrioventricular node ablation and modification hold promise as options to control the ventricular rate without drugs.