Postgraduate medicine
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Postgraduate medicine · Oct 1992
Delirium and acute psychosis. Mental states calling for clear diagnostic thinking and careful management.
Management of a delirious or acutely psychotic patient calls for rapid but well-considered decision making by the treating physician. Clear diagnostic thinking is vitally important in making a presumptive diagnosis and forming a treatment plan. Appropriate treatment usually returns patients to a less agitated state and allows for definitive treatment of any underlying illness.
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Carbon monoxide poisoning is a significant health threat in the United States. Smoke inhalation from fires is the most common source. History of carbon monoxide exposure and elevated carboxyhemoglobin levels should alert physicians to the diagnosis of acute poisoning. ⋯ If suspicion remains, carboxyhemoglobin levels should be determined and oxygen therapy should be started empirically while laboratory results are pending. Prompt administration of hyperbaric oxygen may reduce the risk of death. If carbon monoxide poisoning is confirmed, the source must be identified and recommendations for correction or avoidance should be made.
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Postgraduate medicine · Sep 1992
Review Case ReportsIron deficiency and anemia of chronic disease. Clues to differentiating these conditions.
Iron deficiency occurs when the body's iron stores are exhausted. The source of blood loss leading to iron deficiency must be identified in all cases. Anemia of chronic disease generally results from an infectious, inflammatory, or malignant process. ⋯ Differentiating iron deficiency anemia from anemia of chronic disease may be difficult because of similarities in presentation. Physicians need to be aware of special clinical considerations when these two types of anemia coexist. Ferrous sulfate therapy is the ideal form of iron replacement.
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Postgraduate medicine · Aug 1992
ReviewAcute and postoperative pain. Management from a primary care perspective.
Most pain is controllable. Patient education and careful intraoperative technique are useful prophylactic measures. Simple analgesics and non-steroidal anti-inflammatory drugs reduce pain, fever, and inflammation and are well tolerated when dosing guidelines are followed carefully. ⋯ Various acute-pain syndromes respond to blockade of the sympathetic or somatic neural pathways. Knowledge of the appropriate anatomic structures and careful technique are mandatory with this method. Moreover, it should be considered only one part of a comprehensive treatment plan.
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Several factors need to be considered when evaluating animal bites. These include type of animal involved, specific nature of the wound, circumstances of the attack, interval between injury and treatment, and location of the bite. Of concern are direct destruction of tissue and risk of infection. ⋯ The choice of antibiotic is also controversial, but initial empirical treatment generally relies on broad-spectrum coverage. Rabies prophylaxis is indicated for bites by carnivorous wild animals, bats, and unvaccinated domestic animals. Review of the patient's tetanus status is mandatory.