The Journal of the Florida Medical Association
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Ectopic pregnancy is an increasingly common and potentially catastrophic condition for which patients often present to the ED with abdominal pain or vaginal bleeding. Recent developments in laboratory tests (sensitive beta hCG, progesterone assays), ultrasonography (transvaginal probes, Doppler ultrasound), and combinations of these modalities (hCG Discriminatory Zone for ultrasonographic evidence of intrauterine pregnancy) have allowed the earlier diagnosis of ectopic pregnancy, with an associated reduction in maternal mortality and morbidity. Understanding the strengths and limitations of the variety of diagnostic modalities available will allow the clinician to formulate a rational strategy for the early diagnosis of ectopic pregnancy. ⋯ Unstable patients require immediate resuscitation and gynecologic consultation; invasive diagnostic methods may supplant laboratory and sonography. Unclear cases may require the use of quantitative beta hCG (discriminatory zone), other pregnancy hormone (progesterone) testing, invasive procedures (laparoscopy, culdocentesis, D & C), or observation (serial beta hCG). A suggested algorithm incorporating these elements is presented (Figure 2).
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This article reviews the dangers related to marine animal envenomations in Florida. Venomous marine animals exhibit diverse mechanisms of injury and toxicity. ⋯ Stinging invertebrate animals include sponges, coelenterates (jellyfish, hydroids, corals, and sea anemones), echinoderms (sea urchins, starfish and sea cucumbers), annelid worms (bristleworm), and mollusks (cone shells, octopi and nudibranches). Stinging vertebrates discussed include stingrays, catfish, scorpionfish, and leatherjacks.
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Although variable, labor pain is among the most severe of pain syndromes, and has been described as severe to excruciating in 50 to 70 percent of primiparas. "Twilight sleep" or amnesia was commonly used in the first half of this century via potent intramuscular, intravenous and inhalational agents. Subsequently, epidural anesthesia, first caudal then lumbar was used which offered superior pain relief without clouding the sensorium. However, epidurals with local anesthetics also contributed to dense sensory and motor blocks which are not necessary for labor. Presently, both spinal and epidural opioids are used along with decreasing doses of local anesthetics, rendering the laboring patient a relatively pain-free labor but allowing her more mobility and control of her environment.
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It is now recognized that from the newborn period onwards, children are capable of experiencing pain. This includes the premature infant. The challenge for healthcare providers is to incorporate methods of pain assessment and treatment into their daily practices. ⋯ Based on these developmental stages, pain assessment measures have been developed. Pharmacologic advances have accompanied this improved understanding of infant, child, and adolescent psychology. While acute pain accounts for the majority of children's experiences, recurrent/chronic pain states do occur (e.g. sickle cell related and neuropathic) and can be effectively treated.