American family physician
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Pulmonary function testing is useful in evaluating dyspnea, wheezing and cough, determining the severity of pulmonary disease, monitoring the response to therapy and assessing preoperative pulmonary risk. Accurate office spirometry requires routine preventive maintenance, cleaning and calibration of equipment and quality control measures. To obtain a flow-volume loop, the seated or standing patient is instructed to inspire maximally to total lung capacity, exhale as hard, fast and completely as possible (forced vital capacity [FVC]), and inhale quickly and deeply to total lung capacity (TLC). ⋯ Obstruction is characterized by reduced forced expiratory volume in one second (FEV1) and FEV1/forced vital capacity (FEV1/FVC%), and normal to increased TLC and residual volume. Restriction is characterized by reduced TLC and residual volume and normal FEV1/FVC%. Spirometry may also reveal abnormalities of the upper airway, including the nasopharynx, vocal cords, trachea and proximal large airways.
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Hundreds of thousands of significant alcohol withdrawal episodes are encountered by primary care physicians every year. If the situation is appreciated at an early stage, most patients can be managed successfully on an outpatient basis with benzodiazepines. ⋯ Mortality from delirium tremens has been reduced to less than 5 percent of patients, through early diagnosis, supportive nursing care, treatment of coexisting medical conditions and aggressive pharmacologic therapy. Patients with a history of multiple detoxification episodes are more likely to experience seizures and severe withdrawal symptoms.