American family physician
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Many trauma repairs and dermatologic procedures performed on the face require anesthesia of the involved area. The specific requirements for anesthesia and vasoconstriction vary, depending on the location, size and depth of the injury or lesion. ⋯ In addition, direct infiltration of a volume of anesthetic sufficient to produce adequate anesthesia can cause distortion of the tissue, hindering the identification of margins. Intraoral nerve blocks routinely used by dentists can achieve safe and effective regional anesthesia in the anterior portion of the face.
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Naltrexone is a narcotic antagonist that has been shown to reduce alcohol craving and alcohol use in patients with alcohol dependence. It should not be used as exclusive treatment but only as an adjunct to a comprehensive program that includes psychologic and social treatment approaches such as those in Alcoholics Anonymous or professional programs. ⋯ Alcohol is known to enhance opioid receptors. Evidently, naltrexone blockade of these receptors results in reduced craving for alcohol, less of a "high" while drinking and less alcohol use.
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American family physician · Apr 1997
ReviewInitial management of the patient with altered mental status.
Primary care physicians may encounter patients with altered mental status or neurologic deficit. Because the differential diagnosis for altered mental status includes conditions with significant morbidity and mortality, care of these patients must be rapid and thorough. ⋯ Therefore, these patients often require immediate referral to an emergency department. Proper evaluation and initial management include evaluation of metabolic factors, assessment for toxic ingestions and a thorough neurologic assessment.