American family physician
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Infectious endocarditis results from bacterial or fungal infection of the endocardial surface of the heart and is associated with significant morbidity and mortality. Risk factors include the presence of a prosthetic heart valve, structural or congenital heart disease, intravenous drug use, and a recent history of invasive procedures. Endocarditis should be suspected in patients with unexplained fevers, night sweats, or signs of systemic illness. ⋯ Common blood culture isolates include Staphylococcus aureus, viridans Streptococcus, enterococci, and coagulase-negative staphylococci. Valvular structural and functional integrity may be adversely affected in infectious endocarditis, and surgical consultation is warranted in patients with aggressive or persistent infections, emboli, and valvular compromise or rupture. After completion of antibiotic therapy, patients should be educated about the importance of daily dental hygiene, regular visits to the dentist, and the need for antibiotic prophylaxis before certain procedures.
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Finger fractures and dislocations are common injuries that are often managed by family physicians. A systematic physical examination is imperative to avoid complications and poor outcomes following these injuries. Radiography (commonly anteroposterior, true lateral, and oblique views) is required in the evaluation of finger fractures and dislocations. ⋯ Referral to a hand specialist is needed if a dislocation cannot be reduced; is unstable following reduction; or involves significant ligament, tendon, or soft tissue injury. Some common finger fractures can be treated conservatively with appropriate reduction and immobilization. Referral to a hand specialist is required if a fracture is unstable, involves a large portion (greater than 30 percent) of the intra-articular surface, or has significant rotation.