American family physician
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Postpartum hemorrhage remains a source of maternal morbidity and mortality in modern obstetric medicine. While the risk factors for postpartum hemorrhage are well described, many patients who develop this complication have no known antenatal risk factors. Therefore, in every delivery the attending physician must be vigilant for signs of hemorrhage. ⋯ Successful treatment of postpartum hemorrhage requires the prompt recognition of ongoing bleeding, followed by uterine massage and oxytocin administration. The intramuscular administration of ergot or prostaglandin preparations can help with refractory bleeding. Most deaths from postpartum hemorrhage occur not because of brisk blood loss, but because of the ineffective management of continuous low-level bleeding.
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Fractures of the clavicle are among the most common fractures seen by family physicians. Common mechanisms of injury include a fall on an outstretched hand or direct trauma to the bone. Fractures of the middle third of the clavicle are the most common and usually heal without complication when managed with immobilization using a sling or figure-of-8 bandage. ⋯ Nondisplaced proximal fractures are successfully treated with sling immobilization. Orthopedic referral is indicated for significant displacement or sternoclavicular dislocation. By following appropriate management guidelines, family physicians can successfully treat most clavicle fractures.
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American family physician · Dec 1996
Review Practice Guideline GuidelineDiagnosis and treatment of idiopathic thrombocytopenic purpura. American Society of Hematology ITP Practice Guideline Panel.
The American Society of Hematology established a panel to develop practice guidelines for the diagnosis and management of idiopathic thrombocytopenic purpura and to document the extent to which the recommendations are based on either scientific evidence or opinion. A comprehensive literature review found little high-quality scientific evidence to define the natural history of idiopathic thrombocytopenic purpura or to assess the efficacy of diagnostic tests and treatments for the disorder. Recommendations were therefore based on opinion, derived from a formal scoring procedure. ⋯ The panel suggests different treatment approaches in children and adults because of important differences in the behavior of the disease in the two patient groups. The panel recommends that idiopathic thrombocytopenic purpura accompanied by severe bleeding be treated with glucocorticoids, intravenous immunoglobulin and other measures, but that treatment and hospitalization are often unnecessary when patients have only mild to moderate thrombocytopenia or minimal bleeding. Idiopathic thrombocytopenic purpura in pregnant women and the risk of thrombocytopenia in their newborns pose specific problems for diagnosis and treatment.