American family physician
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American family physician · Sep 1996
ReviewMonitoring pulmonary artery wedge pressure in medical patients.
Pulmonary artery wedge pressure is used in the diagnosis and management of critically ill patients. This measurement provides an accurate assessment of hemodynamic status, cardiac function and venous oxygen saturation. Wedge pressure monitoring has been used in the management of patients with complicated myocardial infarction, refractory heart failure, circulatory shock, pulmonary edema and other critical illnesses. ⋯ Clinical assessment or noninvasive tests, including chest radiographs and echocardiography, often provide information adequate for planning management. If therapy fails, or if noninvasive data are uncertain, pulmonary artery catheterization is appropriate. Risks and complications may be secondary to either catheter insertion or the continued presence of the catheter.
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Many of the patients cared for by family physicians are at risk for firearm injury or death. Awareness of the risk factors enables physicians to incorporate firearm safety into clinical practice. In addition, physicians can speak out for firearm safety in the arenas of public education and legislative advocacy.
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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.
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Intussusception is the invagination of one bowel segment into another. It is an emergent condition that most commonly affects infants between five and nine months of age, but it can also occur in other age groups. The etiology is usually idiopathic in infants five to nine months of age; neonates, older children and adults more commonly have lead points such as a Meckel's diverticulum or a neoplasm. ⋯ Barium enema is the gold standard for diagnosis and also has therapeutic potential for reducing the intussusception. Ultrasound is an accurate, low-risk screening tool when performed and interpreted by an experienced ultrasonographer. Surgical reduction is performed if nonoperative reduction is contraindicated or unsuccessful, or if a lead point is suspected.