American family physician
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American family physician · May 1997
Case ReportsCommotio cordis: clinical implications of blunt cardiac trauma.
Blunt cardiac trauma can result not only in major structural impairments but also in subtle derangements without an apparent organic defect. Cardiac dysrhythmias, including ventricular fibrillation and sudden cardiac arrest, can occur in both cardiac contusion and cardiac concussion (commotio cordis) and may be fatal. The true incidence of these nonstructural cardiac injuries is unknown. Continuous electrocardiographic monitoring, assessment of cardiac troponin I and transesophageal echocardiograms are important aids in the evaluation of cardiac contusion and concussion.
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Because anemia is a condition rather than a disease, an underlying cause must be determined when anemia is identified. Microcytic anemia is a common category of anemia. Iron deficiency anemia is the most common type of microcytic anemia and is also the most common anemia. ⋯ Low serum ferritin is the best single laboratory parameter for the diagnosis of iron deficiency. Serum iron, total iron binding capacity and hemoglobin electrophoresis, if necessary, can help differentiate the type of microcytic anemia in patients with normal or elevated levels of serum ferritin. If the evaluation identifies iron deficiency as the type of anemia, the underlying cause must be investigated.
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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.