American family physician
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American family physician · Sep 1994
ReviewTacrine therapy for the dementia of Alzheimer's disease.
Tacrine, a centrally acting cholinesterase inhibitor, may improve cognitive and functional status in patients with mild to moderate Alzheimer's disease. In recent controlled trials, patients have shown improvement in cognitive assessment scores, but the clinical significance of such benefits remains unclear. Appropriate diagnostic evaluation is necessary to prevent inappropriate treatment in patients with non-Alzheimer's dementia. Hepatotoxicity and gastrointestinal symptoms are common adverse effects of tacrine, and frequent monitoring of liver function is required.
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American family physician · Sep 1994
Anesthesia in the emergency setting: Part II. Head and neck, eye and rib injuries.
Anesthesia for procedures of the head and neck includes ear field blocks, supraorbital and supratrochlear nerve blocks, infraorbital, mental, mandibular and posterosuperior alveolar nerve blocks. Topical ophthalmic anesthesia is useful in treating a variety of ocular injuries, including corneal abrasion and laceration, chemical/thermal burns, and injuries caused by foreign bodies and contact lenses. The intercostal nerve block is used to manage the pain of rib fractures, thus improving patient comfort, tidal volume and ventilation, and pulmonary toilet.
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American family physician · Sep 1994
ReviewAnesthesia in the emergency setting: Part I. Hand and foot injuries.
Topical application and local infiltration of anesthetic agents are useful for localized areas, while a circular field block provides superficial anesthesia within the encircled area. Regional anesthesia is accomplished by injecting the anesthetic agent near a nerve or nerve group. Useful anesthetic techniques for repair of hand injuries include wrist blocks, intermetacarpal blocks and local infiltration anesthesia. ⋯ Local infiltration is useful for closing minor lacerations. For foot injuries, the posterior ankle block is used to anesthetize the sole. The anterior ankle block is used for the dorsum of the foot.
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Heat emergencies occur when the body is unable to adequately dissipate heat. Hyperthermic patients should be cooled immediately with a lukewarm-water spray and cool moving air. Patients with heat exhaustion respond well to administration of intravenous fluids. ⋯ Intensive care monitoring and support are indicated. To reduce the risk of heat injury in hot weather, frail and elderly persons must maintain hydration and may need to consider alternate living arrangements. Laborers, athletes and military personnel benefit from gradual acclimation to the heat, increased fluid intake, vapor-permeable clothing and frequent rest periods.