American family physician
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Transdermal fentanyl appears to be a safe and practical alternative to short-acting analgesics in the treatment of cancer pain. The unique pharmacokinetics of the transdermal system, including the prolonged time to peak analgesic effect, long elimination half-life and skin depot concept, should be kept in mind when prescribing the system. Short-acting narcotics are recommended for break-through pain. Side effects of fentanyl, and their management, are similar to those associated with other narcotic analgesics.
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Some ocular conditions represent serious emergencies requiring immediate treatment. Chemical exposure requires prompt irrigation with saline. Major trauma with possible globe perforation requires eye shielding and referral for surgical evaluation. ⋯ Minor trauma with hyphema requires cycloplegic medications, eye shielding and ophthalmologic consultation. Visual floaters, light flashes or "curtains" may represent vitreous or retinal detachment and should be evaluated by an ophthalmologist. Foreign bodies can usually be removed by irrigation or careful instrumentation.
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Health promotion activities benefit the elderly as much as they benefit younger persons. Motor vehicle accident and pedestrian injuries can be reduced by encouraging seat belt use and identifying unsafe drivers. ⋯ All elderly persons should be screened for nutritional adequacy. Smoking cessation should be encouraged and use of alcohol and drugs monitored in all elderly patients.
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The incidence of Lyme disease is increasing, and the disease is spreading geographically. Prompt diagnosis requires recognition of characteristic signs and symptoms of infection with the spirochete Borrelia burgdorferi. ⋯ Although less frequently seen than erythema migrans, peripheral neuropathy of the seventh cranial nerve is another important sign. Tests for Lyme disease await refinement, but laboratory evaluation can be helpful when Lyme disease is suspected.
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Malignant hyperthermia is a rare syndrome that occurs in genetically susceptible individuals who are exposed to frequently used inhalation anesthetics. The disorder is most common in children and young adults. It is triggered through a defect in the ability of skeletal muscles to concentrate and release calcium. ⋯ The use of dantrolene has significantly reduced mortality from malignant hyperthermia. No simple screening test exists. Family members or those with a suspicious history need to be counseled and should consider muscle biopsy and testing prior to surgery.