American family physician
-
The term "papilledema" describes optic disc swelling resulting from increased intracranial pressure. A complete history and direct funduscopic examination of the optic nerve head and adjacent vessels are necessary to differentiate papilledema from optic disc swelling due to other conditions. ⋯ Causes of papilledema include intracranial tumors, idiopathic intracranial hypertension (pseudotumor cerebri), subarachnoid hemorrhage, subdural hematoma and intracranial inflammation. Optic disc edema may also occur from many conditions other than papilledema, including central retinal artery or vein occlusion, congenital structural anomalies and optic neuritis.
-
Hypothermia is an underreported cause of death in the United States. The clinical presentation of hypothermia may include neurologic, cardiovascular and metabolic abnormalities. In severely hypothermic patients, evaluation may reveal no signs of life until the patient is rewarmed. ⋯ Groups at particular risk for hypothermia include outdoor workers, the homeless, trauma victims and the very young or very old. Also at risk are persons with preexisting serious illnesses and those who are taking medications or abusing drugs. Cardiac arrest, hypotension, unresponsiveness and severe hyperkalemia portend a poorer prognosis.
-
The incidence of acute rheumatic fever is increasing in the United States, but many physicians are now unfamiliar with the diagnosis and treatment of this disease. The revised Jones criteria provide guidance for the diagnosis of rheumatic fever; two major criteria or one major and two minor manifestations are required to make the diagnosis. Salicylates are usually the initial treatment of choice for the arthritis of rheumatic fever. Penicillin remains the recommended prophylactic agent for secondary prevention.
-
It has become increasingly obvious that traditional narcotic dosage schemes are not optimally effective in relieving pain. Inadequate relief of pain results in increased patient morbidity, probably due to adverse effects on the neurologic, endocrine, pulmonary and cardiovascular systems. ⋯ This analgesic technique is easy to use and is well accepted by patients, physicians and nurses. Significant benefits include earlier ambulation, decreased overall narcotic use, improved postoperative pulmonary function, shorter hospital stay and reduced health care costs.
-
Psychosocial issues are a major factor in the quality of life of a patient with advanced human immunodeficiency virus infection. To provide effective, supportive care, the physician must assess the patient's psychosocial needs, with an understanding of the patient's sociocultural background. ⋯ Appropriate treatment of neuropsychiatric syndromes and debilitating physical symptoms also add significantly to the patient's quality of life. Most importantly, the patient must be given the opportunity to be an active participant in decisions about treatment and lifestyle.