American family physician
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Pelvic inflammatory disease is caused by spread of organisms from the vagina and cervix to the upper genital tract. The patient may have a life-threatening illness or may remain asymptomatic. ⋯ Polymicrobial infections are the rule. Therapy requires antibiotic agents with broad coverage of aerobic and anaerobic organisms, including Chlamydia trachomatis and Neisseria gonorrhoeae.
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Dorsal penile nerve block with lidocaine is safe and effective for reducing the pain associated with newborn circumcision. Administering the anesthesia adds little time or expense to the overall routine. Complications are minor, limited to local bleeding and hematoma formation. Family physicians performing circumcision should be prepared to use penile nerve block and to advocate it to parents who choose newborn circumcision.
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American family physician · Apr 1991
ReviewPediatric advanced life support: Part I. Airway, circulation and intravascular access.
Effective management of life-threatening emergencies in infants and children demands a high level of technical skill. The Pediatric Advanced Life Support (PALS) provider course, developed jointly by the American Academy of Pediatrics and the American Heart Association, is highly recommended to help physicians prepare for pediatric emergencies. Equipment, cardiopulmonary assessment, airway maintenance, circulation maintenance and intravascular access are discussed in this article. The description of pediatric emergency management follows that of the PALS course.
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Shoulder entrapment during delivery is a true obstetric emergency that can result in significant maternal and infant trauma. Fetal macrosomia, maternal obesity, maternal diabetes and prolonged second stage of labor are associated risk factors. ⋯ With fetal shoulder entrapment, the mother may have significant hemorrhage, fourth-degree perineal lacerations and endometritis. Maneuvers to release the shoulder include closed-fist suprapubic pressure, downward pressure on the posterior shoulder, rotation of the anterior shoulder to the oblique position, rotation of the posterior shoulder beneath the pubic symphysis, release of the posterior arm and anterior rotation of the fetal body.