American family physician
-
Fat embolism causes a distinctive clinical syndrome usually seen in trauma victims with long bone fractures. Clinical findings include hyperthermia, respiratory distress, petechiae and retinal fat emboli. Neurologic changes include decreased sensorium, decerebrate posturing and seizure activity. ⋯ Laboratory abnormalities include hypoxemia, respiratory alkalosis, anemia and hypocalcemia. Treatment consists of general supportive care with vigorous pulmonary therapy. Most patients have a good recovery.
-
Although aortic dissection is rare in children, it does occur, particularly in those with congenital heart disease, connective tissue disorders or severe trauma. Prompt diagnosis is essential. ⋯ The patient is often much more uncomfortable than can be explained on the basis of physical findings. Criteria have been established for choosing medical or surgical therapy.
-
Inadequate assessment of the suicidal patient can have tragic consequences. Reliance should be placed on a comprehensive evaluation, including social profile, mental and physical status, suicidal ideation, intent and behavior, and current social support systems. Heightened awareness, combined with a knowledge about risk factors for suicide and intervention techniques, will help prevent these tragedies.
-
Drug-alcohol interactions can be potentially life-threatening. These fall into three broad categories: the disulfiram reaction, which can lead to vasodilation, flushing, headache and tachycardia; central nervous system depression, which can lead to excessive sedation and respiratory depression, and a miscellaneous category of drug-alcohol interactions.