American family physician
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The stress of acute, severe illness penetrates the patient's intrapsychic defenses to varying depths. The physician who deals with the resulting regressive behavior must identify and strengthen the overwhelmed defenses. Management includes the judicious use of drugs, accurate interpretation of the patient's behavior, and acceptance of the patient. The physician's countertransferential feelings can be helped by the understanding of a trusted colleague.
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Various plaster splints can be used in the management of many acute musculoskeletal injuries seen in the emergency setting. These include gutter splints of thumb, radial and ulnar types; volar forearm, sugar-tong and posterior elbow splints, and knee, short leg and stirrup splints. When properly made, these devices afford symptomatic relief, mechanical support and sometimes even definitive therapy for fractures and soft tissue injuries of the extremities.
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Latrodectus mactans has now invaded towns and cities. The spider's venom is a neurotoxin that causes little local reaction but produces pain and spasm in large skeletal muscle groups within 30 minutes to three hours after the bite. ⋯ Muscle relaxants are useful in treatment, as is calcium gluconate. Antivenin is indicated for high-risk victims, such as those with hypertension and persons younger than 16 or older than 60 years of age.
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Hemorrhoids are frequently seen by family physicians. Prolapse and painless bleeding are the symptoms most commonly experienced by patients with internal hemorrhoids. ⋯ The procedure is safe and effective, and can be performed in the physician's office. Contraindications include infection, chronic liver or bowel disease, clotting disorders and significant thrombosis.
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While more than 2,000 species and subspecies of fleas are known, only nine have significant medical and veterinary importance, and only six involve man. Eggs drop easily from pet hosts to be widely distributed throughout the home. ⋯ Treatment is symptomatic. Control of flea infestation is based on knowledge of the life cycle of the insect.