American family physician
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Advanced abdominal pregnancy is an ominous occurrence. The diagnosis is usually made when the physician considers this possibility as the answer to a puzzling obstetric problem. Marked, unexplained anemia, associated with unusual second- and third-trimester signs and symptoms, should warn the physician of the possibility of a near-term abdominal pregnancy.
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Prompt defibrillation with lower energy levels (200 joules) initially is now recommended. Epinephrine is effective when instilled intratracheally and remains the treatment of choice for restoring cardiac rhythm. ⋯ Sodium bicarbonate and atropine are now used more cautiously. Bretylium and verapamil have improved the treatment of refractory ventricular fibrillation and paroxysmal supraventricular tachycardia, respectively.
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Blunt trauma to the eye occurs frequently, and the aftereffects may be devastating. Traumatic injuries range from simple ecchymosis of the eyelid and subconjunctival hemorrhage to more serious lesions, including hyphema, choroidal or retinal rupture, optic nerve contusion and rupture of the globe. The diagnosis and management of this type of injury is not difficult if approached in an organized way. The family physician can treat most cases and should recognize those that require further consultation.
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Home monitoring of blood glucose is an important new tool in the management of patients with diabetes mellitus. Current monitoring techniques are safe, reliable and reproducible, and they enable diabetics to participate in their own care. There are no contraindications to home glucose monitoring, but some consideration must be given to cost and maintenance. The physician can evaluate the effectiveness of home monitoring by determining the glycosylated hemoglobin level.