The Medical clinics of North America
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Med. Clin. North Am. · Sep 2001
Review Case ReportsDuration of deep vein thrombosis and pulmonary embolism prophylaxis after joint arthroplasty.
One of the most important complications after joint arthroplasty is the development of deep vein thrombosis. Despite effective prophylaxis modalities, studies have shown a significant incidence of thrombotic events after hospital discharge. This article reviews the literature on the incidence of deep vein thrombosis and provides recommendations for managing postoperative joint replacement patients.
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Delirium is a common postoperative complication that is associated with substantial patient morbidity and mortality. Because of the variability in its presentation, delirium has the potential to be overlooked or misdiagnosed. There are few well-designed prospective studies looking at the incidence of delirium; however, retrospective data reveal it to be highly variable. ⋯ Pharmacologic therapy, usually with haloperidol, may be indicated if patients remain agitated. Investigations have supported the premise that delirium is a potentially preventable condition. This prevention can be accomplished by maximizing the patient's medical status and conscientiously avoiding the conditions that are known to precipitate delirium.
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Med. Clin. North Am. · Sep 2001
Review Case ReportsAbnormal coagulation in the postoperative period contributing to excessive bleeding.
This article deals primarily with acquired disorders that disrupt normal hemostasis and cause excessive bleeding in the postoperative period because of the coagulopathy itself or because of drugs needed to treat the hemostatic disorder.
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Alcohol withdrawal syndrome is a significant cause of perioperative morbidity and mortality. Physicians should be able to: (1) identify high-risk patients preoperatively by using the various screening tests, (2) recognize patterns with AWS, and (3) use the appropriate supportive, behavioral, nutritional and pharmacological treatment.
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Cardiac arrhythmias are common in the perioperative period. Most arrhythmias are clinically benign. ⋯ The current availability of a wide array of techniques for controlling serious arrhythmias--pharmacologic, electrical, and interventional--enable the physician to manage most arrhythmias and conduction disturbances successfully. The added risks posed by arrhythmias and conduction disturbances in the perioperative period now can be minimized.