The Medical clinics of North America
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The patient who presents with headache can be diagnosed quickly and efficiently once the correct pattern has been identified. Most patients will have migraine, and treatment is based on the severity and disability. ⋯ Patients who have an acute new onset headache problem that requires immediate attention can be triaged and treated once their pattern and history are clear. Hopefully, increasing comfort levels with diagnosing headaches will allow the primary care practitioner to treat headache patients more effectively and efficiently.
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Dizziness and vertigo present in patients of all ages. Particularly in older patients, dizziness is associated with a variety of cardiovascular, neurosensory, and psychiatric conditions and with the use of multiple medications. For the patient, the symptoms can be debilitating. ⋯ Appropriate diagnosis and treatment can significantly improve quality of life. Most causes of dizziness are benign, but early recognition of serious or life-threatening disease is important. Management of these patients includes referral for neuroimaging and further evaluation in an emergency department.
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Overall, no conclusive data support the use of gastric decontamination in the routine management of the poisoned patient. Studies of asymptomatic patients suggest that no treatment is required, and, given the complications that have been reported, this may be a reasonable approach to' most patients. Even in symptomatic patients, the only demonstrable benefit was found in a post-hoc subgroup analysis and involved an outcome of questionable clinical importance. ⋯ Even patients with more serious ingestions usually have good outcomes with supportive care alone. It is no longer sufficient to justify GL or forced administration of AC with the supposition that "the patient could have taken something bad." However,there are some overdoses where limiting the systemic absorption of the poison may limit the toxic effects and prevent serious toxicity. After careful consideration of the risks, GI decontamination should be targeted at patients who, in the opinion of the treating physician, have a potentially life-threatening exposure.
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Numerous types of envenomations may be encountered by health care workers depending on where in North America they work. Clinicians should be familiar with the animals in their region that may lead to envenomation. A rational approach with use of poison center or medical toxicology consultation services ensures that cases are managed appropriately.
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Toxin-induced hyperthermic syndromes are important to consider in the differential diagnosis of patients presenting with fever and muscle rigidity. If untreated, toxin-induced hyperthermia may result in fatal hyperthermia with multisystem organ failure. All of these syndromes have at their center the disruption of normal thermogenic mechanisms, resulting in the activation of the hypothalamus and sympathetic nervous systems. ⋯ Although it almost always occurs in the setting of surgical anesthesia, cases have occurred in susceptible individuals during exertion. The treatment of MH involves the use of dantrolene. Future improvements in understanding the pathophysiology and clinical presentations of these syndromes will undoubtedly result in earlier recognition and better treatment strategies.