The Journal of family practice
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Generalized tonic-clonic status epilepticus is a relatively common neurologic emergency. The differential diagnosis of this condition includes decerebrate spasms and hysterical seizures. Initial therapy includes establishing an airway and securing an intravenous line. ⋯ Intravenous phenobarbital produces sedation and may cause respiratory depression. Occasionally, other anticonvulsants such as paraldehyde, lidocaine, and general anesthesia will be needed to break status epilepticus. Careful follow-up of the patient and monitoring of the anticonvulsant levels may prevent future bouts of status epilepticus.
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An elderly woman taking 50 mg of nitrofurantoin daily for six months for suppression of recurrent urinary tract infections developed increasing dyspnea and bilateral pulmonary infiltrates. An open-lung biopsy confirmed diffuse interstitial fibrosis consistent with chronic nitrofurantoin pulmonary reaction. A chronic disabling respiratory illness persists in this person 10 months after discontinuing nitrofurantoin. ⋯ Physicians must maintain a high index of suspicion for adverse reaction to nitrofurantoin, particularly in the elderly in whom declining renal function may lead to inadvertent toxic accumulations. Use of alternative antimicrobial agents with higher benefit-to-risk ratios for treatment of urinary tract infections should be considered. Persons suffering serious adverse reactions to nitrofurantoin should carry written warnings about reexposure.
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The teaching of practical clinical skills to medical students and residents has been traditionally taught on an unstructured basis. This has led to situations in which physicians have been expected to perform manual procedures without adequate prior exposure or instruction. As a result of this perceived deficit in training, a curriculum has been designed to prepare new family medicine residents for some of the procedures they will be expected to perform in their first year of training. These procedures include airway management and endotracheal intubation, orthopedic casting, use of outlet forceps, suturing, and cardiopulmonary resuscitation.
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A family data base is defined along with the method for obtaining it. It can be used in its entirety to evaluate troubled families, or it can be abbreviated for intake and screening functions. ⋯ The primary focus of the data base is psychosocial, but other problems, such as inherited or infectious disease in the family, are also included. This method has been used to teach concepts of family oriented care and to facilitate health care delivery in a variety of settings.
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Wrist and digital nerve blocks are useful for the management of many common problems of the hands and fingers, including fractures, lacerations, and infections requiring drainage. The principal nerves in the wrist (radial, median, and ulnar), and the digital nerves in the hand or fingers are anatomically superficial. They can be easily located and are accessible for percutaneous injection of anesthetic agents such as lidocaine (Xylocaine), bupivacaine (Marcaine), and mepivacaine (Carbocaine). Careful selection of the anesthetic agent and type of nerve block can provides safe and effective anesthesia for many surgical procedures of the hands and fingers.