The Journal of family practice
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A total of 9,955 isolates of Staphylococcus aureus (SA) from an urban hospital and clinic and from rural office settings obtained during 1971 through 1978 were compared for susceptibility to penicillin G. Clear downward trends in susceptibility of SA were noted for all urban settings during the 1970s. ⋯ Penicillin G susceptibility of SA from two rural sources was likewise very low (20.9 percent and 28.7 percent). Therefore, Staphylococcus aureus must be considered resistant to penicillin G until proven otherwise, irrespective of the source of the isolate.
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Shock is a descriptive term indicating generalized inadequancy of organ perfusion. In the critically ill patient, the common denominator is insufficient microcirculatory flow. All patients have excessive sympathetic tone with arteriolar and venular vasoconstriction. ⋯ Although the presentation of shock may vary with age, one usually detects evidence of inadequate tissue perfusion, hypotension, and poor urine output. Treatment consists of early recognition, establishment and maintenance of intravascular volume, and cardiorespiratory assistance with mechanical ventilation and various inotropic and vasoactive drugs. Pediatric mortality remains high despite new and sophisticated treatment methods.
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The emergency management of the agitated patient is a common medical problem. Agitated behavior is not a diagnosis but a descriptive term; the initial task of the physician involves determining the etiology of the behavioral disturbance and evaluating the possible contribution of organic factors. ⋯ Agitated patients will generally fall into one of four diagnostic categories: agitation precipitated by drug intoxication, agitation precipitated by drug withdrawal, agitation precipitated by an organic brain syndrome, or agitation precipitated by a functional disorder. Appropriate pharmacological and psychological management techniques for these situations are discussed.
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By judicious consideration of the clinical appearance, by direct examination with magnification, and by culture results, skin biopsy, and other laboratory results, the clinician is able to diagnose most pathological conditions of the scalp. The scalp participates in many systemic disorders and frequently is the chief site of involvement. Similarly, many generalized disorders limited to the skin exhibit their most typical manifestations in the scalp. ⋯ By utilizing follow-up examinations at appropriate intervals, the diagnosis can eventually be made. Once a diagnosis is made, appropriate treatment will generally produce satisfactory improvement or cure. Nevertheless, a few generally rare conditions will defy the physician's most enlightened and aggressive therapy.