The Journal of the American Osteopathic Association
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J Am Osteopath Assoc · Dec 2000
ReviewAcute gastrointestinal bleeding: clinical essentials for the initial evaluation and risk assessment by the primary care physician.
Acute gastrointestinal bleeding is a common medical emergency that frequently results in hospitalization. Rapid initial assessment of clinical parameters such as estimated volume of blood lost, appearance of expelled blood, hypotension, mental status changes, and coagulopathy should all be evaluated as part of the outcomes prediction equation. ⋯ Endoscopic therapy can reduce the rates of recurrent bleeding, surgery, and length of hospital stay in patient with these "stigmata of recent bleeding." Other endoscopic ulcer appearances such as brown or black pigment in the ulcer base or a clean ulcer base do not require endoscopic therapy, as rates of recurrent bleeding are very low for these lesions. Use of these clinical and endoscopic outcome predictors can also be useful in refining triage decisions as to which patients need to be in the intensive care unit, which need to be admitted to the hospital, and which can have early oral feeding and expedited hospital discharge or outpatient care.
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J Am Osteopath Assoc · Dec 2000
Biography Historical Article Classical ArticleThe future in retrospect. 1935.
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J Am Osteopath Assoc · Dec 2000
Biography Historical Article Classical ArticleTendencies in a social, political, and governmental way which may influence doctors. 1937.
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J Am Osteopath Assoc · Nov 2000
ReviewThrombolytic, antithrombin, and antiplatelet treatment of acute coronary syndromes.
Acute coronary syndromes are a major public health problem and the leading cause of death in the western world. Acute coronary syndromes consist of unstable angina pectoris, non-ST-segment-elevation myocardial infarction, and ST-segment-elevation myocardial infarction. These diseases represent a continuum of increasing severity and are pathophysiologically linked to intracoronary thrombus formation that is nonocclusive, transiently occlusive, or completely occlusive, respectively. ⋯ Newer intravenous antiplatelet agents reduce 30-day mortality and myocardial infarction in unstable angina and non-ST-segment-elevation myocardial infarction. Adenosine diphosphate antagonist antiplatelet agents have an ill-defined role in the treatment of acute coronary syndromes. Fibrinolytic therapy has been shown to reduce mortality in ST-segment-elevation myocardial infarction but may pose a hazard in other acute coronary syndromes.
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More than 5 million Americans visit hospital emergency departments each year with the complaint of chest pain. Two million patients are admitted to hospitals because of chest pain, but the diagnosis of coronary heart disease is confirmed in only one fourth of them. ⋯ The goal of management of patients with acute coronary syndrome is to rapidly recognize and manage their cardiac ischemic event, define the risk of myocardial ischemia and recurrent cardiac events, and minimize unnecessary risk to the patient. These decisions can all be made by the use of standard clinical descriptors that include chest pain, the electrocardiogram, and biochemical markers of myocardial injury during and after an acute ischemic episode.