Postgraduate medicine
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Postgraduate medicine · Oct 1986
Emergency management of hand injuries. When to repair, when to refer.
The primary care physician can accurately diagnose hand injuries by obtaining a thorough patient history and performing a complete physical examination of the hand. When the severity of injury is doubtful, immobilization in a splint with next-day referral is appropriate. Immediate consultation should be obtained with nerve or vascular damage, fracture-dislocation injuries, open fractures, substantial skin loss, or flexor tendon injuries at or distal to the wrist.
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Based on the current literature, the following steps seem reasonable in evaluating a pleural effusion: document the presence, location, and approximate volume of pleural fluid; decide clinically on the likelihood of an exudative effusion; if clinical evaluation suggests an exudative effusion, perform a thoracentesis and obtain fluid for diagnostic evaluation; perform the necessary tests to characterize the effusion as a transudate or an exudate; if a transudate exists, normally do not perform further tests on the effusion; if an exudate exists, perform selected tests to narrow the differential diagnosis; if this evaluation is undiagnostic, consider closed pleural biopsy; if the diagnosis remains unclear after two closed biopsies, consider pleuroscopy with biopsy or open pleural biopsy at the time of a thoracotomy.
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Migraine headaches may be confused with other types of headache, namely, those caused by tension and by organic disorders, but several features often set them apart. For one, migraines are often accompanied by other symptoms, such as nausea and vomiting. ⋯ Treatment can involve such methods as biofeedback, diet, and limitation of exercise, and a number of medications are available for both treatment and prophylaxis. Studies of drug treatment of childhood migraine are few, so clinicians must tailor treatment to the individual case, watching for side effects and limiting the duration of treatment as much as possible.