Postgraduate medicine
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Emergency fluid resuscitation of hypovolemic patients begins with an accurate assessment of the degree of volume depletion as well as identification of the cause and associated abnormalities. On the basis of this information, the proper resuscitative fluid can be chosen and administered by the appropriate route, as guided by the urgency of the situation. ⋯ In other situations, oral rehydration is often appropriate. Specific fluids then can be tailored to the individual patient's needs and adjusted as warranted by ongoing monitoring.
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Postgraduate medicine · Sep 1996
ReviewWide-complex tachycardias. The importance of identifying the mechanism.
Initial assessment of widecomplex tachycardias (WCTs) should begin with patient history and physical examination. If there is a history of remote myocardial infarction, WCT should be considered as ventricular tachycardia until proved otherwise. In most cases, WCT is subsequently shown by electrophysiologic evaluation to be ventricular tachycardia. ⋯ When there is doubt about the diagnosis, elective electrical cardioversion may be considered. Medical therapy should consist of intravenous magnesium sulfate and procainamide hydrochloride (Pronestyl). A beta blocker may also be considered if more aggressive blockade of the atrioventricular node becomes necessary.