Postgraduate medicine
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Postgraduate medicine · Jun 1998
ReviewNear drowning. Rescuing patients through education as well as treatment.
Optimal prehospital care of near-drowning victims requires bystanders and emergency-response personnel who are knowledgeable in CPR and proper rescue techniques. Primary care physicians can play an important role when asked to teach CPR, first-responder, or emergency-care classes or to serve as medical director for a local ambulance group. Rapid response and appropriate ventilation and airway protection by prehospitalization providers can improve the condition of near-drowning victims on arrival in the emergency department and their chances for neurologically intact survival. With knowledge of the local risks of drowning, proper emergency treatment, appropriate referral, and conscientious efforts at prevention conducted in the office and the community, primary care physicians can have maximum impact on this summer-time killer.
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Postgraduate medicine · Jun 1998
ReviewBites and stings of the arthropod kind. Treating reactions that can range from annoying to menacing.
Bites and stings from arthropods are largely inevitable because of the number of offending species and their distribution throughout our environment. Wasps, bees, ants, mosquitoes, gnats, chiggers, and fleas are found all across the United States. Thus far, Africanized honeybees are limited to southwestern states and fire ants to southern states. ⋯ Fortunately, in most people, bites and stings from arthropods produce only self-limited reactions, which can usually be managed with cold packs, analgesics, and topical agents. In the few encounters that produce serious reactions, prompt diagnosis and appropriate treatment result in a good outcome in nearly all cases. The number of stings and bites can be reduced with use of a few basic avoidance and protection measures.
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Postgraduate medicine · Apr 1998
ReviewLong-term oxygen therapy for COPD. Improving longevity and quality of life in hypoxemic patients.
Long-term oxygen therapy can increase life expectancy in hypoxemic patients with COPD. Accurate identification of hypoxemia requires arterial blood gas measurements. Pulse oximetry can be used to measure trends in oxygenation, oxygen needs, and oxygen requirements during exercise and sleep. A detailed oxygen prescription indicates: (1) the oxygen dose (L/min), (2) the number of hours per day that oxygen therapy is required, (3) the dose required during exercise, (4) the oxygen supply system: concentrator, compressed gas cylinder, or liquid oxygen reservoir, and (5) the delivery device: nasal cannula, demand-flow device, reservoir cannula, or transtracheal oxygen catheter.