Postgraduate medicine
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Postgraduate medicine · Feb 1997
ReviewManaging fever in infants and toddlers: toward a standard of care.
Fever in infants and toddlers can portend a serious bacterial illness requiring a prompt medical response. When dealing with a febrile child between 1 and 36 months of age, physicians should consider toxicity, focal infections, age, and the results of a sepsis workup and then use a strategy based on the Rochester criteria to assess whether the patient is at low risk for a serious bacterial illness. On the basis of that determination, a plan for inpatient or outpatient management can be selected. Variations in treatment can reasonably be based on clinical judgment and physician and parent preferences.
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Postgraduate medicine · Jan 1997
ReviewAcute congestive heart failure. The need for aggressive therapy.
Immediate management of congestive heart failure (CHF) is directed at reduction of preload and afterload and augmentation of forward blood flow and cardiac output. A variety of pharmacologic agents (e.g., diuretics, positive inotropic agents, vasodilators, vasopressors) are available for use in the intensive care unit. ⋯ Current drug therapy cannot cure CHF, but a search for useful and safe oral positive inotropic agents continues, with the hope of improving both the quantity and quality of patients' lives. Heart transplantation is an alternative for some patients with severe ventricular dysfunction.
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Postgraduate medicine · Nov 1996
Review Case ReportsIron deficiency anemia. When is parenteral therapy warranted?
Iron deficiency anemia is a common problem encountered in primary care practice. Once the diagnosis is confirmed and the possible causes are identified, replacement of iron stores is indicated. Most patients respond favorably to oral iron preparations. ⋯ Test doses of undiluted iron dextran occasionally elicit anaphylactic reactions. However, affected patients still may be successfully treated intravenously with the use of prophylactic antihistamines, corticosteroids, and histamine2 blockers. Treatment of iron deficiency anemia almost always brings symptomatic improvement.
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Postgraduate medicine · Nov 1996
ReviewPreoperative pulmonary evaluation. Identifying patients at increased risk for complications.
During surgical procedures, multiple physiologic changes affect the pulmonary system and its defense mechanisms. The presence of basic risk factors (eg, smoking, chronic obstructive pulmonary disease, severe obesity) can affect whether these physiologic changes result in pulmonary complications or even death. ⋯ The presence of risk factors and the type of operation to be performed should guide decisions about whether to perform a procedure or to use prophylactic measures before and after surgery. New operative techniques may allow some procedures that were prohibited in the past to be performed in high-risk patients.