Postgraduate medicine
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Postgraduate medicine · Oct 1996
ReviewUrologic emergencies. Trauma injuries and conditions affecting the penis, scrotum, and testicles.
Urologic emergencies involving the penis, scrotum, and testicles include priapism, paraphimosis, testicular torsion, and Fournier's gangrene. Familiarity with the signs and symptoms of these conditions can lead to prompt diagnosis. Special care is needed in differentiating testicular torsion from the more common condition of epididymitis. Evaluation of trauma injuries of the genito-urinary tract includes classification (blunt or penetrating), assessment of the extent of injury, and urologic consultation if appropriate.
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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.
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Physicians must be alert to the possibility of abuse within the family and home. They should be well prepared to help victims begin the transition to a safer environment. An awareness of the prevalence of abuse and a high index of suspicion are the most effective clinical tools for assisting victims of domestic violence. ⋯ Comprehensive management includes not only treatment but also investigation of injuries, reporting of suspected abuse, referral to appropriate community agencies for violence management or counseling, and addressing underlying chemical dependency or mental disorders. Close follow-up is critical to both detection and prevention. Physicians are obliged not only to treat individuals but also to support social policies that reduce family violence.
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Postgraduate medicine · Jul 1996
ReviewDelirium. Quick recognition, careful evaluation, and appropriate treatment.
Delirium is a common medical condition, especially in elderly hospitalized patients. The syndrome is characterized by a short course of confusion and changes in perception and behavior. ⋯ Prompt recognition and aggressive treatment of the underlying cause are essential for a positive outcome. Supportive measures are designed to calm and protect the patient and provide symptomatic relief until the precipitating condition is corrected.