Postgraduate medicine
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Postgraduate medicine · Apr 1996
Case ReportsGas gangrene: potential for hyperbaric oxygen therapy.
Clostridial myonecrosis (gas gangrene) is an uncommon sequela of traumatic injury. Infection with Clostridium perfringens in devitalized tissue is the most common cause. Wide surgical debridement and appropriate antibiotic therapy remain the standard of care. ⋯ Although no prospective human data are available, retrospective data indicate that concomitant hyperbaric oxygen therapy has resulted in a twofold reduction in mortality. Where feasible, hyperbaric oxygen therapy should routinely be incorporated into the treatment plan for gas gangrene. Primary care physicians are in a unique position not only to make an early diagnosis but also to have a central role in coordinating multidisciplinary care often needed for this potentially fatal infection.
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Postgraduate medicine · Jan 1996
ReviewAccidental hypothermia. When thermoregulation is overwhelmed.
The diagnosis of hypothermia must be entertained when patients present with unexplained mental status changes or arrhythmias. Prompt recognition and aggressive treatment of complications should reduce cold-related fatalities. The choice of an appropriate rewarming method must be individualized and depends on the severity of hypothermia and the patient's degree of hemodynamic tolerance.
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Postgraduate medicine · Oct 1995
ReviewBreathlessness. Strategies aimed at identifying and treating the cause of dyspnea.
The cause of dyspnea should always be assumed to be physical in nature, although a psychological component may sometimes exist. The workup should include thorough history taking, physical examination, chest radiography, electrocardiography, and determination of arterial blood gas levels or pulse oximetry readings. ⋯ It may be used to assess oxygenation when the cause of dyspnea is known. It is also useful to monitor the clinical course during treatment, which should be directed to the underlying process.
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Postgraduate medicine · Jun 1995
Review Case ReportsPhysiologic evaluation of bronchial asthma. Why objective testing is essential.
Physiologic evaluation of bronchial asthma is extremely valuable. Simple objective measurements of expiratory airflow and lung volume help physicians determine disease status and monitor patient response to therapy. More elaborate measurements of pulmonary function are not commonly needed in primary care practice. The three case studies described in this article show that objective assessment of lung function is critical in effective treatment of asthma.
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Postgraduate medicine · Jun 1995
ReviewVertebral osteomyelitis. How to differentiate it from other causes of back and neck pain.
Vertebral osteomyelitis, an uncommon infection, usually presents with the very common symptom of neck or back pain. Awareness of this disorder and its distinctive features aids physicians in prompt ordering of appropriate imaging studies, which usually lead to the diagnosis. Early diagnosis, identification of the infecting microbe, and appropriate antimicrobial therapy are the keys to preventing complications and reducing the need for surgical intervention.