Postgraduate medicine
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Several factors need to be considered when evaluating animal bites. These include type of animal involved, specific nature of the wound, circumstances of the attack, interval between injury and treatment, and location of the bite. Of concern are direct destruction of tissue and risk of infection. ⋯ The choice of antibiotic is also controversial, but initial empirical treatment generally relies on broad-spectrum coverage. Rabies prophylaxis is indicated for bites by carnivorous wild animals, bats, and unvaccinated domestic animals. Review of the patient's tetanus status is mandatory.
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Postgraduate medicine · Jun 1992
Predicting outcome in brain-injured patients. Using the Glasgow Coma Scale in primary care practice.
The Glasgow Coma Scale provides a quick and simple way to assess the level of consciousness of a brain-injured patient and to predict that patient's social outcome. The information provided by such prediction of prognosis can help primary care physicians choose the appropriate therapeutic regimen and also allows investigators to compare alternative regimens.
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Postgraduate medicine · Mar 1992
Dealing with delirium. A common problem in hospitalized elderly patients.
Delirium is a common problem, particularly in hospitalized elderly patients. It may be the first indication of serious illness, such as infection, cardiopulmonary disease, or a metabolic disturbance. The condition is precipitated by medications, toxins, and abrupt changes in environment. ⋯ As the elderly population increases, physicians may expect to encounter this condition more often. Maintaining a high index of suspicion may prevent many cases and arrest others at onset. Proper management includes prompt diagnosis and treatment of the underlying illness, as well as use of commonsense measures to calm and reassure the patient.
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Postgraduate medicine · Feb 1992
ReviewPostoperative pulmonary complications. When are preventive and therapeutic measures necessary?
Relevant clinical and physiologic data are available to help guide decision making in the management of patients who are at risk for or already have postoperative pulmonary complications. Prophylactic measures should be simple and focused. ⋯ Proper treatment of postoperative atelectasis requires adequate patient assessment and knowledge of the therapeutic options. Costs, measured in dollars as well as in patient morbidity and mortality, are substantially greater when physicians fail to recognize and treat reversible disease before elective surgery and when effective postoperative therapy is not provided in accordance with individual needs.
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Ambulatory blood pressure monitoring allows repetitive and non-invasive measurements to be taken over a 24-hour period or longer in the patient's usual environment. A technically successful recording yields valuable information about circadian blood pressure patterns and the mean, peak, nadir, standard deviation, and variability of both systolic and diastolic blood pressure. Although ambulatory monitoring should not be used in all hypertensive patients, it can aid in the evaluation of specific problems, such as borderline, resistant, and episodic hypertension; transient hypotension; and blood pressure-related target-organ damage. It also helps in assessing the efficacy of anti-hypertensive medications and in conducting longitudinal epidemiologic studies of target-organ damage and cardiovascular events.