Postgraduate medicine
-
Postgraduate medicine · Dec 1991
ReviewAdult respiratory distress syndrome. Strategies to provide support and enhance oxygen delivery.
Respiratory failure itself is rarely the cause of death in patients with adult respiratory distress syndrome (ARDS). The multiple-organ failure that often accompanies the syndrome or the underlying disease or trauma that leads to ARDS is more frequently the cause. Thus, care of these patients consists of providing life-sustaining support until they respond to therapy. The authors explain what happens in respiratory failure and how gas exchange can be enhanced in these critically ill patients.
-
Postgraduate medicine · Nov 1991
Case ReportsWheezing as a sign of foreign-body aspiration in infants and children.
Airway obstruction from aspiration of a foreign body should be suspected in all infants and children who have swallowing or respiratory difficulties. If the patient is unable to clear the airway by coughing, the Heimlich maneuver should be attempted. Parents can help to prevent airway obstruction by keeping small objects away from infants and children and by teaching them to chew food thoroughly.
-
Postgraduate medicine · Nov 1991
Congestive heart failure in acute myocardial infarction. Treating the spectrum from mild failure to cardiogenic shock.
Congestive heart failure (CHF) accompanying acute myocardial infarction (MI) may have various manifestations, ranging from mild failure to cardiogenic shock. Initial treatment depends on the cause, which is usually determined through careful physical examination. ⋯ A practical working knowledge of the clinical correlates of left ventricular dysfunction in acute MI allows rational use of the several classes of drugs available to treat CHF. With severe CHF, invasive monitoring is usually required, and mechanical complications of MI need to be identified and managed appropriately.
-
Postgraduate medicine · Nov 1991
New techniques in postoperative analgesia. Including patient-controlled intravenous administration.
New and more efficient techniques of postoperative pain management have been recently introduced. Patient-controlled intravenous (and perhaps subcutaneous) administration of analgesics is an improvement over traditional intramuscular injection. Its efficacy, safety, and high acceptance by patients, surgeons, and nurses make this technique increasingly popular for routine management of postoperative pain. ⋯ Spinal administration requires more routine surveillance and, when inadequately managed, has the potential for serious side effects and complications. Clinical investigations currently in progress are aimed at finding more successful and safer methods of postoperative pain control. The best methods will likely involve a multifaceted therapeutic approach rather than the simple effect of one "magic bullet."
-
Postgraduate medicine · Jul 1991
Case ReportsSerious bacterial infections in children. When can outpatient treatment be used?
Several studies now support outpatient treatment of many serious bacterial infections in children, such as periorbital or buccal cellulitis, urinary tract infection, pneumonia, and abscess. However, an appropriate agent, that is, a third-generation cephalosporin with a long half-life, must be available and its effectiveness properly researched. In addition, children must be free of other illnesses and able to ingest fluids and maintain hydration, and their parents must be willing and able to cooperate with an outpatient treatment regimen. Family physicians can maintain the close patient and family contact needed to facilitate this form of therapy.