Postgraduate medicine
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Postgraduate medicine · Apr 1991
Review Case ReportsNeuroleptic malignant syndrome. When levodopa withdrawal is the cause.
Neuroleptic malignant syndrome has been described in patients receiving dopamine antagonists and in a few patients after withdrawal of dopaminergic antiparkinson therapy. Complications affect almost all organ systems and can be life-threatening. ⋯ Treatment includes withdrawal of the causative agent and supportive therapy for complications. When withdrawal of a dopaminergic medication is the suspected cause, the agent should be reinstated.
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Postgraduate medicine · Apr 1991
ReviewNutrition support of critically ill patients. Guidelines for optimal management.
Nutrition support is an important component of the management of critically ill patients. Before support is initiated, realistic goals should be established and risks and benefits considered. Initially, hemodynamic status should take precedence over nutritional status. ⋯ In most cases calorie requirements can be estimated adequately with use of the Harris-Benedict equation. Indirect calorimetry provides valuable information in patients with impending respiratory failure; withdrawing excess calories and substituting lipid calories for carbohydrate calories, if necessary, may be beneficial. Clinical response can be assessed by nitrogen balance studies and weekly measurement of weight and serum transferrin levels.
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Postgraduate medicine · Mar 1991
ReviewEmergency resuscitation in children. The role of intraosseous infusion.
Intraosseous infusion is a temporary procedure for use in pediatric emergencies when intravenous access is difficult. Multiple drugs and fluids can be safely administered through the intraosseous route. Dosage and rate of infusion are essentially the same as with intravenous infusion.
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During resuscitation, it is important to distinguish between those maneuvers directed at patient revival and those directed at examination and measurement. Revival should always be the top priority. The steps for revival are easily remembered as ABCDEF: Airway, Breathing, Circulation, Decompression, Elimination, and Fluids. Once these steps have been completed, vital functions can be assessed and measurements to aid in diagnosis can be taken.
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Postgraduate medicine · Jan 1991
Case ReportsSpontaneous pneumomediastinum. An unusual cause of a sore throat.
Sore throat, usually related to pharyngitis, is a common presenting symptom in the primary care setting. Drs Frenkel and Lyons describe a case showing that physicians need to be aware of another, puzzling cause--spontaneous pneumo-mediastinum.