Postgraduate medicine
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All healthcare professionals need to become aware of the extent and seriousness of smokeless tobacco use. In this article, the authors briefly review the current status of smokeless tobacco and describe its usage patterns and practices, pharmacologic (addictive) aspects, and associated health problems. They also suggest ways that primary care physicians can discover or prevent smokeless tobacco use in their patients.
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Postgraduate medicine · May 1990
ReviewThe Heimlich maneuver. Best technique for saving any choking victim's life.
The American Red Cross (ARC) and the American Heart Association (AHA) advocated backslaps, chest thrusts, and abdominal thrusts for 10 years after the Heimlich maneuver was introduced in 1974. Even after the Surgeon General in 1985 declared these methods to be "hazardous, even lethal," the ARC and the AHA continue to recommend backslaps and chest thrusts for infants under 1 year of age. ARC and AHA instructional materials that advocate use of these methods have not been recalled, and the public has not been warned of the dangers. ⋯ In fact, the energy produced by the backslap drives the foreign object in the wrong direction, toward the lungs, while the energy produced by the Heimlich maneuver drives the object away from the lungs, toward the mouth. Backslaps and chest thrusts should be publicly recalled as a treatment for choking infants before further deaths and injuries occur. The Heimlich maneuver is the best rescue technique for treating choking victims of all ages.
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Coma is a common, life-threatening medical problem encountered by primary care physicians. The principles of emergency management mandate that adequate oxygenation, blood flow, and supplementation with thiamine and glucose be given to the brain before a thorough diagnostic evaluation is undertaken. Knowledge of the usual causes of coma coupled with clues from the neurologic examination often aid in diagnosis and provide useful prognostic information.
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Effective therapy for thyrotoxicosis hinges on prompt recognition of the syndrome. When the diagnosis is suspected clinically but is not certain, the free thyroxine index is the most cost-effective test to order initially. ⋯ Definitive therapy includes antithyroid drugs, iodine 131, and surgery. Patient preference has a large role in the final therapeutic choice.
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Postgraduate medicine · Apr 1990
Superficial fungal infections. A practical guide for primary care physicians.
Clinicians who establish a proper diagnosis should have little difficulty managing dermatophyte infections. Diagnosis can be confirmed by direct microscopic examination with a potassium hydroxide preparation or by culture with the dermatophyte test medium. Safe, reliable antifungal therapy is available. Treatment will be more effective if antifungal therapy is not prescribed until fungal organisms have been identified and if topical steroids are not prescribed until fungal organisms have been excluded.