Postgraduate medicine
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Septic shock is a difficult and complex condition that requires a thorough and thoughtful approach in all aspects of care. The most likely cause may become apparent by considering the clinical presentation of the patient and information from the history, physical examination, and appropriate laboratory tests. Appropriate antibiotic therapy should be initiated as soon as possible. Only an aggressive diagnostic and therapeutic approach can reduce the mortality and morbidity of this condition.
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Postgraduate medicine · Jan 1990
Comparative StudyOpen cardiac resuscitation. A surgeon's viewpoint.
Open cardiac massage yields better hemodynamic results in the laboratory than does closed cardiac massage. However, reported survival rates with the two methods are similar, except in postcardiotomy patients and patients with penetrating injury. ⋯ Closed cardiac massage can be instituted more universally and more quickly than open massage and thus should remain the mainstay of cardiac resuscitation. Open cardiac massage can be performed by trained surgical personnel in appropriate situations.
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Postgraduate medicine · Dec 1989
Blood component therapy. New guidelines for avoiding complications.
Transfusion medicine is an expanding subspecialty that continues to be reshaped and redefined. The current indications for red blood cell (RBC) transfusion are the presence of tissue hypoxia or a hemoglobin level of less than 7 g/dL. Platelet concentrates should be given prophylactically for severe thrombocytopenia secondary to production defects. ⋯ No blood transfusion is without risk to the recipient. Two of the major transfusion-related complications are alloimmunization and graft-versus-host disease. Techniques for preventing these conditions are available.
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Inhalation injuries most often occur with cutaneous burns, and the likelihood of an inhalation injury increases incrementally with age of the patient and size of the burn. Damage to the pulmonary parenchymal tissue manifests as increased capillary permeability leading to excessive lung fluid formation and increasing hypoxia. An inhalation injury may be diagnosed using observation of indirect criteria in conjunction with fiberoptic bronchoscopy, xenon 133 radiospirometry, and/or measurement of extravascular lung water. ⋯ High-flow oxygen therapy reduces the half-life of carbon monoxide to an acceptable period. The patient proceeds through three stages: pulmonary insufficiency, pulmonary edema, and bronchopneumonia. Treatment is directed toward supporting oxygenation using endotracheal intubation with mechanical ventilation, humidification of inspired air, early mobilization, chest physiotherapy, antibiotics for documented infection, and adequate systemic hydration.
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Both plaster of Paris and fiberglass can be used for temporary or definitive treatment of acute extremity fractures, sprains, and strains. Longitudinal slab splints are appropriate for immobilizing inflamed tendons or joints of the wrist, elbow, and knee. "Sugar-tong" splints work well for humerus, forearm, and ankle fractures or sprains.