Postgraduate medicine
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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.
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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.
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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."
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Postgraduate medicine · Jul 1991
Sepsis and septic shock. Deadly complications that are on the rise.
Most patients are already hospitalized when sepsis and septic shock develop, and in spite of therapy, at least 50% die. Although newer therapeutic agents are being evaluated, current management consists of antibiotics, fluids for volume resuscitation, inotropic agents, and surgery for septic foci. Greater emphasis on preventive measures is recommended.
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Postgraduate medicine · Jul 1991
Using anticoagulants safely. Guidelines for therapeutic and prophylactic regimens.
Heparin and warfarin sodium (Coumadin, Panwarfin, Sofarin) are used most often to treat acute and recurrent venous thromboembolic disease, arterial disease, valvular heart disease, and atrial fibrillation. These agents along with dextran, pneumatic compression devices, and gradient stockings are also used to prevent deep venous thrombosis and pulmonary embolism in patients at high risk (eg, those with venous stasis, lower limb or spinal cord trauma, clotting abnormalities). Anticoagulation therapy is monitored by maintaining the activated partial thromboplastin time and the prothrombin time in the therapeutic range.