Postgraduate medicine
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Patients with chronic obstructive lung disease (COLD) experience one or more episodes of acute respiratory failure in the late years of their illness. Initial evaluation is aimed at assessing the precipitating factor or factors as well as the severity of the acute episode and the need for intubation and mechanical ventilation. Specific treatment is directed toward the individual precipitating cause, as well as toward the general relief of hypoxemia and airflow obstruction. The prognosis for recovery from most episodes of acute respiratory failure is excellent and warrants an aggressive approach.
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Postgraduate medicine · Jan 1986
Mechanical ventilation. Physiology, equipment design, and management.
The major goals of mechanical ventilation are the prevention of significant respiratory acidosis and the correction of arterial hypoxemia. Ventilators are categorized as negative- or positive-pressure types, depending on their effect on airway pressure. Positive-pressure ventilators, which are used in the treatment of acute respiratory failure, may be subclassified as pressure-, volume-, or time-cycled. ⋯ Ventilation may be provided in a number of modes. No clear-cut advantage of intermittent mandatory ventilation over assisted mechanical ventilation has been demonstrated. By following simple guidelines, the clinician can initiate mechanical ventilation that provides an ideal ventilatory pattern.
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Postgraduate medicine · Nov 1985
Home intravenous antibiotic therapy. A practical management approach for the 1980s.
The development of antibiotics with extended duration of activity, combined with the social and economic changes in the practice of medicine in recent years, has resulted in use of home intravenous (IV) antibiotic therapy to treat a wide range of infections in selected patients. At Lovelace Medical Center, infections of the musculoskeletal system have accounted for two thirds of the cases for which such therapy is used. First-and third-generation cephalosporins have been used most often and at our institution are almost identical in terms of actual charges to the patient. Although several important medicolegal and ethical problems have yet to be resolved, home IV antibiotic therapy has been shown to be safe, effective, and capable of reducing medical costs to both patients and health care providers.
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Categorization of trauma injuries and identification of special resources and facilities for treatment of major injuries have markedly affected morbidity and mortality. Reduction in trauma morbidity and mortality depends on early identification of severely injured patients, proper initial stabilization, and safe interhospital transfer. The trauma score and the American College of Surgeons anatomical injury categorization are valuable triage tools. Protocols for initial stabilization and for safe transfer have been described to assist the primary referring physician in providing optimal early care.
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Postgraduate medicine · Sep 1985
Nerve blocks and chronic pain states--an update. 2. Clinical indications.
With the unfortunate exception of the differential spinal block, diagnostic nerve blocking has become somewhat obsolete with the development of newer, more sophisticated diagnostic technology. Therapeutic nerve blocks remain useful in treating patients with various terminal cancers, some forms of back pain, tic douloreux, causalgia, reflex sympathetic dystrophy, and many trigger point syndromes. For dysfunctional and pain-disabled patients (rated as class 1 or 3 on Emory Pain Estimate Model), block therapy must be structured in comprehensive pain rehabilitation programs.