Postgraduate medicine
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When a mammal's bite breaks the skin, aggressive management is indicated to prevent infection and provide for a good cosmetic and functional result. Vigorous irrigation and thorough debridement play a more important role than antibiotics in preventing infection. ⋯ Suturing may or may not be advisable, depending on cosmetic considerations and risk of infection. Prophylaxis against tetanus is a must, and hepatitis and rabies prophylaxis may also be necessary in selected cases.
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Postgraduate medicine · May 1983
Chronic pain. A pharmacologic review and behavior modification approach.
Management of pain syndromes clearly requires a multidimensional approach and involves social, psychologic, and somatic factors. At the Behavioral Medicine/Pain Therapy Center of Jewish Hospital, St Louis, most patients significantly increase social and physical activity using the combined approach outlined. A majority of patients previously treated with complicated drug regimens do well on little or no medicine. When medications are required for long-term treatment, tricyclic antidepressants have been most successful.
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While primary neurologic damage in the patient with head trauma may be irreversible, damage from secondary injuries can often be avoided with rapid identification and correction of factors potentially leading to such injury. In patients with severe injuries, systematic evaluation is needed, including assessment of respiratory and circulatory systems, history taking, inspection of the head, and neurologic, general, and roentgenographic examination, as well as monitoring of vital functions, continuing patient care, and administration of intravenous fluids and medications.
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Epidemiologic studies in the United States suggest that a low potassium intake may be important in the genesis of hypertension. The higher blood pressure in blacks than in whites in the United States is associated with lower excretion of potassium. ⋯ The high cost of a high-potassium diet may be the reason for the low potassium consumption. Potassium may reduce blood pressure by increasing sodium excretion, decreasing renin secretion, decreasing sympathetic nerve activity, or directly dilating the arteries.
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Acute obstruction of the upper airway can be caused by several events. With some, such as anaphylaxis and trauma, obstruction may not be immediate and the physician may be able to take steps to avert it. ⋯ The most serious complication of this procedure is chronic subglottic stenosis. Vocal cord paralysis may result from tumor or neck trauma but especially from neck or mediastinal surgery, and the vocal cords should always be examined before and after such surgery.