Duodecim; lääketieteellinen aikakauskirja
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Practice Guideline
[Update on current care guidelines. The treatment of status epilepticus].
Status epilepticus is a medical emergency. Most epileptic seizures last for 1-4 minutes and seizures lasting over five minutes, should be treated as status epilepticus. ⋯ Third-line treatment is suppressive general anaesthesia, monitored by continuous EEG. Antiepileptic medication of patients with epilepsy should be carefully re-evaluated after episode of status epilepticus.
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According to the Finnsepsis Study, the incidence in Finland of severe sepsis requiring intensive care was 0.38/1,000 inhabitants/year. ICU and hospital mortality was 15.5% and 28.3%, respectively. The Finnsepsis Study showed that compliance with protocols was rather poor and antimicrobial treatment was often delayed. ⋯ Low-dose hydrocortisone may be used to shorten the need for vasopressors. Activated protein C should be considered in selected patients. The blood glucose target recommendation is between 5 and 8 mmol/l.
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A sensation of a lump in the throat will often cause fear of tumor. Underlying the symptom is only seldom a tumor, which is, however, malignant in about 97 to 99% of cases of hypopharyngeal occurrence. Excessive alcohol consumption and smoking constitute the their greatest risk factors. We present a patient case relating to a rare benign tumor of the hypopharynx (giant fibrovascular polyp, GFP).
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Self-administered nitrous oxide relieves labour pain in approximately two-thirds of women, and there is a dose-response with a maximum effect at a concentration of 70%. Nitrous oxide can be used during all stages of labour, and it has no impact on the progress of labour. Occupational exposure of health care workers to nitrous oxide has no adverse effects on their reproductive health if there is an adequate scavenging system in the delivery rooms. The greenhouse effect of the medical use of nitrous oxide is minimal and in future, its catalytic splitting to nitrogen and oxygen may overcome this adverse effect.
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Every woman in labor shall have the right to receive effective analgesia if she so wishes. Management of labor pains should strive for individuality according to the mother's wishes, even if they are changing. ⋯ Anesthesia may be given when labor is clearly under way, and can be continued even at the expulsive stage. With contemporary drug mixtures it is possible to carry on with the anesthesia throughout the delivery without significantly affecting its course.