Revue médicale suisse
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Revue médicale suisse · Oct 2015
[Doctor, I am having trouble breathing, an in-hospital point of view].
Breathlessness is frequent in the hospital setting: almost 50% of seriously ill hospitalised patients complain of dyspnoea, and its presence aggravates morbidity and mortality. Evaluation of breathlessness, based on self-report, must be completed with the measurement of vital signs and with a search for clinical signs of serious problems - desaturation, stridor, use of accessory muscles or alteration of mental status - that need urgent treatment. After this first therapeutic step, the diagnostic strategy consists of a multidisciplihary approach to determine the physiopathological mechanisms of dyspnoea that will determinate its final management.
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The refeeding syndrome is frequent and potentially deadly, still it is underdiagnosed. It is defined by clinical and biological manifestations that are seen upon refeeding of malnourished patients. ⋯ Riskconditions are well summarized by the NICE criteria. To avoid refeeding syndrome, it is fundamental to find and correct any electrolytic deficiency and to give thiamine before starting a slow and progressive oral, enteral or parenteral refeeding.
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Acute pericarditis is an inflammation of the pericardium. Different etiologies are known, and can be classified in three groups: infectious, neoplastic and auto-immun. ⋯ A diffuse and concave ST elevation permits the distinction with myocardial ischemia. The first line therapy is an association between NSAR and colchicine, the latter has shown to reduce the risk of recurrence.
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Revue médicale suisse · Oct 2015
[Loco-regional complications of pharyngitis: the example of Lemierre's syndrome].
Pharyngitis is a common cause of consultation in ambulatory medicine. Although it is benign in most cases, serious complications may happen and must be recognized quickly. Lemierre's syndrome is one of them. ⋯ Diagnosis relies essentially on the characteristic presentation of the disease. Therapy consists of surgical drainage of purulent collections and necrotic tissues associated with a prolonged course of antibiotics. Some authors also recommend a anticoagulation.