Southern medical journal
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Southern medical journal · Jan 1988
Biography Historical ArticleCoke's the one: the centennial of the "ideal brain tonic" that became a symbol of America.
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We have described three patients with diabetes and renal insufficiency who had hyperkalemia during heparin therapy. These cases lend support to previous findings, and emphasize the clinical importance of this entity. We believe that heparin-induced hyperkalemia is a potentially life-threatening problem that is more common than previously appreciated. We suggest that in high-risk patients (ie, those with diabetes and/or renal insufficiency) serum potassium be monitored frequently during heparin therapy.
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Southern medical journal · Nov 1987
ReviewPreoperative medical consultation and evaluation of surgical risk.
Internists are frequently asked to assess the surgical risk of patients with various medical problems. Numerous recent prospective studies have defined specific risk factors for increased morbidity and mortality in the preoperative evaluation of surgical patients. Careful attention to such factors as age, type of operation and anesthesia, underlying pulmonary, hypertensive, cardiac, renal, hepatic, endocrine, and hematologic diseases, and nutritional status can reduce the complication rate and death rate in surgical patients if specific preoperative, operative, and postoperative therapeutic maneuvers are instituted. A comprehensive comparative analysis by the internist, surgeon, and anesthesiologist should be made on all high-risk surgical patients to improve their medical care.
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Southern medical journal · Nov 1987
Evaluation of coronary artery disease in patients having noncardiac surgery.
Perioperative myocardial infarction and cardiac death are feared complications of noncardiac surgery. Preoperative risk assessment begins with clinical variables. There is no formula for determining who needs further evaluation. In selected patients, thallium scintigraphy or coronary arteriography is needed to define preoperative risk.
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Southern medical journal · Oct 1987
Central venous cannulation done by house officers in the intensive care unit: a prospective study.
Central venous cannulation (CVC) is a procedure frequently performed by house staff in the intensive care units of teaching hospitals. In the medical ICUs of our two hospitals, CVC was successfully done by house officers in 172 cases requiring 231 attempts (one operator at one insertion site), for a success rate of 74%. There were 14 complications (6.1%), five requiring intervention, but none fatal. ⋯ CVC during resuscitation was frequently unsuccessful (41%) and/or complicated (13.6%). Although success rates were comparable, complications were more common among experienced house officers than among interns, perhaps reflecting patient selection. There was a trend toward fewer and/or less severe complications during the course of the month and of the study.