Comprehensive therapy
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Randomized, double-blind, placebo-controlled studies and observational studies have demonstrated that statins reduce mortality and major cardiovascular events in high-risk persons with hypercholesterolemia. The Heart Protection Study showed that statins reduced mortality and major cardiovascular events in high-risk persons, regardless of the initial level of serum lipids, age, or gender. Lipid-lowering therapy reduces cardiovascular morbidity and mortality in high-risk persons, forming the basis for the updated National Cholesterol Education Program (NCEP) III guidelines.
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Comprehensive therapy · Jan 2006
ReviewCritical care medicine update: essentials for the nonintensivist, part 1.
The intensive care unit (ICU) can be a challenging environment for health care practitioners who are not trained in critical care medicine. A structured approach to patient care is necessary in order to achieve optimal clinical outcomes. ⋯ We provide a structured overview of the management of the critically ill patient and focus on problems commonly encountered in the heterogeneous ICU patient population. In Part 1 we review (a) altered states of consciousness and sedation, (b) respiratory failure and ventilators, (c) cardiovascular monitoring and management, and (d) fluid and electrolyte disorders.
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Comprehensive therapy · Jan 2006
Case ReportsSuperior vena cava obstruction presenting as a complication of repeated central venous cannulations.
Frequent use of central venous cannulations and dialysis catheters has led to increased complications like venous thrombosis and catheter-related sepsis. Superior vena cava subclavian obstruction secondary to extensive thrombosis of the central veins and internal jugular veins is presented. The risk factors, diagnostic modalities, and treatment options are discussed.
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Chronic obstructive pulmonary disease (COPD) is a major cause of mortality and morbidity throughout the world. It is the only cause of death among the top 10 causes that is increasing and is expected to become the third leading cause of death in the world by 2020. A diagnosis of COPD should be considered in any patient with previous exposure to risk factors for the disease and/or the presence of chronic cough, sputum production, or dyspnea. ⋯ Other adjunctive measures include vaccination, oxygen therapy, pulmonary rehabilitation, and certain surgical measures like bullectomy and lung transplantation. Management of acute exacerbations includes the use of systemic steroids, antibiotics, bronchodilators, and oxygen therapy. During very severe exacerbations, patients may need ventilatory support.
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Comprehensive therapy · Jan 2006
ReviewTreatment of heart failure with decreased left ventricular ejection fraction.
Class I recommendations for treating patients with current or prior symptoms of heart failure with reduced left ventricular ejection fraction (LVEF) include using diuretics and salt restriction in individuals with fluid retention. Use angiotensin-converting enzyme (ACE) inhibitors, beta blockers, and angiotensin II receptor blockers if intolerant to ACE inhibitors because of cough or angioneurotic edema. Nonsteroidal anti-inflammatory drugs, most antiarrhythmic drugs, and calcium channel blockers should be avoided or withdrawn. ⋯ ICD is indicated in patients with ischemic heart disease for at least 40 d post-myocardial infarction or nonischemic cardiomyopathy, an LVEF of 30% or less, New York Heart Association (NYHA) class II or III symptoms on optimal medical therapy, and an expectation of survival of at least 1 yr. Cardiac resynchronization therapy should be used in individuals with an LVEF of 35% or below, NYHA class III or IV symptoms despite optimal therapy, and a QRS duration greater than 120 ms. An aldosterone antagonist can be added in selected patients with moderately severe to severe symptoms of heart failure who can be carefully monitored for renal function and potassium concentration (serum creatinine should be