California medicine
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The topical use of anesthetic agents involves an element of risk. Systemic toxic reactions are rare, but they do occur and may result in death. ⋯ Emphasis is placed on the causes, prophylaxis and treatment of severe systemic toxic reactions which follow the topical application of local anesthetic drugs. If systemic toxic reactions resulting from a safe dose of a local anesthetic agent are correctly treated, there will usually follow an uneventful recovery rather than a catastrophe.
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Gastric and duodenal ulcers are common conditions. There is a good natural tendency to heal but medical care does facilitate healing and the prevention of relapse. ⋯ With gastric ulcer, careful clinical and radiological observations will enable simple and malignant ulcers to be distinguished with considerable accuracy. The risk of gastrectomy is less than the risk of leaving a persistently unhealed ulcer, and should be undertaken if ulcers remain unhealed or if there are frequent relapses threatening economic security.
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Headache is the commonest complication of spinal puncture. There is no significant difference in the incidence of headache after lumbar puncture, whether or not the puncture is followed by injection of an anesthetic agent. ⋯ Prevention of postlumbar puncture headache consists largely in attempts to avoid the development of the pressure differential between that of the cerebrospinal fluid and intracranial venous pressure. Treatment consists of analgesics, hydration and attempts to restore normal cerebrospinal fluid pressure.
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When the team of physicians-cardiologist, anesthesiologist and surgeon-who are to attend a patient during a cardiac operation study the patient together in preoperative evaluation, they are better able to anticipate emergencies that might arise during the procedure and to deal with them without loss of time for discussion. The principal problems of the anesthesiologist during operation are maintenance of adequate ventilation and oxygenation, maintenance of the lightest level of anesthesia possible (the minimum degree of poisoning), and maintenance of adequate circulation. The cardiologist must maintain constant observation of the heart rate and rhythm and be alert for early signs of myocardial oxygen deficiency.