Swiss medical weekly
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Gastric lavage, intestinal charcoal decontamination and specific drug antagonism, therapeutic measures widely applied in other intoxications, are of no clear benefit or unavailable in patients with alcohol intoxication. The gastric first-pass-effect is important in modifying the kinetics of alcohol, and clinically relevant drug-alcohol interactions occur in situations of both acute and chronic alcohol abuse. Alcohol-induced hypoglycemia and ketoacidosis should be considered in every severely ill alcoholic patient. The recognition of alcoholism is important and rewarding, since therapeutic action by the practicing physician can be of significant help.
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Sudden, explosive headache is rather rare. Though dramatic for the patient and the physician, it does not necessarily herald an intracranial catastrophe. Benign and dangerous thunderclap headaches cannot be distinguished from the features of headache itself, but rather on the basis of the situation, the additional symptoms and the findings. ⋯ To confirm diagnosis, additional investigations such as CT, lumbar puncture or cerebrovascular ultrasound, and in rare cases MRI, should be performed early as the available time for effective therapy in many situations is short. Many of the benign forms of sudden headache can be diagnosed with a focused interview (cold or drug induced and food dependent headaches, sinusitis, glaucoma). Others, such as neuralgia, cough and coital headache, can be diagnosed as benign only when additional investigations have ruled out symptomatic forms.
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Swiss medical weekly · Apr 1993
Review["Needlestick" accidents--procedures following potentially infectious exposure in medical personnel].
Accidental exposure to blood carries with it a definite risk for the health care worker of infection by various bloodborne pathogens, especially the hepatitis B, hepatitis C, and human immunodeficiency virus. The risk of transmission from exposure to HIV is lower than that associated with exposure to HBV and HCV. Should HIV infection occur, however, the outcome is likely to be fatal. ⋯ The post-exposure management is discussed. Neither the efficacy nor the safety of AZT (zidovudine) for use as a chemoprophylactic agent following occupational exposures to HIV has been established. Nevertheless in selected cases it can be proposed to health care workers.
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Oncological emergencies are frequent, particularly in advanced cancer stages. Many situations can only be tackled successfully with the cooperation of a well organized team of specialists. Spinal cord compression caused by cancer requires particularly swift action. ⋯ Although hematopoietic growth factors are now available to hasten neutrophil recovery, these drugs should not be given on a routine basis. Another relatively frequent emergency is the superior vena cava syndrome, which is almost always due to a malignant tumour. Any treatment plan prepared to deal with an oncological emergency in a particular patient should take into account the prognosis of the underlying disease, the prospects for further therapy, and the patient's attitude.
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Endocrine crises can occur in diabetes mellitus, in pituitary failure when there is a lack of ACTH, TSH or ADH secretion, in severe hyper- or hypothyroidism (thyroid storm and myxedema coma), severe hyper- or hypoparathyroidism (parathyroid crisis and tetany), in adrenal failure and in patients with pheochromocytoma or carcinoid tumors. Cushing's syndrome can be associated with psychotic crises. This review describes the most important clinical features and the basic diagnostic and therapeutic aspects of the non diabetic endocrine crises.