emergency department physician approach to the arrhythmic patient

... Risk Continued Inpatient Care? Admission Patient Screening Not at Risk Periodic Re-Screening Discharge Planning/Continuity of Care No Yes Goals Achieved Patient Monitoring At Risk Patient Assessment ... rate of false positive Many patients WITH hypertension test positive Many patients WITH hypertension test positive Many Patients WITHOUT hypertension test positive Few Patients WITHOUT hypertension ... nutrition screening • A systematic approach for – Data collection – Recording data – Interpretation of that data • Ongoing process – A more detailed look at the patient s condition – Includes assessment...

Ngày tải lên: 15/10/2017, 20:42

... (Table 52-4) For instance, the finding of scaling papules (present in patients with psoriasis or atopic dermatitis) places the patient in a different diagnostic category than would hemorrhagic papules, ... lesion and the redness and scale are secondary, while the correct interpretation would be that the patient has a pruritic eczematous dermatitis with erosions caused by scratching Figure 52-1 Superficial...

Ngày tải lên: 06/07/2014, 20:20

Ngày tải lên: 06/07/2014, 20:20

... on the lower legs are seen in this patient with cutaneous small vessel vasculitis (Courtesy of Robert Swerlick, MD; with permission.)[newpage] APPROACH TO THE PATIENT: SKIN DISORDER In examining ... diagnosis (Fig 52-6) For example, a hospitalized patient with a generalized erythematous exanthem is more likely to have a drug eruption than is a patient with a similar rash limited to the sun-exposed ... eyes, nose, nasopharynx, and anogenital region In the initial examination it is important that the patient be disrobed as completely as possible This will minimize chances of missing important individual...

Ngày tải lên: 06/07/2014, 20:20

Ngày tải lên: 06/07/2014, 20:20

Ngày tải lên: 06/07/2014, 20:20

... Family history (particularly relevant for patients with melanoma, atopy, psoriasis, or acne) 10 Social, sexual, or travel history as relevant to the patient DIAGNOSTIC TECHNIQUES Many skin diseases...

Ngày tải lên: 06/07/2014, 20:20

... or papulovesicles) This test is best performed by physicians with special expertise in patch testing and is often helpful in the evaluation of patients with chronic dermatitis FURTHER READINGS ... sensitivity to a specific antigen In this procedure, a battery of suspected allergens is applied to the patient' s back under occlusive dressings and allowed to remain in contact with the skin for 48 h ... lamp may also aid in the demonstration of tinea versicolor and in recognition of ash leaf spots in patients with tuberous sclerosis Figure 52-12 Vitiligo Characteristic lesions display an acral distribution...

Ngày tải lên: 06/07/2014, 20:20

... the patient with heart disease may remain functional and maintain a self-image as a fully intact person with just a malfunctioning part, a diseased organ ("a bum ticker") By contrast, the patient ... One consequence of the traitorous behavior of cancer cells is that the patient feels betrayed by his or her body The cancer patient feels that he or she, and not just a body part, is diseased The ... Along with the decrease in incidence has come an increase in survival for cancer patients The 5-year survival for white patients was 39% in 1960–1963 and 68% in 1996– 2002 Cancers are more often deadly...

Ngày tải lên: 07/07/2014, 01:20

... the diagnosis of cancer is made, the management of the patient is best undertaken as a multidisciplinary collaboration among the primary care physician, medical oncologists, surgical oncologists, ... duration of symptoms may reveal the chronicity of disease The past medical history may alert the physician to the presence of underlying diseases that may affect the choice of therapy or the side ... point out the need to begin surveillance or other preventive therapy for unaffected siblings of the patient The review of systems may suggest early symptoms of metastatic disease or a paraneoplastic...

Ngày tải lên: 07/07/2014, 01:20

... of the patient Patients who are bedridden before developing cancer are likely to fare worse, stage for stage, than fully active patients Physiologic reserve is a determinant of how a patient ... surrogate markers for physiologic reserve are used, such as the patient' s age or Karnofsky performance status (Table 77-4) Older patients and those with a Karnofsky performance status

Ngày tải lên: 07/07/2014, 01:20

... The skilled physician also has much to offer the patient for whom curative therapy is no longer an option Often a combination of guilt and frustration over the inability to cure the patient and ... inability to cure the patient and the pressure of a busy schedule greatly limit the time a physician spends with a patient who is receiving only palliative care Resist these forces In addition to the ... is provided by holding the patient' s hand, continuing regular examinations, and taking time to talk 2 The National Cancer Institute maintains a database called PDQ (Physician Data Query) that...

Ngày tải lên: 07/07/2014, 01:20

Ngày tải lên: 07/07/2014, 01:20

... course of their disease Unsound approaches are usually hawked on the basis of unsubstantiated anecdotes and not only cannot help the patient but may be harmful Physicians should strive to keep ... such as support groups, psychotherapy, and guided imagery may be of benefit Many patients opt for unproven or unsound approaches to treatment when it appears that conventional medicine is unlikely ... Physicians should strive to keep communications open and nonjudgmental, so that patients are more likely to discuss with the physician what they are actually doing The appearance of unexpected toxicity...

Ngày tải lên: 07/07/2014, 01:20

... Thus, very few patients will have inadequate pain relief if appropriate measures are taken A specific approach to pain relief is detailed in Chap 11 Nausea Emesis in the cancer patient is usually ... The patient should be given a 10-division visual analogue scale on which to indicate the severity of the pain The clinical condition is often dynamic, making it necessary to reassess the patient ... is being sought A variety of tools are available with which to address cancer pain About 85% of patients will have pain relief from pharmacologic intervention However, other modalities, including...

Ngày tải lên: 07/07/2014, 01:20

... mechanisms are further elucidated Psychosocial Support The psychosocial needs of patients vary with their situation Patients undergoing treatment experience fear, anxiety, and depression Self-image ... is highly prevalent and needs to be discussed openly with the patient An empathetic health care team is sensitive to the individual patient' s needs and permits negotiation where such flexibility ... are an unusual complication The major complications are occlusion, leakage, and fluid overload Patients with severe liver disease may develop disseminated intravascular coagulation Nutrition...

Ngày tải lên: 07/07/2014, 01:20

... patient management It is best to speak frankly with the patient and the family regarding the likely course of disease These discussions can be difficult for the physician as well as for the patient ... in-hospital death The care of dying patients may take a toll on the physician A "burnout" syndrome has been described that is characterized by fatigue, disengagement from patients and colleagues, and ... of the interaction are to reassure the patient and family that everything that can be done to provide comfort will be done They will not be abandoned Many patients prefer to be cared for in their...

Ngày tải lên: 07/07/2014, 01:20

... Approach to the Patient: Acute Febrile Illness A physician must have a consistent approach to acutely ill patients Even before the history is elicited ... performed, an immediate assessment of the patient' s general appearance yields valuable information The perceptive physician' s subjective sense that a patient is septic or toxic often proves accurate ... examined for bacteria; these patients can have >106 organisms per milliliter of blood (compared with 10 4/mL in patients with an intact spleen) Blood smears from patients at risk for severe parasitic...

Ngày tải lên: 07/07/2014, 04:20

... the patient is >50 years old or 76 has comorbid disease, add ampicillin (2 g q4h) for Listeria coverage Vancomycin (1 g q12h) Dexamet hasone (10 mg q6h x days) improves outcome adult in patients ... treatment when 29, 130, culture data 143, fludrocortisoneb or may improve outcome in Cefepime (2 g patients with q12h) septic shock Overwhel ming Streptoc post- occus g q12h) plus splenectomy pneumoniae, ... (activated) is administered at a dose of 24 µg/kg per hour for 96 h It has been approved for use in patients with severe sepsis and a high risk of death as defined by an Acute Physiology and Chronic...

Ngày tải lên: 07/07/2014, 04:20

... for patients with severe sepsis Overwhelming Infection in Asplenic Patients (See also Chap 265) Patients without splenic function are at risk for overwhelming bacterial sepsis Asplenic adult patients ... Chap 265) Patients with bacteremia leading to septic shock may have a primary site of infection (e.g., pneumonia, pyelonephritis, or cholangitis) that is not evident initially Elderly patients ... Elderly patients with comorbid conditions, hosts compromised by malignancy and neutropenia, and patients who have recently undergone a surgical procedure or hospitalization are at increased risk...

Ngày tải lên: 07/07/2014, 04:20