approach to the patient with acute respiratory failure

... that the erosion is the primary 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 ... (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, ... important to differentiate primary from secondary skin lesions If the examiner focuses on linear erosions overlying an area of erythema and scaling, he or she may incorrectly assume that the erosion...

Ngày tải lên: 06/07/2014, 20:20

... elicits the desire to scratch Pruritus is often the predominant symptom of inflammatory skin diseases (e.g., atopic dermatitis, allergic contact dermatitis); it is also commonly associated with ... epidermal atrophy) Scar: A change in the skin secondary to trauma or inflammation Sites may be erythematous, hypopigmented, or hyperpigmented depending on their age or character Sites on hair-bearing ... Lichenoid: Violaceous to purple, polygonal lesions that resemble those seen in lichen planus Milia: Small, firm, white papules filled with keratin Morbilliform: Generalized, small erythematous macules...

Ngày tải lên: 06/07/2014, 20:20

... highly with 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 ... possible to assess the distribution of the eruption accurately The patient should first be viewed from a distance of about 1.5–2 m (4–6 ft) so that the general character of the skin and the distribution ... patient with cutaneous small vessel vasculitis (Courtesy of Robert Swerlick, MD; with permission.)[newpage] APPROACH TO THE PATIENT: SKIN DISORDER In examining the skin it is usually advisable to...

Ngày tải lên: 06/07/2014, 20:20

... The distribution of some common dermatologic diseases and lesions Figure 52-7 Psoriasis This papulosquamous skin disease is characterized by small and large erythematous papules and plaques with...

Ngày tải lên: 06/07/2014, 20:20

... contrast, lesions with a generalized arrangement are common and suggest a systemic etiology Figure 52-9 Erythema multiforme This eruption is characterized by multiple erythematous plaques with a target ... usually represents a hypersensitivity reaction to drugs (e.g., sulfonylamides) or infections (e.g., HSV) (Courtesy of the Yale Resident's Slide Collection; with permission.) Figure 52-10 ...

Ngày tải lên: 06/07/2014, 20:20

... against the surface of the skin and rotated with downward pressure until it penetrates to the subcutaneous tissue The circular biopsy is then lifted with forceps, and the bottom is cut with iris ... area of skin is anesthetized with 1% lidocaine with or without epinephrine The skin lesion in question can be excised or saucerized with a scalpel or removed by punch biopsy In the latter technique, ... History of allergies Presence of photosensitivity Review of systems Family history (particularly relevant for patients with melanoma, atopy, psoriasis, or acne) 10 Social, sexual, or travel history...

Ngày tải lên: 06/07/2014, 20:20

... to document 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 ... best performed by physicians with special expertise in patch testing and is often helpful in the evaluation of patients with chronic dermatitis FURTHER READINGS Dermatology Lexicon Project: www.futurehealth.rochester.edu/dlp2/ ... designed to assess whether a skin lesion will blanch with pressure as, for example, in determining whether a red lesion is hemorrhagic or simply blood-filled Urticaria (Fig 52-11) will blanch with...

Ngày tải lên: 06/07/2014, 20:20

... same as the prognosis of the person with aortic stenosis who develops the first symptoms of congestive heart failure (median survival, ~8 months) However, the patient with heart disease ... malfunction one step further Not only is there a failure of the cancer cell to maintain its specialized function, but it also strikes out on its own; the cancer cell competes to survive using natural ... selection to seek advantage over normal cells in a recapitulation of evolution One consequence of the traitorous behavior of cancer cells is that the patient feels betrayed by his or her body The cancer...

Ngày tải lên: 07/07/2014, 01:20

... The past medical history may alert the physician to the presence of underlying diseases that may affect the choice of therapy or the side effects of treatment The social history may reveal occupational ... predisposition and 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 ... 77-3 Patient Management Important information is obtained from every portion of the routine history and physical examination The duration of symptoms may reveal the chronicity of disease The past...

Ngày tải lên: 07/07/2014, 01:20

... Against Cancer and the American Joint Committee on Cancer (AJCC) The TNM classification is an anatomically based system that categorizes the tumor on the basis of the size of the primary tumor ... other prognostic factors have been identified (Chaps 104, 105, and 106) In addition to tumor burden, a second major determinant of treatment outcome is the physiologic reserve of the patient Patients ... are likely to fare worse, stage for stage, than fully active patients Physiologic reserve is a determinant of how a patient is likely to cope with the physiologic stresses imposed by the cancer...

Ngày tải lên: 07/07/2014, 01:20

... 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 the pressure of a ... 81) Tools are now available to minimize the acute toxicity of cancer treatment New symptoms developing in the course of cancer treatment should always be assumed to be reversible until proven otherwise ... schedule greatly limit the time a physician spends with a patient who is receiving only palliative care Resist these forces In addition to the medicines administered to alleviate symptoms (see below),...

Ngày tải lên: 07/07/2014, 01:20

... Pregnancy disease, gonadal germ cell tumor Calcitonin Medullary cancer of the thyroid Catecholamines Pheochromocytoma Oncofetal Antigens Alphafetoprotein Hepatocellular carcinoma, gonadal germ Cirrhosis, ... Neuron-specific enolase Lactate dehydrogenase Small cell cancer of the lung,neuroblastoma Lymphoma, Ewing's sarcoma Hepatitis, hemolytic many others Tumor-Associated Proteins anemia, Prostate-specific ... Carcinoembryonic antigen Adenocarcinomas hepatitis Pancreatitis, of the colon, pancreas, hepatitis, lung, breast, ovary inflammatory bowel disease, smoking Enzymes Prostatic acid Prostate cancer...

Ngày tải lên: 07/07/2014, 01:20

... most patients who are cured of cancer return to normal lives Supportive Care In many ways, the success of cancer therapy depends on the success of the supportive care Failure to control the symptoms ... nonjudgmental, so that patients are more likely to discuss with the physician what they are actually doing The appearance of unexpected toxicity may be an indication that a supplemental therapy is being ... in the 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...

Ngày tải lên: 07/07/2014, 01:20

... on which to indicate the severity of the pain The clinical condition is often dynamic, making it necessary to reassess the patient frequently Pain therapy should not be withheld while the cause ... chemotherapy (Chap 81) Its severity can be predicted from the drugs used to treat the cancer Three forms of emesis are recognized on the basis of their timing with regard to the noxious insult Acute ... signals in the chemoreceptor trigger zone in the medulla, the cerebral cortex, and peripherally in the intestinal tract lead to stimulation of the vomiting center in the medulla, the motor center...

Ngày tải lên: 07/07/2014, 01:20

... Sexual dysfunction 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 ... adversely affect the course of treatment Cancer survivors have other sets of difficulties Patients may have fears associated with the termination of a treatment they associate with their continued ... that cancer therapy is substantially more toxic and less effective in the face of malnutrition Nevertheless, it remains unclear whether nutritional intervention can alter the natural history Unless...

Ngày tải lên: 07/07/2014, 01:20

... affected by the diagnosis and is coping with it is an important goal of patient management It is best to speak frankly with the patient and the family regarding the likely course of disease These discussions ... and the goal of palliative therapy is embraced in the hope of being able to live with disease; finally, at the disclosure of imminent death, another adjustment in outlook takes place The patient ... difficult for the physician as well as for the patient and family The critical features of the interaction are to reassure the patient and family that everything that can be done to provide comfort...

Ngày tải lên: 07/07/2014, 01:20

... discharge mortality rates in patients with ARF as the only organ failure were 3.2% and 14.7%, respectively The question arises as to why isolated respiratory failure leads to such relatively low mortality ... standard ventilatory treatment strategies are effective in treating patients with isolated respiratory failure, and other organ systems that are healthy may be better able to tolerate the well known ... contribute to the observed high mortality rates in patients with ARF [7,17–19] The role of the severity of ARF itself is under discussion It may depend on the indicator used to assess this severity The...

Ngày tải lên: 12/08/2014, 19:22

... before the onset of acute respiratory failure High spinal anesthesia associated with vasomotor block, profound bradycardia and respiratory insufficiency could be responsible for the postoperative ... due to the risk of intrauterine infection Two days later and approximately hours after the scheduled Cesarean section, the patient developed acute respiratory distress and was transferred to the ... be due to any inflammatory process without concomitant infection Radiological findings were not specific for pneumonia, but even in patients with symptoms consistent with a lower respiratory tract...

Ngày tải lên: 11/08/2014, 23:21

... of tracheostomy in patients with acute respiratory failure Physician belief in the utility of tracheostomy, patient selection and the lack of blinding may introduce bias, leading to difficulties ... performing a tracheostomy relatively early in patients with acute respiratory failure We tested the hypothesis that tracheostomy, when performed prior to active weaning, does not influence the duration ... MV The 21 patients in the ET group were demographically similar to the 53 patients in the ST group, except for the greater number of patients with TBI in the ET group (Table 2) All 21 of the...

Ngày tải lên: 12/08/2014, 20:20

... mortality in patients admitted to the intensive care unit with acute respiratory failure Cessation of established therapy appears to be hazardous Initiation of therapy prior to discharge appears to confer ... 24(19 to 30) 24(19 to 30) 25(20 to 30) 0.75 24(18 to 30) 25(20 to 30) 0.38 161(101 to 240) 169(101 to 239) 144 (92 to 216) 0.20 169 (99 to 248) 152(100 to 228) 0.41 5.9(4.9 to 7.8) 5.9(5 to 7.8) ... 70(62 to 78.75) 25.8(22.6 to 30.8) 70(61 to 79) 25.85(22.6 to 30.8) 0.013 0.06 32(26 to 46) 32(24 to 45) 73(63 to 76) 25.8(22.5 to 28.4) 36 (31 to 46) 0.12 32(24 to 45) 44(30 to 44) 0.07 98(84 to...

Ngày tải lên: 13/08/2014, 21:21