... between the need to protect and support the health ofthe individual andthe public with the rights ofthe individual and involves ethical issues of distributive justice in regard to the costs and ... radiographs on the basis ofthe number and size of calcified epiphyseal centers; the size, shape, density, and sharpness of outline ofthe ends of bones; andthe distance separating the epiphyseal ... understanding ofthe information at frequent intervals and by recapitulating at the close ofthe visit, the interviewer and patient and family can ensure that they understand each other If the clinician’s...
... Assessment ofthe patient's general appearance and vital signs, skin and soft tissue examination, andthe neurologic evaluation are of particular importance The patient may appear either anxious and ... Measurement of blood pressure, heart rate, and respiratory rate helps determine the degree of hemodynamic and metabolic compromise The patient's airway must be evaluated to rule out the risk of obstruction ... associated with toxic shock syndrome (TSS) and drug fever The soft tissue and muscle examination is critical Areas of erythema or duskiness, edema, and tenderness may indicate underlying necrotizing...
... score of ≥25 and/ or multiorgan failure b Hydrocortisone (50-mg IV bolus q6h) with fludrocortisone (50-µg tablet daily for days) may improve outcomes of severe sepsis, particularly in the setting of ... 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 Health Evaluation ... to β-lactam agents Adjust treatment as soon as the diagnosis is confirmed d The optimal dose of IV immunoglobulin has not been determined, but the median dose in observational studies is g/kg...
... succumb to sepsis at 58 times the rate ofthe general population; 50–70% of cases occur within the first years after splenectomy, with a mortality rate of up to 80%, but the increased risk persists ... outside the United States, especially in developing countries in Africa and Asia The septic form is particularly rare and is associated with shock, multiorgan failure, and a 30% mortality rate These ... empirical therapeutic regimens are presented in Table 115-1 Sepsis Without an Obvious Focus of Primary Infection These patients initially have a brief prodrome of nonspecific symptoms and signs...
... on the wrists and ankles and then spread over the legs and trunk The lesions become hemorrhagic and are frequently petechial The rash spreads to palms and soles later in the course The centripetal ... transmitted by larval mites or chiggers and is one ofthe most common infections in southeastern Asia andthe western Pacific The organism is found in areas of heavy scrub vegetation (e.g., along ... status, and meningismus However, the rapidly progressive form of disease is not usually associated with meningitis The rash is initially pink, blanching, and maculopapular, appearing on the trunk and...
... sudden onset of malaise, chills, fever, and hypotension The patient develops bullous or hemorrhagic skin lesions, usually on the lower extremities, and 75% of patients have leg pain The mortality ... Colonization rather than overt infection ofthe vagina or a postoperative wound, for example, is typical with staphylococcal TSS, andthe mucosal areas appear hyperemic but not infected The diagnosis of ... Ebola and Marburg virus infections in Africa), and Flaviviridae (e.g., yellow fever in Africa and South America and dengue in Asia, Africa, andthe Americas) Lassa fever as well as Ebola and Marburg...
... decreases because of thrombosis ofthe small blood vessels and destruction ofthe peripheral nerves—an ominous sign The mortality rate is 25–30% overall, >70% in association with TSS, and nearly 100% ... febrile, apathetic, tachycardic, and tachypneic and may express a feeling of impending doom Hypotension and renal failure develop later, and hyperalertness is evident preterminally The skin over the ... present along with sepsis and hemodynamic instability Rapid recognition ofthe toxic patient with central neurologic signs is crucial to improvement ofthe dismal prognosis of these entities Subdural...
... fever, and almost 90% have back pain Paresthesia, bowel and bladder dysfunction, radicular pain, and weakness are frequent neurologic complaints, and examination ofthe patient may reveal abnormal ... sinusitis, and wound infection Rapid clinical deterioration and death can be associated with destruction ofthe primary site of infection, as is seen in endocarditis and in necrotizing infections ofthe ... examination ofthe patient may reveal abnormal reflexes and motor and sensory deficits The ESR and leukocyte counts are usually elevated Rapid recognition and treatment, which may include surgical drainage,...
... have occurred primarily in Southeast Asia, particularly Vietnam However, evidence of a rapidly expanding geographic distribution ofthe virus throughout the world is of grave concern Avian influenza ... may develop and may precede respiratory symptoms Dyspnea develops a median of days after the onset of symptoms and can progress to respiratory distress syndrome, multiorgan failure, and death within ... distinguish these patients from other infected febrile patients who will not progress to fulminant disease The alert physician must recognize the acute infectious disease emergency and then proceed...
... interviews and focus groups with the following professionals: a focus group of emergency physicians; a focus group of emergency nurses and respiratory therapists; the chief medical officer ofthe ED; and ... accuracy ofthe rule, and physician comfort and compliance Implementation ofthe rule has the potential to significantly reduce health care costs and improve the efficiency and safety of patient ... specific to the ED setting These include: the diversity of cases from minor to major andthe diversity of conditions seen; limited continuity of care; management of children across primary and secondary...
... interviews and focus groups with the following professionals: a focus group of emergency physicians; a focus group of emergency nurses and respiratory therapists; the chief medical officer ofthe ED; and ... accuracy ofthe rule, and physician comfort and compliance Implementation ofthe rule has the potential to significantly reduce health care costs and improve the efficiency and safety of patient ... specific to the ED setting These include: the diversity of cases from minor to major andthe diversity of conditions seen; limited continuity of care; management of children across primary and secondary...
... and quality of end -of- life care [28,29] The Study to Understand Prognosis and Preferences for Outcomes and Risks of Treatment in the USA [29] demonstrated that 31% ofthe cohort of patients admitted ... [22,23], and this is related at least in part to the complexity of diseases, the multiplicity of therapies, frequent invasive interventions and, within the intensive care unit (ICU), the intensity of ... andthe skills and abilities ofthe ward staff Both the Audit Commission [57] andthe Department of Health working party report ‘Comprehensive Critical Care’ [55] supported the development of...
... cholesterol levels within a few days ofthe burn, with the lowest values occurring between the days and 10 They noted that both LDL and HDL, which carry over 80% ofthe total cholesterol in humans, ... condition’ during the febrile phase of tuberculosis In 1920, Kipp noted a relationship between the degree of hypocholesterolemia andthe severity of infection We were unable to identify other articles ... triglyceride-rich very-low-density lipoproteins increased in the acute phase Ofthe various reasons offered for the hypocholesterolemia seen in critically ill and injured patients, especially those with sepsis,...
... on admission, the timing of onset of albumin administration, use of other colloids and blood products (red blood cells, fresh frozen plasma), andthe mean fluid balance, the degree of organ failure ... coagulation, and neurological) being collected on admission and every 24 hours thereafter For a single missing value, a replacement was calculated using the mean value ofthe results on either side ofthe ... Table shows the baseline characteristics ofthe propensity-matched patients on admission on the basis of age, gender, comorbidities, type of admission, SAPS II and SOFA scores, procedures, and sepsis...
... rT3, the authors ask whether we should consider treating cardiac patients who have the euthyroid sick syndrome with T3 (and not T4) to facilitate cardiac recovery There is now evidence that the ... function is an important indicator of outcome after an acute myocardial infarction [9] Although there will be resistance from the endocrinology community to trials of T3 therapy in acutely ill patients, ... illness: the ‘euthyroid sick syndrome’ Endocr Rev 1982, 3:164-217 Bianco AC, Salvatore D, Gereben B, Berry MJ, Larsen PR: Biochemistry, cellular and molecular biology, and physiological roles of the...
... and colleagues argues strongly for the study of other markers, including cystatin C and β2M, in the near future Competing interests The author declares that they have no competing interests References ... duration and site of injury So, is it time to leave serum creatinine behind as a marker of renal function in patients with AKI? Currently, the answer is no, but the work of Herrero-Morin and colleagues ... [12] and KIM-1 (kidney injury molecule-1) [13], is required in pediatric patients to develop a panel of markers for the accurate and reliable assessment of early AKI development, AKI duration and...
... Perceptions by family members ofthe dying experience of older and seriously ill patients SUPPORT Investigators Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments Ann Intern ... end -of- life issues to patients and their families [11] It is not uncommon for physicians to ask loaded questions in their quest for end -of- life decisions For example, ‘This is your grandmother’s ... technically futile Under the current rules, the only test of futility is that embodied by the question, ‘Will this treatment result in sustained life?’ If the answer is ‘yes’, then virtually any treatment...
... whom the mass was located in the portion of body or tail ofthe pancreas For tumors of SPT located in the neck and body ofthe pancreas, resection ofthe midportion ofthe pancreas andthe mass ... in the other reported series.7 Literatures showed the head and tail ofthe pancreas were the preferential sites ofthe occurrence of SPT.3,7,10,14,15,16 In our series, the presenting clinical and ... preserving the rim ofthe head and tail portion can be achieved However, for the patient in whom the mass was located within the head ofthe pancreas, given the low malignancy, well-defined margin and...