ITEMS IN AFP WITH MESH TERM:
Perioperative Management of Diabetes - Article
ABSTRACT: Maintaining glycemic and metabolic control is difficult in diabetic patients who are undergoing surgery. The preoperative evaluation of all patients with diabetes should include careful screening for asymptomatic cardiac or renal disease. Frequent self-monitoring of glucose levels is important in the week before surgery so that insulin regimens can be adjusted as needed. Oral agents and long-acting insulin are usually discontinued before surgery, although the newer long-acting insulin analog glargine may be appropriately administered for basal insulin coverage throughout the surgical period. The usual regimen of sliding scale subcutaneous insulin for perioperative glycemic control may be a less preferable method because it can have unreliable absorption and lead to erratic blood glucose levels. Intravenous insulin infusion offers advantages because of the more predictable absorption rates and ability to rapidly titrate insulin delivery up or down to maintain proper glycemic control. Insulin is typically infused at 1 to 2 U per hour and adjusted according to the results of frequent blood glucose checks. A separate infusion of dextrose prevents hypoglycemia. Potassium is usually added to the dextrose infusion at 10 to 20 mEq per L in patients with normal renal function and normal preoperative serum potassium levels. Frequent monitoring of electrolytes and acid-base status is important during the perioperative period, especially in patients with type 1 diabetes because ketoacidosis can develop at modest levels of hyperglycemia.
ABSTRACT: Injuries to the head and neck are common in sports. Sideline physicians must be attentive and prepared with an organized approach to detect and manage these injuries. Because head and neck injuries often occur simultaneously, the sideline physician can combine the head and neck evaluations. When assessing a conscious athlete, the physician initially evaluates the neck for spinal cord injury and determines whether the athlete can be moved safely to the sideline for further evaluation. This decision is made using an on-field assessment of the athlete's peripheral sensation and strength, as well as neck tenderness and range of motion. If these evaluations are normal, axial loading and Spurling testing can be performed. Once the neck has been determined to be normal, the athlete can be assisted to the sideline for assessment of concussion symptoms and severity. This assessment should include evaluations of the athlete's reported symptoms, recently acquired memory, and postural stability. Injured athletes should be monitored with serial examinations, and those with severe, prolonged, or progressive findings require transport to an emergency department for further evaluation.
ABSTRACT: Most primary care physicians report at least one emergency presenting to their office per year. Asthma, anaphylaxis, shock, seizures, and cardiac arrest are among the most common adult and childhood emergencies in the office setting. Most offices are not fully prepared for these medical emergencies. Practices can initiate a preparedness program by purchasing emergency equipment and medications that reflect the spectrum of anticipated emergencies in their patient populations, the practitioners' skills, and the distance to the nearest emergency department. Physicians and staff should make every effort to maintain current certification in basic or advanced lifesaving courses. Offices may also wish to create a written emergency protocol that outlines the steps to be followed in the event of a medical office emergency. By preparing for medical emergencies with the correct equipment, education, and protocols, offices can greatly decrease the risk of an unfavorable outcome.
Creating a Successful After-Hours Clinic - Feature
Combative Delirium - Curbside Consultation
Responding to an In-flight Emergency - Curbside Consultation
Sexual Assault of Women - Article
ABSTRACT: Sexual violence affects up to one third of women during their lifetime. Sexual assault is underreported, and more than one half of assaults are committed by someone known to the survivor. Although both men and women can be sexually assaulted, women are at greatest risk. Some groups are more vulnerable, including adolescents; survivors of childhood sexual or physical abuse; persons who are disabled; persons with substance abuse problems; sex workers; persons who are poor or homeless; and persons living in prisons, institutions, or areas of military conflict. Family physicians care for sexual assault survivors immediately and years after the assault. Immediate care includes the treatment of injuries, prophylaxis for sexually transmitted infections, administration of emergency contraception to prevent pregnancy, and the sensitive management of psychological issues. Family physicians should collect evidence for a “rape kit” only if they are experienced in treating persons who have been sexually assaulted because of the legal ramifications of improper collection and storage of evidence. Sexual assault may result in long-term mental and physical health problems. Presentations to the family physician may include self-destructive behaviors, chronic pelvic pain, and difficulty with pelvic examinations. Prevention of sexual assault is societal and should focus on public health education. Safety and support programs have been shown to reduce sexual assaults.
Pediatric Emergencies: Preparedness and Prevention - Editorials