ITEMS IN AFP WITH MESH TERM:
Painful Plaques Shortly After Hospital Discharge - Photo Quiz
ABSTRACT: The care of a patient in the intensive care unit extends well beyond his or her hospitalization. Evaluation of a patient after leaving the intensive care unit involves a review of the hospital stay, including principal diagnosis, exposure to medications, period spent in the intensive care unit, and history of prolonged mechanical ventilation. Fatigue should prompt evaluation for possible anemia, nutritional deficits, sleep disturbance, muscular deconditioning, and neurologic impairment. Other common problems include poor appetite with possible weight loss, falls, and sexual dysfunction. Psychological morbidities, posttraumatic stress disorder, anxiety disorder, and depression also often occur in the post-intensive care unit patient. These conditions are more common among patients with a history of delirium, prolonged sedation, mechanical ventilation, and acute respiratory distress syndrome. The physician should gain an understanding of the patient's altered quality of life, including employment status, and the state of his or her relationships with loved ones or the primary caregiver. As in many aspects of medicine, a multidisciplinary treatment approach is most beneficial to the post-intensive care unit patient.
Improving Outpatient Referrals to Secondary Care - Cochrane for Clinicians
Outpatient Burns: Prevention and Care - Article
ABSTRACT: Most burn injuries can be managed on an outpatient basis by primary care physicians. Prevention efforts can significantly lower the incidence of burns, especially in children. Burns should be managed in the same manner as any other trauma, including a primary and secondary survey. Superficial burns can be treated with topical application of lotions, honey, aloe vera, or antibiotic ointment. Partial-thickness burns should be treated with a topical antimicrobial agent or an absorptive occlusive dressing to help reduce pain, promote healing, and prevent wound desiccation. Topical silver sulfadiazine is the standard treatment; however, newer occlusive dressings can provide faster healing and are often more cost-effective. Physicians must reevaluate patients frequently after a burn injury and be aware of the indications for referral to a burn specialist.
ABSTRACT: The American College of Chest Physicians provides recommendations for the use of anticoagulant medications for several indications that are important in the primary care setting. Warfarin, a vitamin K antagonist, is recommended for the treatment of venous thromboembolism and for the prevention of stroke in persons with atrial fibrillation, atrial flutter, or valvular heart disease. When warfarin therapy is initiated for venous thromboembolism, it should be given the first day, along with a heparin product or fondaparinux. The heparin product or fondaparinux should be continued for at least five days and until the patient’s international normalized ratio is at least 2.0 for two consecutive days. The international normalized ratio goal and duration of treatment with warfarin vary depending on indication and risk. Warfarin therapy should be stopped five days before major surgery and restarted 12 to 24 hours postoperatively. Bridging with low-molecular-weight heparin or other agents is based on balancing the risk of thromboembolism with the risk of bleeding. Increasingly, self-testing is an option for selected patients on warfarin therapy. The ninth edition of the American College of Chest Physicians guidelines, published in 2012, includes a discussion of anticoagulants that have gained approval from the U.S. Food and Drug Administration since publication of the eighth edition in 2008. Dabigatran and apixaban are indicated for the prevention of systemic embolism and stroke in persons with nonvalvular atrial fibrillation. Rivaroxaban is indicated for the prevention of deep venous thrombosis in patients undergoing knee or hip replacement surgery, for treatment of deep venous thrombosis and pulmonary embolism, for reducing the risk of recurrent deep venous thrombosis and pulmonary embolism after initial treatment, and for prevention of systemic embolism in patients with nonvalvular atrial fibrillation.