By David Hui (auth.)
This ebook offers an built-in symptom-based and issue-based method with quick access to excessive yield scientific details. for every subject, conscientiously equipped sections on varied diagnoses, investigations and coverings are designed to facilitate sufferer care and exam practise. - a number of medical pearls and comparability tables support increase studying. - overseas devices (US and metric) facilitate software in daily medical perform. - Many hugely very important, hardly mentioned issues in medication are lined (e.g., smoking cessation, weight problems, transfusion reactions, needle stick accidents, code prestige dialogue, interpretation of gram stain, palliative care). - crucial reference for each clinical pupil, resident, fellow, practising surgeon, nurse, and healthcare professional assistant. - 3rd version has new layout with reader pleasant improvements.
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Additional info for Approach to Internal Medicine: A Resource Book for Clinical Practice
Compared to MIBI, echocardiogram is more specific and less sensitive. Contraindicated in severe hypertension and arrhythmias APPROACH TO DIAGNOSIS OF STABLE CAD—start with history, physical, rest ECG, and CXR. If low probability, do not investigate further. If high probability, proceed with management. If intermediate probability ! stress test ! cardiac CT, MIBI or stress echo ! g. troponin) at least twice separated by 6–8 h and serial ECG. Despite all appropriate investigations, MI missed rate is 2–5% ECG CHANGES IN ACUTE MI—see APPROACH TO ECG p.
Despite all appropriate investigations, MI missed rate is 2–5% ECG CHANGES IN ACUTE MI—see APPROACH TO ECG p. 5 mm RISK GROUPS—low = 0–2, intermediate = 3–4, high = 5–7. 8% 10% 12% ACTION registry 2008/2009 data ACUTE MANAGEMENT ABC—O2 to keep sat >95%, IVs, inotropes, consider balloon pump if hemodynamic instability PAIN CONTROL—nitroglycerin (nitro drip 25 mg in 250 mL D5W, start at 5 mg/min IV, then " by 5–10 mg/ min every 3–5 min to 20 mg/min, then " by 10 mg/ min every 3–5 min up to 200 mg/min, or until relief of pain, stop titration if SBP is <100 mmHg.
ANALYZE LUNG VOLUMES—identify restrictive defect, severity 5. ANALYZE DLCO AND DLCO ADJUSTED FOR ALVEOLAR VOLUME (VA)—a measure of gas exchange; if abnormal, suggests disease even if spirometry and lung volumes are normal CLASSIFICATION OF PULMONARY DISEASES OBSTRUCTIVE—asthma, COPD, bronchiectasis, cystic fibrosis, bronchiolitis obliterans RESTRICTIVE PARENCHYMAL—sarcoidosis, idiopathic pulmonary fibrosis, pneumoconiosis, other interstitial lung diseases EXTRAPARENCHYMAL—neuromuscular (diaphragmatic paralysis, myasthenia gravis, Guillain– Barre´ syndrome, muscular dystrophies), chest wall (kyphoscoliosis, obesity, ankylosing spondylitis) TERMINOLOGIES DLCO—carbon monoxide diffusion capacity FEF25–75%—forced expiratory flow during the middle of a FVC maneuver, represents flow of small airways 22 Approach to Pulmonary Function Tests FLOW–VOLUME LOOP PATTERNS (CONT’D) FLOW–VOLUME LOOP PATTERNS Inspiration Flow Expiration NORMAL Inspiration Volume SPIROMETRY AND LUNG VOLUME PATTERNS Flow Volume OBSTRUCTIVE DISEASE—scooped appearance of expiratory curve seen in COPD.
Approach to Internal Medicine: A Resource Book for Clinical Practice by David Hui (auth.)