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5141. Workers' Compensation System (Treatment)

approximately 1917. Prior to workers' compensation legislation, the employee and the employer could be affected by a claim. The employee could potentially lose his or her job, income, and ability to receive medical treatment. The employee would often have to fund his or her own legal defense (which could potentially become quite expensive) and prove in a court of common law that the employer was negligent. The employer was also at a significant risk, because lawsuits were costly (even with a favorable (...) ) Associate Professor, Physical Medicine and Rehabilitation, The University of Western Ontario; Consulting Staff, Department of Physical Medicine and Rehabilitation, St Joseph's Health Care Centre Patrick J Potter, MD, FRCP(C) is a member of the following medical societies: , , , , , and Disclosure: Nothing to disclose. Richard Salcido, MD Chairman, Erdman Professor of Rehabilitation, Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine Richard Salcido, MD

2014 eMedicine.com

5142. Meningococcemia (Overview)

). In 2005, the mortality rate in the United States was 10-14%. Meningococcal meningitis without antibiotic therapy is uniformly fatal. Previous Next: Patient Education Health education improves public recognition of nonblanching rashes associated with meningococcal disease and was instrumental in reducing mortality in the United Kingdom. Parents readily recognize the tumbler test; if a rash does not fade when a glass tumbler is pressed against the skin, the rash is nonblanching, and medical advice (...) ) are the preferred antibiotics Alternative agents include (1) ampicillin 12 g/d either by continuous infusion or by divided dosing q4h or (2) moxifloxacin 6-8 g/d IV The course of therapy is 7-10 days Note: Meningococci are resistant to vancomycin and the aminoglycosides Chloramphenicol may be considered in patients who are allergic to beta-lactam antibiotics. It appears to be most useful when administrated as a single IM injection during epidemics in developed countries. See and for more detail. Next

2014 eMedicine.com

5143. Meningococcemia (Overview)

). In 2005, the mortality rate in the United States was 10-14%. Meningococcal meningitis without antibiotic therapy is uniformly fatal. Previous Next: Patient Education Health education improves public recognition of nonblanching rashes associated with meningococcal disease and was instrumental in reducing mortality in the United Kingdom. Parents readily recognize the tumbler test; if a rash does not fade when a glass tumbler is pressed against the skin, the rash is nonblanching, and medical advice (...) ) are the preferred antibiotics Alternative agents include (1) ampicillin 12 g/d either by continuous infusion or by divided dosing q4h or (2) moxifloxacin 6-8 g/d IV The course of therapy is 7-10 days Note: Meningococci are resistant to vancomycin and the aminoglycosides Chloramphenicol may be considered in patients who are allergic to beta-lactam antibiotics. It appears to be most useful when administrated as a single IM injection during epidemics in developed countries. See and for more detail. Next

2014 eMedicine.com

5144. Meningococcal Infections (Overview)

) or cefotaxime (2 g IV q4-6h) are the preferred antibiotics Alternative agents include (1) ampicillin 12 g/d either by continuous infusion or by divided dosing q4h or (2) moxifloxacin 6-8 g/d IV The course of therapy is 7-10 days Note: Meningococci are resistant to vancomycin and the aminoglycosides Chloramphenicol may be considered in patients who are allergic to beta-lactam antibiotics. It appears to be most useful when administrated as a single IM injection during epidemics in developed countries. See (...) mortality in children with invasive meningococcal disease. [ ] Risk factors Most patients with meningococcal disease were previously healthy; however, patients with certain medical conditions are at increased risk for developing meningococcal infection. Risk factors include the following: Close contact with a patient with primary invasive disease: Epidemics among new recruits (eg, in "Boot Camp") and college freshmen in dormitories are classic examples of meningococcal spread and (see Epidemiology

2014 eMedicine.com

5145. Meningitis (Overview)

and Medication.) The specific infectious agents that are involved in bacterial meningitis vary among different patient age groups, and the inflammation may evolve into the following conditions: Ventriculitis Empyema Cerebritis Abscess formation Meningitis can also be also classified more specifically according to its etiology. Numerous infectious and noninfectious causes of meningitis have been identified. Examples of common noninfectious causes include medications (eg, nonsteroidal anti-inflammatory drugs (...) Headache Neck stiffness Other symptoms can include nausea, vomiting, photalgia (photophobia), sleepiness, confusion, irritability, delirium, and coma. Patients with viral meningitis may have a history of preceding systemic symptoms (eg, myalgias, fatigue, or anorexia). The history should also address the following: Epidemiologic factors and predisposing risks Exposure to a patients or animals with a similar illness Previous medical treatment and existing conditions Geographic location and travel

2014 eMedicine.com

5146. Metabolic Acidosis (Overview)

Author: Christie P Thomas, MBBS, FRCP, FASN, FAHA; Chief Editor: Vecihi Batuman, MD, FASN Share Email Print Feedback Close Sections Sections Metabolic Acidosis Overview Practice Essentials Metabolic acidosis is a clinical disturbance characterized by an increase in plasma acidity. Metabolic acidosis should be considered a sign of an underlying disease process. Identification of this underlying condition is essential to initiate appropriate therapy. (See Etiology, , , and .) Understanding (...) - Buffers Buffers are weak acids or bases that are able to minimize changes in pH by taking up or releasing H + . Phosphate is an example of an effective buffer, as in the following reaction: HPO 4 2- + (H + )↔H 2 PO 4 - Upon addition of an H + to extracellular fluids, the monohydrogen phosphate binds H + to form dihydrogen phosphate, minimizing the change in pH. Similarly, when [H + ] is decreased, the reaction is shifted to the left. Thus, buffers work as a first-line of defense to blunt the changes

2014 eMedicine.com

5147. Milroy Disease (Overview)

. Pharmacotherapy The following medications are used in to manage lymphedema: Benzopyrones (eg, coumarin, flavonoids) Retinoidlike agents (eg, acitretin, topical tazarotene) Anthelmintic agents (eg, albendazole) Topical skin products (eg, ammonium lactate lotion, topical urea) Antibiotics (eg, cefazolin, clindamycin, penicillin G) Nonpharmacotherapy Conservative measures for managing lymphedema include the following: Maintenance of appropriate hygiene and skin care Use of complex physical therapy (first-line (...) treatment) [ ] and compression stockings Weight loss (if overweight) Avoiding trauma Avoiding constrictive clothing Elevating affected limb Surgical option Surgical treatment is palliative, not curative, and it does not obviate the need for continued medical therapy. Procedures are divided into physiologic (to improve lymphatic drainage) and excisional (removal of the affected tissues to reduce the lymphedema-related load) surgeries. Surgical intervention is reserved for patients who do not improve

2014 eMedicine.com

5148. Multifocal Choroidopathy Syndromes (Overview)

that do not correspond to clinical lesions have also been noted. [ ] Etiology The etiology of MCP remains unknown. Extensive systemic medical evaluations have not yet identified a single common cause for MCP. Unlike POHS, where 90% of patients exhibit positive reactions to the histoplasmin skin test, only 25% of patients with MCP exhibit positive reactions to this skin test. [ ] Positive treponemal serology is evident in up to 27% of patients with MCP, yet no modification of the disease (...) with penicillin treatments has been achieved to date. Radiologic investigations of patients with MCP have demonstrated hilar adenopathy in a small minority of patients (approximately 4%) along with pulmonary calcification (approximately 10%). In conjunction with this, approximately 20% of patients with MCP have a positive Mantoux test. Half of those patients, when treated with antituberculous medications, have a decrease in the ocular inflammation. Sarcoidosis has also been diagnosed in more than one third

2014 eMedicine.com

5149. Urinary Tract Infection, Females (Treatment)

-12h for 7-14d Duration of therapy: shorter courses (7d) are reasonable if patient improves rapidly; longer courses (10-14d) are reasonable if patient has a delayed response or is hospitalized. Parenteral therapy can be switched to oral therapy once clinical improvement is observed. Contributor Information and Disclosures Author John L Brusch, MD, FACP Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health (...) of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Salary Employment Mark Zwanger, MD, MBA Assistant Professor, Department of Emergency Medicine, Jefferson Medical College of Thomas Jefferson University Mark Zwanger, MD, MBA is a member of the following medical societies: , , and Disclosure: Nothing to disclose. What would you like to print? What would you like to print? Sections Urinary Tract Infection (UTI) and Cystitis (Bladder Infection

2014 eMedicine.com

5150. Urethral Diverticulum (Treatment)

Reconstructive Surgeons, , , , Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Chief Editor Kris Strohbehn, MD Professor of Obstetrics and Gynecology, Geisel School of Medicine at Dartmouth; Director, Division of Female Pelvic Medicine and Reconstructive Surgery (...) Urethral Diverticulum (Treatment) Urethral Diverticulum Treatment & Management: Medical Therapy, Surgical Therapy, Preoperative Details Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjY5NDkzLXRyZWF0bWVudA

2014 eMedicine.com

5151. Upper Respiratory Tract Infection (Treatment)

treatment. Symptom-based therapy represents the mainstay of URI treatment in immunocompetent adults, although antimicrobial or antiviral therapy is appropriate in selected patients (see Medication). Several URIs warranting special attention are described in this section. In November 2013, The American Academy of Pediatrics released a set of three basic principles for the effective use of antibiotics to treat pediatric URIs, including acute otitis media, acute bacterial sinusitis, and streptococcal (...) is administered according to pulse oximetry results. Dry air may worsen inflammation, so the use of humidified oxygen or a room humidifier is recommended. Medications Presumptive intravenous antibiotics are indicated, tailored to results from blood cultures. Empiric coverage for Haemophilus influenzae is appropriate. Antibiotic therapy should begin after blood cultures (and epiglottic cultures, if laryngoscopy is performed) are taken. Common choices include ceftriaxone or other third-generation cephalosporins

2014 eMedicine.com

5152. Vaccinia (Treatment)

. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Richard B Brown, MD, FACP Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine Richard B Brown, MD, FACP is a member of the following medical societies (...) *Incidence was slightly higher when vaccination occurred before age 1 year. Contributor Information and Disclosures Author Nikesh A Patel Medical University of South Carolina College of Medicine Nikesh A Patel is a member of the following medical societies: , Disclosure: Nothing to disclose. Coauthor(s) Dayna Diven, MD Professor, Department of Dermatology, University of Texas Southwestern Austin Programs Dayna Diven, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose

2014 eMedicine.com

5153. Tuberculosis of the Genitourinary System (Treatment)

of the prostate, although only medical therapy is usually needed. In patients with obstructive symptomatology, resecting the prostate is reasonable. In addition, in resistant TB, prostate resection can theoretically lessen the infected tissue burden. Surgical treatment should be undertaken only once anti-TB therapy has been initiated to reduce the risk of exposure to the surgical team. In persons infected with human immunodeficiency virus (HIV), prostatic TB can present as an abscess. Surgical drainage (...) -effective in developing countries. Before starting medications, investigate regional drug-resistance data. The chemoprophylaxis protocol for unconfirmed clinical disease is isoniazid (INH) for 6 months (9 mo in patients who are positive for human immunodeficiency virus [HIV]), INH and rifampin for 3 months, or rifampin and pyrazinamide for 2 months. Previous Next: Complications of GUTB Complications of genitourinary tuberculosis (GUTB) include the following: Superinfection Abscess Sinus formation Renal

2014 eMedicine.com

5154. Trichosporon Infections (Treatment)

, FACP, FCCP, FIDSA Program Director, Infectious Diseases Fellowship, Naval Medical Center San Diego; Associate Professor of Medicine, Uniformed Services University of the Health Sciences Ryan C Maves, MD, FACP, FCCP, FIDSA is a member of the following medical societies: , , , , , Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference (...) Disclosure: Received salary from Medscape for employment. for: Medscape. Thomas M Kerkering, MD Chief of Infectious Diseases, Virginia Tech Carilion School of Medicine Thomas M Kerkering, MD is a member of the following medical societies: , , , , , , , Disclosure: Nothing to disclose. Chief Editor Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Clinical Professor of Medicine, University of Central Florida College of Medicine Mark R Wallace, MD

2014 eMedicine.com

5155. Transfusion Reactions (Treatment)

Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Ronald A Sacher, MBBCh, FRCPC, DTM&H Professor of Internal Medicine and Pathology, Director, Hoxworth Blood Center, University of Cincinnati Academic Health Center Ronald A Sacher, MBBCh, FRCPC, DTM&H is a member of the following medical societies: , , , , , , , , Disclosure: Nothing to disclose. Chief Editor Emmanuel C (...) with the medical director of the hospital's blood bank or a designee (eg, a clinical pathology resident, transfusion medicine fellow). Depending on the findings, the blood bank consultant may arrange for microbiologic stains and cultures of the residual contents of the blood product container, clerical checks for patient and product identification in the laboratory, repeat compatibility testing using a freshly collected blood sample from the recipient, or other pertinent diagnostic studies. The diagnosis

2014 eMedicine.com

5156. Toxicity, Mustard Agent (Treatment)

for protection and therapy. J Am Acad Dermatol . 1995 May. 32(5 Pt 1):765-76. . US Army Medical Research Institute of Chemical Defense. Medical Management of Chemical Casualties Handbook . 3rd ed. Aug 1999. DeSantis-Rodrigues A, Chang YC, Hahn RA, Po IP, Zhou P, Lacey CJ, et al. ADAM17 Inhibitors Attenuate Corneal Epithelial Detachment Induced by Mustard Exposure. Invest Ophthalmol Vis Sci . 2016 Apr. 57 (4):1687-98. . . Media Gallery of 0 Tables Contributor Information and Disclosures Author Daniel J Dire (...) -in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Chief Editor Zygmunt F Dembek, PhD, MPH, MS, LHD Associate Professor, Department of Military and Emergency Medicine, Adjunct Assistant Professor, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine Zygmunt F Dembek, PhD, MPH, MS, LHD is a member of the following medical societies: , Disclosure: Nothing

2014 eMedicine.com

5157. Personality Disorders (Overview)

is a member of the following medical societies: , , Disclosure: Nothing to disclose. Chief Editor Iqbal Ahmed, MBBS, FRCPsych(UK) Faculty, Department of Psychiatry, Tripler Army Medical Center; Clinical Professor of Psychiatry, Uniformed Services University of the Health Sciences; Clinical Professor of Psychiatry, Clinical Professor of Geriatric Medicine, University of Hawaii, John A Burns School of Medicine Iqbal Ahmed, MBBS, FRCPsych(UK) is a member of the following medical societies: , , , Royal (...) College of Psychiatrists, , Disclosure: Nothing to disclose. Acknowledgements Jerry Balentine, DO Professor of Emergency Medicine, New York College of Osteopathic Medicine; Executive Vice President, Chief Medical Officer, Attending Physician in Department of Emergency Medicine, St Barnabas Hospital Jerry Balentine, DO is a member of the following medical societies: , , , , and Disclosure: Nothing to disclose. Michael S Beeson, MD, MBA, FACEP Professor of Emergency Medicine, Northeastern Ohio

2014 eMedicine.com

5158. Perimortem Cesarean Delivery (Overview)

difference to fetal outcome. Support beyond likely fetal survival is controversial. [ ] Dillon and colleagues make a strong distinction between true brain death and persistent vegetative state, arguing that termination of support measures is ethically defensible only in the former case. [ ] Yet another factor that may affect decision making is potential medicolegal considerations. Fear of litigation may prevent intervention in what would be, by all medical judgment, appropriate circumstances for a PMCD (...) should take care to avoid needle sticks, scalpel cuts, and other safety issues. Provider safety is at higher risk in emergency situations, where appropriate lighting, proper equipment, and provider experience may be lacking. Maternal resuscitation efforts—including definitive management of the airway, cardiopulmonary resuscitation (CPR), fluids, and advanced cardiac life support (ACLS) protocol–driven pharmaceutical therapy—should not be interrupted to allow more room for the surgical intervention

2014 eMedicine.com

5159. Pericarditis, Uremic (Overview)

infectious etiologies and testing for tuberculosis exposure (ie, PPD or interferon-gamma release assays) may be helpful. See for more detail. Management Treatment for specific causes of pericarditis is directed according to the underlying cause. For patients with idiopathic or viral pericarditis, therapy is directed at symptom relief. Pharmacologic treatment Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) are the mainstays of therapy. NSAID agents have a similar efficacy, with relief of chest (...) medical management. Patients with effusions larger than 250 mL, effusions in which size increases despite intensive dialysis for 10-14 days, or effusions with evidence of tamponade are candidates for pericardiocentesis. Pericardial window placement is used for effusive pericarditis therapy. In critically ill patients, a balloon catheter may be used to create a pericardial window, in which only 9 cm 2 or less of pericardium is resected. Consider subxiphoid pericardiotomy for large effusions that do

2014 eMedicine.com

5160. Pericarditis, Acute (Overview)

and testing for tuberculosis exposure (ie, PPD or interferon-gamma release assays) may be helpful. See for more detail. Management Treatment for specific causes of pericarditis is directed according to the underlying cause. For patients with idiopathic or viral pericarditis, therapy is directed at symptom relief. Pharmacologic treatment Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) are the mainstays of therapy. NSAID agents have a similar efficacy, with relief of chest pain in about 85-90 (...) primary brain, comprise the rest of the cases. Kaposi sarcoma has also become a more prominent cause of neoplastic disease with the AIDS epidemic. Drugs Some medications, including penicillin and cromolyn sodium, induce pericarditis through a hypersensitivity reaction. The anthracycline antineoplastic agents, such as doxorubicin and cyclophosphamide, have direct cardiac toxicity and can cause acute pericarditis and myocarditis. Pericarditis can also develop from a drug-induced lupus syndrome caused

2014 eMedicine.com

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