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E/M Medical Decision Making

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8741. Upper Gastrointestinal Bleeding: Surgical Perspective (Treatment)

=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTg3ODU3LXRyZWF0bWVudA== processing > Upper Gastrointestinal Bleeding Treatment & Management Updated: Mar 21, 2016 Author: Maurice A Cerulli, MD, FACP, FACG, FASGE, AGAF; Chief Editor: BS Anand, MD Share Email Print Feedback Close Sections Sections Upper Gastrointestinal Bleeding Treatment Approach Considerations The goal of medical therapy in upper gastrointestinal bleeding (UGIB) is to correct shock and coagulation abnormalities and to stabilize the patient so that further evaluation and treatment can proceed (...) guideline for the total amount of crystalloid fluid volume needed to correct the hypovolemia is the 3-for-1 rule. Replace each milliliter of blood loss with 3 mL of crystalloid fluid. This restores the lost plasma volume. Patients with severe coexisting medical illnesses, such as cardiovascular and pulmonary diseases, may require pulmonary artery catheter insertion to closely monitor hemodynamic cardiac performance profiles during the early resuscitative phase. Once the ABCs have been addressed, assess

2014 eMedicine Surgery

8742. Ulnar-Sided Wrist Pain (Treatment)

== processing > Ulnar-Sided Wrist Pain Updated: Aug 27, 2018 Author: David M Lichtman, MD; Chief Editor: Harris Gellman, MD Share Email Print Feedback Close Sections Sections Ulnar-Sided Wrist Pain Background Wrist often proves to be a challenging presenting complaint. Determining the cause of ulnar-sided wrist pain is difficult, largely because of the complexity of the anatomic and biomechanical properties of the ulnar wrist. [ , ] The objectives of this article are to provide an overview of the most (...) to confirm the diagnosis. [ , ] Contrast material may be injected into one of the three noncommunicating spaces of the carpus: the distal radioulnar joint (DRUJ), the radiocarpal joint, and the midcarpal joint. The decision to obtain a single-injection arthrogram versus a triple-injection arthrogram must be based on specific clinical findings. At least one third of cadaver dissections have abnormal communications of the wrist joint. Mikic reported that the incidence of degenerative perforations

2014 eMedicine Surgery

8743. Tibial Shaft Fractures (Treatment)

, Department of Orthopedic Surgery, University of Minnesota College of Medicine Brian K Konowalchuk, MD 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. Chief Editor Thomas M DeBerardino, MD Orthopedic Surgeon, The San (...) Antonio Orthopaedic Group; Professor of Orthopedic Surgery, Baylor College of Medicine as Co-Director, Combined Baylor College of Medicine-The San Antonio Orthopaedic Group, Texas Sports Medicine Fellowship; Medical Director, Burkhart Research Institute for Orthopaedics (BRIO) of the San Antonio Orthopaedic Group; Consulting Surgeon, Sports Medicine, Arthroscopy and Reconstruction of the Knee, Hip and Shoulder Thomas M DeBerardino, MD is a member of the following medical societies: , , , , Herodicus

2014 eMedicine Surgery

8744. Tibia Fractures, Open (Treatment)

for employment. for: Medscape. Chief Editor Thomas M DeBerardino, MD Orthopedic Surgeon, The San Antonio Orthopaedic Group; Professor of Orthopedic Surgery, Baylor College of Medicine as Co-Director, Combined Baylor College of Medicine-The San Antonio Orthopaedic Group, Texas Sports Medicine Fellowship; Medical Director, Burkhart Research Institute for Orthopaedics (BRIO) of the San Antonio Orthopaedic Group; Consulting Surgeon, Sports Medicine, Arthroscopy and Reconstruction of the Knee, Hip and Shoulder (...) Thomas M DeBerardino, MD is a member of the following medical societies: , , , , Herodicus Society, Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Arthrex, Inc.; MTF; Aesculap; The Foundry, Cotera; ABMT; Conmed;
Received research grant from: Histogenics; Cotera; Arthrex. Additional Contributors Dennis P Grogan, MD Clinical Professor (Retired), Department of Orthopedic Surgery, University of South Florida College of Medicine; Orthopedic Surgeon

2014 eMedicine Surgery

8745. Transfusion and Autotransfusion (Treatment)

Medical News. Available at . Accessed: January 27, 2015. Fergusson DA, Hébert PC, Mazer CD, Fremes S, MacAdams C, Murkin JM, et al. A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med . 2008 May 29. 358(22):2319-31. . Allison G, Feeney C. Successful use of a polymerized hemoglobin blood substitute in a critically anemic Jehovah's Witness. South Med J . 2004 Dec. 97:1257-1258. . Amato A, Pescatori M. Perioperative blood transfusions for the recurrence of colorectal (...) allogeneic blood transfusion. Cochrane Database of Systematic Reviews . 2006 Oct 18. 4:CD001888: . Codner P, Cinat M. Massive transfusion for trauma is appropriate. TraumaCare . 2005. 15(3):148-152. Corwin HL, Gettinger A, Pearl RG, Fink MP, Levy MM, Abraham E, et al. The CRIT Study: Anemia and blood transfusion in the critically ill--Current clinical practice in the United States. Crit Care Med . 2004. 32(1):39-52. . Curtis BR, McFarland JG. Mechanisms of transfusion-related acute lung injury (TRALI

2014 eMedicine Surgery

8746. Rheumatoid Spondylitis (Treatment)

. Spine . 1989 Oct. 14(10):1057-64. . Kawaida H, Sakou T, Morizono Y, Yoshkuni N. Magnetic resonance imaging of upper cervical disorders in rheumatoid arthritis. Spine . 1989 Nov. 14(11):1144-8. . Boden SD. Rheumatoid arthritis of the cervical spine. Surgical decision making based on predictors of paralysis and recovery. Spine (Phila Pa 1976) . 1994 Oct 15. 19(20):2275-80. . Kauppi M, Anttila P. A stiff collar can restrict atlantoaxial instability in rheumatoid cervical spine in selected cases. Ann (...) . . Heyde CE, Fakler JK, Hasenboehler E, et al. Pitfalls and complications in the treatment of cervical spine fractures in patients with ankylosing spondylitis. Patient Saf Surg . 2008 Jun 6. 2:15. . Pahys JM, Pahys JR, Cho SK, et al. Methods to decrease postoperative infections following posterior cervical spine surgery. J Bone Joint Surg Am . 2013 Mar 20. 95(6):549-54. . Wattenmaker I, Concepcion M, Hibberd P, Lipson S. Upper-airway obstruction and perioperative management of the airway in patients

2014 eMedicine Surgery

8747. Neuromodulation Surgery for Psychiatric Disorders (Overview)

or making them go away. Performing these so-called "rituals," however, provides only temporary relief, and not performing them markedly increases anxiety. No definitive agreement exists on what constitutes medically refractory or treatment resistant OCD. The definition most commonly used is an unsatisfactory response to 2 adequate trials of serotonin reuptake inhibitors, [ ] although most would suggest a trial of cognitive behavioral therapy (CBT) prior to defining someone as treatment resistant (...) to accepted criteria for treatment-refractory MDD/OCD, limitation of such efforts to tertiary-care academic centers, limitation of patient selection to those patients with decision-making capacity, and the avoidance of procedures whose purpose involves law enforcement, political, or social ends. [ ] Previous Next: Relevant Anatomy In 1937, James Papez introduced a circuitry that included the hippocampus, the fornix, the mammillary bodies, the mammillothalamic tract, the anterior thalamic, the subgenual

2014 eMedicine.com

8748. Nerve Entrapment Syndromes of the Lower Extremity (Overview)

I, Inal E, Cesur O, Cakmak M. Electrophysiologic evaluation of genitofemoral nerve in children with inguinal hernia repair. J Pediatr Surg . 2008 Oct. 43(10):1865-8. . Weiss JM, Tolo V. Femoral nerve palsy following iliacus hematoma. Orthopedics . 2008 Feb. 31(2):178. . Kurt S, Kaplan Y, Karaer H, Erkorkmaz U. Femoral nerve involvement in diabetics. Eur J Neurol . 2009 Mar. 16(3):375-9. . Flu HC, Breslau PJ, Hamming JF, Lardenoye JW. A prospective study of incidence of saphenous nerve injury (...) the legs. JAMA . 1947. 134:206. Piton C, Fabre T, Lasseur E, André D, Geneste M, Durandeau A. [Common fibular nerve lesions. Etiology and treatment. Apropos of 146 cases with surgical treatment]. Rev Chir Orthop Reparatrice Appar Mot . 1997. 83(6):515-21. . Tseng KF, Hsu HC, Wang FC, Fong YC. Nerve sheath ganglion of the tibial nerve presenting as a Baker's cyst: a case report. Knee Surg Sports Traumatol Arthrosc . 2006 Sep. 14(9):880-4. . Sabapathy SR, Langer V, Bhatnagar A. Intraneural lipoma

2014 eMedicine Surgery

8749. Lumbar Disc Disease (Overview)

vs surgical treatment of lumbar disk herniation: implications for future trials. Cleve Clin J Med . 2007 Aug. 74(8):577-83. . Thiru M. Annaswamy, MD and Charles Taylor, II MD, PhD. Lumbar Disc disorders. American Academy of Physical Medicine and Rehabilitation. Available at . 08/18/2017; Accessed: September 25, 2018. Jo Jordan, Tamara Shawver Morgan, James Weinstein, Kika Konstantinou. Herniated Lumbar Disk. American Academy of Family Physicians. Available at . Accessed: September 25, 2018 (...) Degenerative lumbar disc disease. The various forces placed upon the discs of the lumbar spine that can result in degenerative changes. Degenerated lumbar disc disease. Magnetic resonance image of a herniated nucleus pulposus of the lumbar spine. of 3 Tables Contributor Information and Disclosures Author Kamran Sahrakar, MD, FACS Clinical Professor, Department of Neurosurgery, University of California, San Francisco, School of Medicine Kamran Sahrakar, MD, FACS is a member of the following medical

2014 eMedicine Surgery

8750. Liver Transplantation (Overview)

transplantation. Transplantation . 2005 Jan 27. 79(2):213-8. . Aberg F, Höckerstedt K, Roine RP, Sintonen H, Isoniemi H. Influence of liver-disease etiology on long-term quality of life and employment after liver transplantation. Clin Transplant . 2012 Mar 8. . Volk ML, Biggins SW, Huang MA, Argo CK, Fontana RJ, Anspach RR. Decision making in liver transplant selection committees: a multicenter study. Ann Intern Med . 2011 Oct 18. 155(8):503-8. . . Park MS, Kim S, Patel J, Hajdu CH, Do RK, Mannelli L, et al (...) . 68(5):427-34. . Slifkin M, Doron S, Snydman DR. Viral prophylaxis in organ transplant patients. Drugs . 2004. 64(24):2763-92. . Aberg F, Mäkisalo H, Höckerstedt K, Isoniemi H. Infectious complications more than 1 year after liver transplantation: a 3-decade nationwide experience. Am J Transplant . 2011 Feb. 11(2):287-95. . Rath PM, Saner F, Paul A, Lehmann N, Steinmann E, Buer J, et al. Multiplex PCR for rapid and improved diagnosis of bloodstream infections in liver transplant recipients. J Clin

2014 eMedicine Surgery

8751. Kyphosis (Overview)

of distal junctional kyphosis in Scheuermann kyphosis. A comparison of 3 methods. Acta Orthop Traumatol Turc . 2017 Dec 28. . . Bridwell KH. Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine (Phila Pa 1976) . 2006 Sep 1. 31 (19 Suppl):S171-8. . Jain A, Sponseller PD, Newton PO, Shah SA, Cahill PJ, Njoku DB, et al. Smaller body size increases the percentage of blood volume lost during posterior spinal arthrodesis. J Bone (...) outcomes, complications, and technique. Spine (Phila Pa 1976) . 2007 Nov 15. 32 (24):2644-52. . Media Gallery Preoperative lateral radiograph of patient with 85° thoracic deformity secondary to Scheuermann kyphosis. of 1 Tables Contributor Information and Disclosures Author R Carter Cassidy, MD Associate Professor of Orthopedic Surgery, University of Kentucky College of Medicine R Carter Cassidy, MD is a member of the following medical societies: , , , Disclosure: Received income in an amount equal

2014 eMedicine Surgery

8752. Peritonitis and Abdominal Sepsis (Overview)

Professor of Surgery, Anesthesia and Emergency Medicine, Senior Medical Advisor, Board of Directors, Program Chief of Trauma, Emergency and Critical Care, Consulting Staff, Professor Juan Bosch Trauma Hospital, Dominican Republic Ruben Peralta, MD, FACS is a member of the following medical societies: , , , , , , , , Disclosure: Nothing to disclose. Coauthor(s) Lena M Napolitano, MD, FACS, FCCM, FCCP Professor of Surgery, University of Michigan School of Medicine; Chief, Surgical Critical Care, Program (...) all frankly devitalized bowel. The second-look operation serves to reevaluate for further demarcation and decision-making regarding reanastomosis or diversion. Closure of abdomen to prevent herniation of the abdominal contents and contamination of the abdominal cavity from the outside can be achieved by using gauze and large, impermeable, self-adhesive membrane dressings; mesh (eg, Vicryl, Dexon); nonabsorbable mesh (eg, GORE-TEX, polypropylene), with or without zipper or Velcrolike closure

2014 eMedicine Surgery

8753. Penetrating Neck Trauma (Overview)

. Two days with a broken knife blade in the neck--an interesting case of Horner's syndrome. Emerg Med J . 2011 Jul. 28(7):629-31. . Brennan J, Lopez M, Gibbons MD, Hayes D, Faulkner J, Dorlac WC, et al. Penetrating neck trauma in Operation Iraqi Freedom. Otolaryngol Head Neck Surg . 2011 Feb. 144(2):180-5. . Woo K, Magner DP, Wilson MT, Margulies DR. CT angiography in penetrating neck trauma reduces the need for operative neck exploration. Am Surg . 2005 Sep. 71(9):754-8. . Ferguson E, Dennis JW, Vu (...) Freedom. Ear Nose Throat J . 2009 Sep. 88(9):E19-21. . Ramasamy A, Midwinter M, Mahoney P, Clasper J. Learning the lessons from conflict: Pre-hospital cervical spine stabilisation following ballistic neck trauma. Injury . 2009 Jul 16. epub ahead of print. . Ahmed A. Selective observational management of penetrating neck injury in northern Nigeria. S Afr J Surg . 2009 Aug. 47(3):80, 82-5. . Demetriades D, Theodorou D, Cornwell E 3rd, et al. Penetrating injuries of the neck in patients in stable

2014 eMedicine Surgery

8754. Hemangioblastoma (Overview)

to the patient unless the risk of operation outweighs its potential benefits. Acute anticoagulation, the presence of active systemic infection, and severe medical problems that would make too risky generally are considered contraindications for an elective neurosurgical operation. However, the decision should be made on an individual basis. Next: Epidemiology Incidence and location Hemangioblastomas are rare, and according to various series, they account for 1-2.5% of all intracranial neoplasms. [ , ] Most (...) Medical Research Center, Polish Academy of Sciences, Poland; Clinical Staff Scientist, Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH); Fishbein Fellow, JAMA Ryszard M Pluta, MD, PhD is a member of the following medical societies: , Disclosure: Nothing to disclose. Chief Editor Brian H Kopell, MD Associate Professor, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Brian H Kopell, MD is a member of the following

2014 eMedicine Surgery

8755. Transfusion and Autotransfusion (Overview)

Medical News. Available at . Accessed: January 27, 2015. Fergusson DA, Hébert PC, Mazer CD, Fremes S, MacAdams C, Murkin JM, et al. A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med . 2008 May 29. 358(22):2319-31. . Allison G, Feeney C. Successful use of a polymerized hemoglobin blood substitute in a critically anemic Jehovah's Witness. South Med J . 2004 Dec. 97:1257-1258. . Amato A, Pescatori M. Perioperative blood transfusions for the recurrence of colorectal (...) allogeneic blood transfusion. Cochrane Database of Systematic Reviews . 2006 Oct 18. 4:CD001888: . Codner P, Cinat M. Massive transfusion for trauma is appropriate. TraumaCare . 2005. 15(3):148-152. Corwin HL, Gettinger A, Pearl RG, Fink MP, Levy MM, Abraham E, et al. The CRIT Study: Anemia and blood transfusion in the critically ill--Current clinical practice in the United States. Crit Care Med . 2004. 32(1):39-52. . Curtis BR, McFarland JG. Mechanisms of transfusion-related acute lung injury (TRALI

2014 eMedicine Surgery

8756. Rehabilitation of Persons With Spinal Cord Injuries (Follow-up)

the rehabilitation interventions most strongly associated with positive outcomes. The aim of the SCIRehab project was to provide detailed information on treatments delivered by rehabilitation disciplines and to contribute to outcomes-based guidelines for clinical decision-making. The SCIRehab project included 1376 patients with acute SCIs, with outcome data being abstracted from medical records (clinical outcomes data) at six SCI rehabilitation facilities and obtained from patient interviews at 6 and 12 months (...) Rehabilitation of Persons With Spinal Cord Injuries (Follow-up) Rehabilitation of Persons With Spinal Cord Injuries: Background, Common Medical Problems, Thromboembolic Disease 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

2014 eMedicine Surgery

8757. Proximal Femoral Focal Deficiency (Follow-up)

durch das in der Beinlangsachse um 180 degree gedrehte fussgelenk. Arch Orthop . 1930. 28:175-178. Van Nes CP. Rotation-plasty for congenital defects of the femur. Making use of the shortened limb to control the knee joint of a prosthesis. J Bone Joint Surg . 1950. 32B:12-16. Fowler E, Zernicke R, Setoguchi Y, Oppenheim W. Energy expenditure during walking by children who have proximal femoral focal deficiency. J Bone Joint Surg Am . 1996 Dec. 78(12):1857-62. . Ackman J, Altiok H, Flanagan A, Peer M (...) 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. B Sonny Bal, MD, JD, MBA Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine B Sonny Bal, MD, JD, MBA is a member of the following medical societies: Disclosure: Serve(d

2014 eMedicine Surgery

8758. Proximal Humerus Fractures (Follow-up)

be classified with the Neer or AO/ASIF (Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation) classification systems. Each of these methods has certain advantages, but they also share some common problems. Because both classification systems have limited reliability, reproducibility among observers, and consistency in findings by the same observer at different times, the initial radiographs cannot be relied upon entirely to make a treatment decision. Even if computed (...) . 17(3):399-409. . Hanson B, Neidenbach P, de Boer P, Stengel D. Functional outcomes after nonoperative management of fractures of the proximal humerus. J Shoulder Elbow Surg . 2009 Jul-Aug. 18(4):612-21. . Torrens C, Corrales M, Vilà G, Santana F, Cáceres E. Functional and Quality-of-Life Results of Displaced and Nondisplaced Proximal Humeral Fractures Treated Conservatively. J Orthop Trauma . 2011 Oct. 25(10):581-7. . Iyengar JJ, Devcic Z, Sproul RC, Feeley BT. Nonoperative treatment of proximal

2014 eMedicine Surgery

8759. Posterior Cruciate Ligament Pathology (Follow-up)

Mar. 65(3):310-22. . Noyes FR, Barber-Westin SD. Decision making and surgical treatment of posterior cruciate ligament ruptures. Scott WN, ed. Insall and Scott Surgery of the Knee . 6th ed. Philadelphia: Elsevier; 2018. 719-90. Musahl V, Ayeni OR, Citak M, Irrgang JJ, Pearle AD, Wickiewicz TL. The influence of bony morphology on the magnitude of the pivot shift. Knee Surg Sports Traumatol Arthrosc . 2010 Sep. 18 (9):1232-8. . Hewett TE, Noyes FR, Lee MD. Diagnosis of complete and partial posterior (...) Surgery, Miami Valley Hospital and Dayton Veterans Affairs Medical Center Matthew Lawless, MD is a member of the following medical societies: Disclosure: Nothing to disclose. Coauthor(s) Damian M Andrisani, MD Staff Physician, Department of Orthopedic Surgery, Wright State University School of Medicine 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

2014 eMedicine Surgery

8760. Pneumothorax (Follow-up)

signs, and perform pulse oximetry. A tension pneumothorax is almost always associated with hypotension. Administer oxygen to the patient, ventilate the patient, and establish an intravenous (IV) line. Tension pneumothorax Failure of the emergency medical service personnel (EMS) and medical control physician to make a correct diagnosis of tension pneumothorax and to promptly perform needle decompression in the prehospital setting can result in rapid clinical deterioration and cardiac arrest. Most (...) , Heffner JE. Spontaneous pneumothorax. N Engl J Med . 2000 Mar 23. 342(12):868-74. . Noppen M, Dekeukeleire T, Hanon S, Stratakos G, Amjadi K, Madsen P. Fluorescein-enhanced autofluorescence thoracoscopy in patients with primary spontaneous pneumothorax and normal subjects. Am J Respir Crit Care Med . 2006 Jul 1. 174(1):26-30. . Tabakoglu E, Ciftci S, Hatipoglu ON, Altiay G, Caglar T. Levels of superoxide dismutase and malondialdehyde in primary spontaneous pneumothorax. Mediators Inflamm . 2004 Jun

2014 eMedicine Surgery

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