1/11. The intravenous use of coconut water.Medical resources routinely used for intravenous hydration and resuscitation of critically ill patients may be limited in remote regions of the world. When faced with these shortages, physicians have had to improvise with the available resources, or simply do without. We report the successful use of coconut water as a short-term intravenous hydration fluid for a Solomon Island patient, a laboratory analysis of the local coconuts, and a review of previously documented intravenous coconut use.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/11. Does delirium need immediate medical referral in a frail, homebound elder?BACKGROUND AND PURPOSE: This case report describes the clinical decision making process of a physical therapist whose examination of a home bound elderly woman led to a referral for hospitalization. We illustrate how the use of a comprehensive systems screen and thorough examination identified a patient with treatable conditions that required medical care. CASE DESCRIPTION: The patient was a frail 93-year-old woman. She was referred for home-care physical therapy with multiple medical comorbidities and functional decline following a short hospitalization for fall-related injuries. Her function improved after several visits, but upon resuming treatment after a 2- week hiatus, the patient demonstrated major decline in cognitive and physical function. OUTCOMES: The comprehensive systems screen revealed that the patient had increased pallor, loose and frequent bowel movements, urinary incontinence and increased frequency of micturition, confusion and apathy, and extreme fatigue. Her examination showed large declines in scores for Functional Independence Measures, Mini Mental Status Examination, Berg Balance Test, and Timed Up and Go. These results were consistent with indicators for delirium, dehydration, and anemia. The findings were reported to the patient's physician and family members agreed to have the patient evaluated in the local emergency room. CONCLUSIONS: This case report illustrates how knowledge of the pathologies associated with delirium and thorough examination can assist the physical therapist in making clinical decisions when homecare patients require prompt medical referral.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/11. Evaluation and management of supraventricular tachycardia in children.Emergency physicians may be called on to resuscitate acute complications in pediatric patients with congenital heart disease. Supraventricular tachycardia, with or without hemodynamic decompensation, is one of the most serious complications. We present the case of a 22-month-old boy with a history of single ventricle who presented to our institution with a history of syncope and hemodynamically stable supraventricular tachycardia. Initial attempts at pharmacologic conversion with propranolol and verapamil failed. The arrhythmia was terminated in response to an IV fluid bolus and dopamine infusion and probably resulted from a combination of anemia, hypovolemia, and impaired contractility. Appropriate evaluation and management relating to the cre of acute supraventricular tachycardia in children are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/11. dehydration in the elderly: insidious and manageable.dehydration in the elderly results from inadequate water replacement, and associated mortality may be high when dehydration is severe. The elderly are at an elevated risk for dehydration, due to decreased thirst perception, decreased water intake, abnormal vasopressin responses to osmotic stimuli, and a predisposition to mild nephrogenic diabetes insipidus. In addition, elderly patients with chronic physical and/or mental disabilities are often unable to drink or obtain water themselves. For these high-risk patients, the physician's role is to initiate measures to prevent dehydration, including fluid orders and intake documentation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/11. Fatal rotavirus gastroenteritis: an analysis of 21 cases.During the period of May 1972 to March 1977, twenty-one fatal cases of rotavirus acute gastroenteritis were recorded in the city of Toronto. The mean age of these subjects was approximately 1 year. Boys outnumbered girls by 12 to 9. death occurred within three days of onset of symptoms in all cases. Sixteen of the subjects were profoundly dehydrated and had sodium levels (serum or vitreous humor) in excess of 150 mEq/liter. In 11 subjects, sodium values were greater than 160 mEq/liter. Although a physician was contacted in 16 instances, these infants still perished. We suggest that both language difficulties and the rapid rate of fluid depletion contributed significantly to the fatal outcome. At autopsy the bowel was often dilated and filled with fluid. Postmortem autolysis precluded an accurate histological assessment of the small bowel mucosa.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/11. dehydration syndromes. Oral rehydration and fluid replacement.dehydration caused by diarrhea remains a major source of morbidity and mortality worldwide. dehydration is a common clinical presentation seen by most physicians. Clinical diagnosis depends on the recognition of signs and symptoms as well as change in weight. Laboratory studies are helpful in categorizing the dehydration as isotonic, hyponatremic, or hypernatremic, which is necessary to plan appropriate therapy. In many situations, oral rehydration therapy is possible and desirable. Intravenous rehydration remains the standard of care for children with severe dehydration and shock.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/11. starvation with hypernatremic dehydration in two breast-fed infants.Unrecognized breast feeding malnutrition may rapidly lead to life-threatening or neurologically devastating consequences. With the increased interest in lactation, it is important that physicians, dietitians, and nurses provide counseling to parents regarding the benefits and difficulties of breast feeding. Appropriate education, assessment of the infant's vigor and maternal milk supply prior to release from the hospital, and close follow-up evaluation are all necessary to help a mother feed successfully, to detect a developing problem, and to avert a potentially serious condition in the baby.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/11. Early identification and treatment necessary to prevent malnutrition in children and adolescents with severe disabilities.Children with severe developmental disabilities frequently have nutrition and growth problems that range from moderate to severe. Because of notable continuing medical concerns and lowered growth expectations, parents and physicians may fail to recognize gradual deterioration in nutritional status before severe medical complications occur. The two cases reported in this article illustrate the need for early identification and treatment to prevent the development of notable morbidity secondary to malnutrition. Children and adolescents who have growth parameters consistently below age norms require assessment and monitoring by a registered dietitian to detect feeding problems and intake changes and to provide early intervention to help prevent negative consequences (eg, dehydration, protein-energy malnutrition, decubitus ulcers, increased rate and duration of infections, and altered bowel motility). An initial assessment should consist of measurement of length or height, weight, triceps, and subcapsular skinfolds; dietary and feeding history and a review of medical history; and biochemical testing as indicated by the medical and dietary histories. Monitoring frequency, which is determined by age, severity of condition, and response to treatment, may vary from weekly to bimonthly.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/11. Madeleine's death.Despite visits to two physicians and two hospitals within 4 days in September 1994, 7-week-old Madeleine Hunter died of flu-related dehydration. The coroner at an inquest into the baby's death said he had never seen a case in which so many things went wrong. The coroner's jury, which made 46 recommendations, determined that physicians and others involved in the care of very small infants should give "due respect to the instinct of the mother." Madeleine's mother, Georgina Hunter, recounts the story of her baby's death.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
10/11. Decision tree and postpartum management for preventing dehydration in the "breastfed" baby.dehydration and poor weight gain in breastfed infants are common but potentially preventable problems. Serious consequences are severe hypernatremic dehydration, severe weight loss, and severe hyperbilirubinemia with possible irreversible damage to the baby's brain or other vital organs. The dangers of dehydration have been emphasized by recent media reports of severe cases. These reports have resulted in increased, but often inappropriate, intervention in breastfeeding. On the basis of our experience at the Hospital for Sick Children, and the Doctors Hospital (Toronto), we have developed a decision tree and management protocol to assess breastfeeding, intervene effectively, and prevent such problems. If all breastfeeding mothers and babies are evaluated by qualified staff before discharge using this tool, it is expected that the serious consequences associated with babies leaving hospital appearing to be breastfeeding, but in fact not breastfeeding at all, will be prevented. Application of this approach, however, will require considerable upgrading of nurses' and physicians' skills and knowledge with regard to breastfeeding. A case report is presented.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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