By Paul D. Chan, David M. Thomas, Eric W. McKinley, Elizabeth K. Stanford
<Current medical Strategies>Pocket-sized reference in define layout. Lists laboratory and diagnostic exams, remedies, and different crucial details for universal difficulties. For scientific scholars and citizens. past variation: c1997. Trim dimension: 7.5 x four inches. Softcover.
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Extra info for Current Clinical Strategies Outpatient and Primary Care Medicine (2001 Edition) (Current Clinical Strategies Series)
Invasive mechanical ventilation is indicated in patients in whom NIPPV fails and in those with obtundation, an inability to clear copious secretions, life-threatening acidosis, or cardiovascular instability. Surgery. Lung volume reduction surgery restores chest wall mechanics, improves lung elastic recoil and airflow, and improves oxygen levels. Transplantation may be considered when other therapeutic options have been exhausted, the FEV1 is less than 25% of predicted. Supplemental oxygen is recommended for patients with either a resting PO2 of 55 mm Hg or a resting PO2 of less than 60 mm Hg and evidence of cor pulmonale or polycythemia.
Longer-acting beta2 agonists (eg, formoterol [Foradil], salmeterol [Serevent]) may be of benefit to selected COPD patients. 5 mg/kg/day. Patients who respond should be treated with fluticasone. Fluticasone (Flovent) 2 puffs bid; inhaler: 44, 110, 220 mcg/puff. Diskus inh: 50, 100, 250 mcg. Triamcinolone (Azmacort) MDI 2-4 puffs bid. Flunisolide (AeroBid, AeroBid-M) MDI 2-4 puffs bid. Beclomethasone (Beclovent) MDI 2-4 puffs bid. Budesonide (Pulmicort) MDI 2 puffs bid. Theophylline is not widely used because of the potential toxicity of the drug.
A baseline chest film is useful because many opportunistic pulmonary infections present with very subtle radiographic findings. A chest radiograph may suggest unrecognized tuberculosis. CD4+ counts assist in determination of the degree of immunologic damage, assess risk of opportunistic complications, and guide the use of prophylaxis against infections. Quantitation of plasma HIV RNA (viral load), a marker of the rate of viral replication, is useful in determining prognosis. It is used to estimate the risk of disease progression and to aid in making antiretroviral therapy decisions.
Current Clinical Strategies Outpatient and Primary Care Medicine (2001 Edition) (Current Clinical Strategies Series) by Paul D. Chan, David M. Thomas, Eric W. McKinley, Elizabeth K. Stanford