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Infections Caused by Spirochetes: Syphilis, Lyme Disease, Leptospirosis 由螺旋体引起的感染:梅毒、莱姆病、钩端螺旋体病
Pub Date : 2018-11-09 DOI: 10.2310/fm.19049
P. Duff
Syphilis is caused by the spirochete Treponema pallidum. It is classified as primary, secondary, tertiary, and latent infection. If left untreated, syphilis can cause devastating injury to the fetus. The drug of choice for treatment of syphilis in pregnancy is penicillin. Lyme disease is caused by Borrelia burgdorferi and is transmitted by the Ixodes scapularis tick. The principal clinical manifestation of Lyme disease is erythema migrans, but patients may also develop arthritis and cardiac and neurologic abnormalities. Congenital Lyme disease has not been reported. The drug of choice for treatment of Lyme disease in pregnancy is amoxicillin. Leptospirosis is usually acquired from direct contact with urine of infected animals or through contaminated water, soil, or vegetation. Pregnant women with mild disease should be treated with oral amoxicillin. Patients with severe disease should be hospitalized and treated with intravenous penicillin or ampicillin.This review contains 5 figures, 5 tables, and 19 references.Key Words: clinical infection, congenital syphilis, latent infection, leptospirosis, Lyme disease, syphilis
梅毒是由梅毒螺旋体引起的。它分为原发性、继发性、三期和潜伏性感染。如果不及时治疗,梅毒会对胎儿造成毁灭性的伤害。治疗妊娠期梅毒的首选药物是青霉素。莱姆病是由伯氏疏螺旋体引起的,由肩胛骨蜱传播。莱姆病的主要临床表现是移行性红斑,但患者也可能出现关节炎、心脏和神经系统异常。先天性莱姆病未见报道。治疗妊娠期莱姆病的首选药物是阿莫西林。钩端螺旋体病通常通过直接接触受感染动物的尿液或通过受污染的水、土壤或植被而获得。轻症孕妇应口服阿莫西林治疗。病情严重的患者应住院并静脉注射青霉素或氨苄西林。本综述包含5张图,5张表,19篇参考文献。关键词:临床感染,先天性梅毒,潜伏感染,钩端螺旋体病,莱姆病,梅毒
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引用次数: 0
Breastfeeding 母乳喂养
Pub Date : 2018-11-02 DOI: 10.1891/9780826184917.0007
Marcie K. Richardson
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引用次数: 0
Principles of Neurologic Ethics 神经伦理学原理
Pub Date : 2018-10-25 DOI: 10.2310/fm.4287
M. Siket, Jay M. Baruch
Neuroethics refers to the branch of applied bioethics pertaining to the neurosciences and emerging technologies that impact our ability to understand or enhance a human mind. In the setting of emergency medicine, the clinician will encounter neuroethical dilemmas pertaining to the acutely brain injured or impaired; similar to other ethical decisions encountered in emergency medicine, such neuroethical dilemmas are often complicated by insufficient information regarding the patient’s wishes and preferences and a short time frame in which to obtain this information. This review examines the basis of neuroethics in emergency medicine; neuroethical inquiry; the neuroscience of ethics and intuition; issues regarding autonomy, informed consent, paternalism, and persuasion; shared decision making; situations in which decision-making capacity is in question; beneficence/nonmaleficence; incidental findings and their implications; risk predictions; and issues of justice. The figure shows the use of tissue plasminogen activator (t-PA) for cerebral ischemia within 3 hours of onset and changes in outcome due to treatment. Tables list common ethical theories, virtues/values of an acute care provider, components of informed consent discussion unique to t-PA in acute ischemic stroke, models of the physician-patient relationship, eight ways to promote effective shared decision making, components of capacity assessment, and emergency department assessment of futility.This review contains 1 figure, 9 tables, and 90 references.Keywords: Ethics, autonomy, shared decision-making, moral dilemmas, framing, decision-making capacity, beneficence and nonmaleficence
神经伦理学是应用生命伦理学的一个分支,涉及影响我们理解或增强人类思维能力的神经科学和新兴技术。在急诊医学的背景下,临床医生会遇到与急性脑损伤或受损有关的神经伦理困境;与急诊医学中遇到的其他伦理决定类似,这种神经伦理困境往往因关于患者意愿和偏好的信息不足以及获得这些信息的时间短而变得复杂。本文综述了急诊医学中神经伦理学的基础;neuroethical调查;伦理学和直觉的神经科学;关于自主、知情同意、家长式作风和说服的问题;共同决策;决策能力受到质疑的情况;善行/ nonmaleficence;偶然发现及其影响;风险预测;以及正义问题。该图显示了组织型纤溶酶原激活剂(t-PA)在脑缺血发作后3小时内的使用情况以及治疗结果的变化。表中列出了常见的伦理理论、急性护理提供者的美德/价值观、急性缺血性卒中中t-PA特有的知情同意讨论的组成部分、医患关系的模型、促进有效共同决策的八种方法、能力评估的组成部分以及急诊部门对无效的评估。本综述包含1张图,9张表,90篇参考文献。关键词:伦理、自主、共同决策、道德困境、框架、决策能力、有益与无害
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引用次数: 0
Failure to Thrive in Infants and Toddlers 婴幼儿不能茁壮成长
Pub Date : 2018-10-02 DOI: 10.2310/fm.5609
Madhura Y Phadke, Anthony F. Porto
Failure to thrive (FTT) is a broad term that is used to document an abnormal pattern of weight gain over time. There is no single definition for FTT, but all proposed definitions use anthropometric parameters such as weight gain or weight for length. The term FTT has been falling out of favor, and the term weight/growth faltering is becoming more common to describe this clinical entity. The underlying problem in FTT is inadequate usable calories. The primary mechanisms leading to FTT are impaired absorption, increased metabolic demands, and inadequate caloric intake. Inadequate caloric intake is the most common of these mechanisms, although FTT is often a combination of the three. The diagnostic evaluation of FTT must take into account the multifactorial nature of this clinical sign. A comprehensive history is essential for diagnosis and should include specific questions about the child’s living situation and feeding habits. The physical examination must include accurate weight and length measurements. Clinicians should look for signs of abuse or neglect, dysmorphic features, abnormal skin or nail findings, digital clubbing, or other signs of chronic disease. Laboratory investigations are rarely revealing in FTT but should be considered if there is a high index of suspicion for underlying disease. Treatment in FTT favors a multidisciplinary approach. The primary goal of treatment is restoration of normal growth velocity. Children with FTT are at increased risk for growth and cognitive problems in later childhood, although the clinical significance of these findings is not well understood. The mainstay of treatment is increasing calories in the diet. Enteral feeding, orally or via a tube, is always preferred over parenteral feeding due to a better safety profile, ease of feeding, and lower cost. Parenteral nutrition is an acceptable way to meet caloric needs in infants and children when enteral nutrition is not possible. Children with FTT and malnutrition should be monitored closely for refeeding syndrome, which results from fluid and electrolyte shifts in malnourished children. In general, FTT can be treated on an outpatient basis with close follow-up. Indications for hospitalization include severe malnutrition/dehydration and concern for child endangerment.This review contains 7 figures, 8 tables and 26 referencesKey words: enteral feeding, failure to thrive, growth charts, nutrition, parenteral nutrition, poor weight gain, tube feeding, weight loss
长得不好(FTT)是一个广义的术语,用来描述一段时间内体重增加的异常模式。FTT没有单一的定义,但所有提出的定义都使用人体测量参数,如体重增加或体重长度。FTT这个术语已经不受欢迎了,而体重/生长缓慢这个术语越来越多地被用来描述这种临床症状。FTT的潜在问题是可用热量不足。导致FTT的主要机制是吸收受损、代谢需求增加和热量摄入不足。热量摄入不足是这些机制中最常见的,尽管FTT通常是三者的结合。FTT的诊断评估必须考虑到这种临床症状的多因素性质。全面的病史对诊断至关重要,并应包括有关儿童生活状况和饮食习惯的具体问题。体格检查必须包括准确的体重和长度测量。临床医生应该寻找虐待或忽视的迹象,畸形特征,异常皮肤或指甲的发现,数字棍棒,或其他慢性疾病的迹象。实验室检查很少能揭示FTT,但如果有高度怀疑潜在疾病的指数,则应考虑。FTT的治疗倾向于多学科方法。治疗的主要目标是恢复正常的生长速度。尽管这些发现的临床意义尚不清楚,但患有FTT的儿童在儿童期后期出现生长和认知问题的风险增加。治疗的主要方法是增加饮食中的卡路里。由于更安全、更容易喂养和成本更低,口服或通过管子的肠内喂养总是优于肠外喂养。肠外营养是一种可接受的方式来满足婴儿和儿童的热量需求,当肠内营养是不可能的。应密切监测FTT和营养不良儿童的再喂养综合征,这是由营养不良儿童的体液和电解质变化引起的。一般来说,FTT可以在门诊进行治疗,并进行密切随访。住院指征包括严重营养不良/脱水和对儿童危险的担忧。关键词:肠内喂养,发育不良,生长图表,营养,肠外营养,增重不良,管饲,体重下降
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引用次数: 0
Gastrointestinal Tract Infections 胃肠道感染
Pub Date : 2018-09-04 DOI: 10.2310/gastro.1296
M. Goldberg, Molly L. Paras
Gastrointestinal infections, which present with acute diarrhea, sometimes accompanied by vomiting, are an extremely common medical complaint, with an annual incidence of 0.6 illnesses per person. Transmission can occur from animals to person, from person to person, or by the ingestion of contaminated foodstuffs. In the United States, more than 90% of cases are caused by viruses, with norovirus being by far the most common. Common among bacterial causes of acute gastrointestinal infection are Salmonella, Campylobacter, Shigella, Shiga toxin–producing Escherichia coli, Vibrio, Yersinia, and Clostridium difficile. These infections are typically self-limited, but depending on the etiologic agent and characteristics of the host, antibiotic therapy may be indicated. Certain gastrointestinal infections are associated with significant complications, including reactive arthritis, Guillain-Barré syndrome, or septicemia.This review contains 4 figures, 7 tables, and 60 references.Key words: Campylobacter, Escherichia coli, Guillain-Barré syndrome, reactive arthritis, Shiga toxin, Shigella, Vibrio, Yersinia
胃肠道感染,表现为急性腹泻,有时伴有呕吐,是一种极其常见的疾病,每年每人发病0.6例。传播可发生在动物之间、人与人之间或通过摄入受污染的食品。在美国,超过90%的病例是由病毒引起的,诺如病毒是迄今为止最常见的。引起急性胃肠道感染的常见细菌有沙门氏菌、弯曲杆菌、志贺氏菌、产志贺氏毒素的大肠杆菌、弧菌、耶尔森氏菌和艰难梭菌。这些感染通常是自限性的,但根据病原和宿主的特点,可能需要抗生素治疗。某些胃肠道感染与显著的并发症相关,包括反应性关节炎、格林-巴罗综合征或败血症。本综述包含4张图,7张表,60篇文献。关键词:弯曲杆菌,大肠杆菌,格林-巴罗综合征,反应性关节炎,志贺毒素,志贺菌,弧菌,耶尔森菌
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引用次数: 0
Acute Viral Meningitis 急性病毒性脑膜炎
Pub Date : 2018-08-22 DOI: 10.2310/fm.1269
K. Roos, J. Brosch
Acute viral meningitis refers to inflammation of the meninges of the brain in response to a viral pathogen. Viruses cause meningitis, encephalitis, myelitis, or a combination of these, meningoencephalitis or encephalomyelitis. Viral meningitis is typically a self-limited disorder with no permanent neurologic sequelae. This chapter reviews the epidemiology, etiology, diagnosis, differential diagnosis, treatment, complications, and prognosis. Tables describe Wallgren’s criteria for aseptic meningitis, important arboviral infections found in North America, herpes family viruses and meningitis, classic cerebrospinal fluid (CSF) abnormalities with viral meningitis, Centers for Disease Control and Prevention criteria for confirming arboviral meningitis, basic CSF studies for viral meningitis, and etiology of CSF pleocytosis. Figures depict common causes of viral meningitis, nuchal rigidity, examination for Kernig sign, and Brudzinski sign for meningeal irritation.This review contains 4 highly rendered figures, 8 tables, and 17 references.
急性病毒性脑膜炎是指脑膜对病毒性病原体的反应而引起的炎症。病毒引起脑膜炎、脑炎、脊髓炎或这些疾病的组合,脑膜脑炎或脑脊髓炎。病毒性脑膜炎是一种典型的自限性疾病,没有永久性的神经系统后遗症。本章回顾流行病学、病因、诊断、鉴别诊断、治疗、并发症和预后。表格描述了无菌性脑膜炎的Wallgren标准、北美发现的重要虫媒病毒感染、疱疹家族病毒和脑膜炎、病毒性脑膜炎的典型脑脊液异常、疾病控制和预防中心确认虫媒病毒性脑膜炎的标准、病毒性脑膜炎的基本脑脊液研究以及脑脊液多细胞症的病因。图中描述了病毒性脑膜炎的常见原因,颈部僵硬,检查Kernig征和Brudzinski征是否有脑膜刺激。这篇综述包含4个高度渲染的图,8个表和17个参考文献。
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引用次数: 0
Child Abuse and Nonaccidental Trauma 儿童虐待和非意外创伤
Pub Date : 2018-08-19 DOI: 10.2310/TYWC.4417
S. Malka
Child abuse accounts for over 1% of visits to pediatric emergency departments (EDs), and injuries related to abuse have higher morbidity and mortality than accidental injuries. Recognizing child abuse and neglect in the ED is challenging but critical to prevent recurrent episodes of abuse and long-term physical and emotional sequelae. This review defines child abuse and neglect and explores historical and physical examination findings, assessment and diagnosis, treatment, disposition, and outcomes for victims of child abuse. Figures show x-rays demonstrating common fracture patterns associated with abusive injury and an algorithm for evaluation of nonaccidental trauma in the ED. Tables list key historical elements in the evaluation for abuse or neglect, bruising characteristics suggestive of abuse, fractures that are specific for abuse, and recommended laboratory evaluation for suspected abuse. This review contains 4 figures, 5 tables, and 36 references.Key words: child abuse, child neglect, nonaccidental trauma, sexual abuse
儿童虐待占儿科急诊科(ed)就诊人数的1%以上,与虐待有关的伤害比意外伤害的发病率和死亡率更高。认识到儿童虐待和忽视在急诊科是具有挑战性的,但关键是防止反复发作的虐待和长期的身体和精神后遗症。这篇综述定义了儿童虐待和忽视,并探讨了历史和身体检查的结果,评估和诊断,治疗,处置,以及虐待儿童受害者的结果。图中显示了x射线显示的与虐待伤害相关的常见骨折模式,以及评估急诊科非意外创伤的算法。表格列出了评估虐待或忽视的关键历史因素,暗示虐待的瘀伤特征,虐待特有的骨折,以及对疑似虐待的推荐实验室评估。本综述包含4张图,5张表,36篇参考文献。关键词:虐待儿童,忽视儿童,非意外创伤,性虐待
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引用次数: 0
Pediatric Fever 小儿发烧
Pub Date : 2018-08-19 DOI: 10.2310/fm.4401
Clifford C. Ellingson, D. Woolridge
Fever is one of the most common chief complaints among pediatric emergency departments. The evaluation and approach to a pediatric fever can be challenging. Although most cases of fever are viral in origin, the potential for a deadly bacterial infection would make even the most seasoned practitioner attentive. This review discusses the initial assessment of the pediatric patient and both necessary and recommended workups for pediatric fevers among various age groups. Common infections of bacterial and viral causes for fever are discussed and treatment recommendations offered.  This review contains 3 figures, 9 Tables and 48 referencesKey words: Pediatric fever, otitis media, pneumonia, urinary tract infection, neonatal sepsis, bacteremia, meningitis, serious bacterial infection, viral illness.
发烧是儿科急诊科最常见的主诉之一。评估和方法的儿科发烧可以是具有挑战性的。虽然大多数发烧病例都是由病毒引起的,但致命细菌感染的可能性会让最老练的医生也很警惕。这篇综述讨论了儿科患者的初步评估和必要的和推荐的检查儿科发烧在不同年龄组。讨论了常见的细菌和病毒引起的发热感染,并提出了治疗建议。关键词:小儿发热、中耳炎、肺炎、尿路感染、新生儿败血症、菌血症、脑膜炎、严重细菌感染、病毒性疾病。
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引用次数: 0
Pediatric Orthopedic Emergencies 儿童骨科急诊
Pub Date : 2018-08-19 DOI: 10.2310/fm.4411
P. Gopwani, J. Koopmans
Proper care of orthopedic injuries and emergencies in children and adolescents requires knowledge of the altered bone and ligament characteristics, varying stages of skeletal development, and potential for congenital or developmental abnormalities. Pediatric fractures affecting the growth plate require unique management to maintain optimal growth. Whereas some specific fractures in these skeletally immature patients require urgent surgical repair, other fractures remodel extremely well and can be managed with a simple splint. Particular dislocations are common in this population and may have concomitant fractures. There are several overuse injuries seen primarily in children, and treatment aims to keep the patient active while allowing the injury to heal. Potentially devastating osteoarticular infections occur in the pediatric population and must be differentiated from more benign causes of joint pain, such as transient synovitis or congenital abnormalities. Children are also at risk for abnormalities such as slipped capital femoral epiphysis or Legg-Calvé-Perthes disease, which are rarely diagnosed in the adult population. It is imperative for a clinician to be aware of these and other nuances to optimally care for orthopedic injuries and emergencies in the pediatric population.This review contains 9 figures, 13 tables and 45 referencesKey words: bone, musculoskeletal, orthopedic, skeletal
儿童和青少年骨科损伤和急诊的适当护理需要了解改变的骨骼和韧带特征,骨骼发育的不同阶段以及先天性或发育异常的可能性。影响生长板的儿童骨折需要独特的治疗方法来维持最佳生长。然而在这些骨骼发育不成熟的患者中,一些特定的骨折需要紧急手术修复,而其他骨折重建得非常好,可以用简单的夹板进行治疗。特殊的脱位在这一人群中很常见,并可能伴有骨折。有几种主要发生在儿童身上的过度使用损伤,治疗的目的是让患者保持活动,同时让损伤愈合。潜在的破坏性骨关节感染发生在儿科人群中,必须与更良性的关节疼痛原因(如短暂性滑膜炎或先天性异常)区分开来。儿童也有发生股骨头骨骺滑动或legg - calv - perthes病等异常的风险,这些疾病在成年人中很少被诊断出来。临床医生必须意识到这些和其他细微差别,以便在儿科人群中最佳地护理骨科损伤和紧急情况。本文包含9图13表45篇文献关键词:骨,肌肉骨骼,骨科,骨骼
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引用次数: 0
Malignant Cutaneous Tumors 恶性皮肤肿瘤
Pub Date : 2018-08-16 DOI: 10.2310/TYWC.1080
A. Halpern, P. Myskowski
This chapter reviews the most common malignant cutaneous tumors. The section on malignant tumors of the epidermis discusses nonmelanoma skin cancer (i.e., basal cell carcinoma and squamous cell carcinoma) and malignant melanoma. The section on malignant tumors of the dermis covers metastatic tumors, primary tumors (Merkel cell carcinoma, Paget disease, extramammary Paget disease, angiosarcoma, and dermatofibrosarcoma protuberans), and Kaposi sarcoma (i.e., classic Kaposi sarcoma, African Kaposi sarcoma, organ-transplant Kaposi sarcoma, and HIV-associated Kaposi sarcoma). The final section covers cutaneous lymphomas. The coverage of each disease includes a discussion of epidemiology, etiology, diagnosis, differential diagnosis, treatment, and prognosis. Tables provide the adjusted estimated relative risks of melanoma by nevus type and number, the American Joint Committee on Cancer (AJCC) TNM classification and staging system, the estimated probability of 10-year survival in patients with primary cutaneous melanoma, and an overview of overview of therapy for cutaneous T cell lymphoma. Figures illustrate the presentation of many malignant cutaneous tumors.This review contains 10 highly rendered figures, 5 tables, and 105 references.
本章回顾了最常见的恶性皮肤肿瘤。关于表皮恶性肿瘤的部分讨论了非黑色素瘤皮肤癌(即基底细胞癌和鳞状细胞癌)和恶性黑色素瘤。真皮恶性肿瘤部分包括转移性肿瘤、原发性肿瘤(默克尔细胞癌、佩吉特病、乳腺外佩吉特病、血管肉瘤和隆突性皮肤纤维肉瘤)和卡波西肉瘤(即经典的卡波西肉瘤、非洲卡波西肉瘤、器官移植的卡波西肉瘤和hiv相关的卡波西肉瘤)。最后一节讨论皮肤淋巴瘤。每种疾病的范围包括流行病学、病因、诊断、鉴别诊断、治疗和预后的讨论。表格提供了根据痣类型和数量调整后的黑色素瘤的估计相对风险,美国癌症联合委员会(AJCC) TNM分类和分期系统,原发性皮肤黑色素瘤患者10年生存率的估计概率,以及皮肤T细胞淋巴瘤治疗的概述。图示许多恶性皮肤肿瘤的表现。这篇综述包含10个高度渲染的图,5个表和105个参考文献。
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引用次数: 0
期刊
DeckerMed Family Medicine
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