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Read e-book online Acute Geriatric Medicine PDF

By J. R. Playfer (auth.), M. Lye (eds.)

ISBN-10: 9400948905

ISBN-13: 9789400948907

ISBN-10: 9401086656

ISBN-13: 9789401086653

Most sufferers in constructed international locations with clinical difficulties requiring clinic care are aged. more and more the dividing line among basic inner medi­ cine and acute geriatric medication is changing into extra blurred. it truly is, however, obvious that a few aged sufferers on clinical or sub-specialty health facility wards turn into 'bed blockers'. Why? additionally, why are 'bed blockers' much less of an issue on an acute geriatric ward? Many clinicians think this can be concerning a quicker entry to the long-stay beds of the geriatric unit. Even a quick learn of clinic working information will exhibit this isn't and can't be the case. whilst geria­ tricians are requested to determine aged 'bed blockers' on colleagues' wards they procedure with anxiousness simply because those sufferers frequently need to be put on an extended ready record for those scarce and intensely dear carrying on with care beds. Do geria­ tricians see assorted acute scientific difficulties in comparison with their colleagues? the answer's no longer instantly noticeable, although geriatricians tend to obtain extra capability 'bed blockers' than their basic clinical colleagues. How is it then, that geriatricians appear to cope larger than their colleagues? All geriatricians have event of common inner drugs however the contrary regrettably doesn't carry. This ebook is written within the wish of redressing the imbalance.

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Example text

They may be due either to a thrombus in situ or an atheromatous plaque or to an embolism arising elsewhere in the vascular tree or from the heart. Sometimes infarction is attributed to haemodynamic causes; cardiac arrhythmias, carotid sinus hypersensitivity and drugs producing hypotension have all been implicated. Textbooks list criteria for distinguishing the different types of stroke (see Table 5). In practice these are unreliable. For example, a small haemorrhage may not cause loss of consciousness and may not be associated with headaches if blood does not reach the subarachnoid space.

In more severe or chronic cardiac failure, compensation may not be achieved and fluid retention becomes excessive as evidenced by peripheral oedema, etc. It is here that diuretics can re-establish compensation. Diuretics in the Elderly Any agent which increases urine output is a diuretic agent. Thus digoxin itself was initially thought to be a diuretic. However, there are now only three different groups of diuretics in clinical use ~ thiazides, loop agents and potassium-sparing diuretics. All are usually effective in the treatment of cardiac failure in old people but manifest varying adverse effects.

In the acute situation, especially following myocardial infarction, phentolamine and nitroprusside are of undoubted benefit. In the elderly patient with 'cold' septicaemic shock, nitroprusside infusion can be life saving. Most experience of balanced dilators has been obtained with prazosin though the newer agent trimazosin may be of more use in the elderly by virtue of less side effects and longer duration of action. Prazosin does not increase heart rate and may demonstrate a severe 'first dose' syncope.

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Acute Geriatric Medicine by J. R. Playfer (auth.), M. Lye (eds.)

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