Medical history, indications

ICtjo value, defined as the concentration that will incapacitate 50% of the exposed population in one minute. The incapacitating signs and symptoms include intense burning of the eyes, nose, and respiratory tract profuse lacrimation excessive salivation blepharospasm tightness in the chest and a feeling of suffocation. The time to incapacitation did not appear to differ among the test subjects exposed to CS via the different dispersion techniques, reduced ambient temperatures, or subjects with medical histories indicating respiratory, cardiovascular, or hepatic dysfunction. 

Her medical history indicated that, while serving as a missionary in western Belise, Central America, 2 months earlier, she had a 3-day illness that inclnded fever, chills, and mild but persistent diarrhea. A friend of Amy s there, a medical missionary, had given her an unidentified medication for 7 days. Amy s diarrhea slowly resolved, and she felt well again nntil her cnrrent abdominal symptoms began. 

Two further cases of hepatocellular carcinoma associated with anabolic steroid therapy have been reported. One was a child with Fanconi s anaemia, who was treated with anabolic steroids for 50 months (2 ). The other also occurred in a patient with Fanconi s anaemia following 4 years medication with androgenic, anabolic steroids (3 ). Examination of the livers of 2 patients with acquired aplastic anaemia who had been treated with similar compounds for 3 months prior to death revealed generalized parenchymal hyperplasia in one and widespread nodular hyperplasia in the other. Since 1971, 10 cases of hepatocellular carcinoma during medication with anabolic steroids have been reported in the literature. The prognosis is poor with a survival time of less than a year. The similar medical history indicates but does not prove a cause-effect relationship between disease and medication. The data must, however, be viewed alongside that pointing to hepatic tumours as complications of treatment with other types of steroids, notably the oral contraceptives. 

Conduct a medical history. Does the patient have any compelling indications Is the patient pregnant ... 

Psychiatric medications do not currently play a prominent role in the treatment of cocaine-dependent patients (see Table 6.4). Although researchers have labored to find medications to treat cocaine addiction, there have not been any notable breakthroughs. As with other substance use disorders, the presence of a psychiatric disorder for which medication is indicated (i.e., depression, anxiety disorders, bipolar affective disorder, or schizophrenia) should prompt appropriate treatment. Similar to the presence of alcohol intoxication, deferring a diagnosis for a day or two in a new patient with no past history is often the more prudent course. 

Sex, age and medical history of the patient including the present medical problem, current and recent drug treatment, including dose and indication, time relations for suspected side-effects, stage of pregnancy at the time of drug exposure and maturity of neonates. 

Before initiating treatment, obtain a medical history and a psychiatric history. Baseline laboratory studies are also indicated if they have not already been completed as part of the initial evaluation of the patient. An evaluation for the presence of any abnormal movements is also advisable. An electrocardiogram should be considered for patients with a history of cardiac problems. 

Polybrominated Biphenyls. As discussed in Section 3.2.1.2, results from a medical history survey study of workers in a PBB manufacturing plant and a nonexposed group of Wisconsin farm residents indicated an association between occupational exposure to PBBs and the occurrence of acne (Chanda et al. 1982). 

Dermal. Medical case histories indicate that dermal exposure to silver or silver compounds for extended periods of time can lead to local skin discoloration similar in nature to the generalized pigmentation seen after repeated oral exposure. However, the amount of silver and the duration of time required to produce this effect cannot be established with the existing information (Buckley 1963 McMahon and Bergfeld 1983). Moreover, adverse effects such as argyria have not been associated with the use of silver sulphadiazine as a bactericidal agent (Fox et al. 1969). No studies were located regarding dermal effects in animals after dermal exposure to silver or silver compounds. 

Presentation 2 HPI TE is a 62-year-old 75-kg man who is admitted to the hospital for shortness of breath (SOB) and "palpitations." He has experienced in the past short episodes of "chest pounding," but previously it always spontaneously resolved. TE has essentially normal laboratory values. Electrocardiography indicates he is in atrial fibrillation. His previous medical history (PMH) is significant for hypertension treated with hydrochlorothiazide only. He has no known drug allergies (NKDA). 

The patient may have a previous medical history or diagnostic findings that indicate the presence of hypertension-related target-organ damage ... 

A careful history and physical examination are key components in the diagnosis of decompensated heart failure. The history should focus on the potential etiologies of heart failure the presence of any precipitating factors onset, duration, and severity of symptoms and a careful medication history. Important elements of the physical examination include vital signs, cardiac auscultation for heart sounds and murmurs, pulmonary examination for the presence of rales, the presence of peripheral edema, and weight. The JVP is a reliable indicator of the patient s volume status and should be evaluated carefully on admission and followed closely as an indicator of the efficacy of diuretic therapy. 

Arterial blood gases and serum electrolytes should be measured regularly in patients with CKD. These patients should also have a complete medical history and review of medications to determine if there are other potential causes of acid-base disturbances (e.g., diabetic ketoacidosis, ingestion of toxins, or GI disorders). The anion gap, indicating the differences in unmeasured anions and cations, should also be calculated (see Chap. 51). An elevated anion gap (>17 mEq/L) is often present in those with CKD due to the accumulation of organic anions, phosphates, and sulfates. 

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