Medical management

THE PATIENT WITH HEART BLOCK. The patient receiving atropine for third-degree heart block is placed on a cardiac monitor during and after administration of the drug. The nurse watches the monitor for a change in pulse rate or rhythm. Tachycardia, other cardiac arrhythmias, or failure of the drug to increase the heart rate must be reported to the primary health care provider immediately because other dm or medical management may be necessary. 

Social detoxification, which involves the nonpharmacological treatment of alcohol withdrawal, has been shown to be effective (see Naranjo et al. 1983). It consists of frequent reassurance, reality orientation, monitoring of vital signs, personal attention, and general nursing care (Naranjo and Sellers 1986). Social detoxification is most appropriate for patients in mild-to-mod-erate withdrawal. The medical problems commonly associated with alcoholism (Sullivan and O Connor 2004) may substantially complicate therapy, so that care must be taken to refer patients whose condition requires medical management. 

In two studies in which benzodia2epines were gradually tapered, concurrent cognitive-behavioral therapy (CBT) did not increase the proportion of patients who were able to successfully discontinue their use of these agents (Oude Voshaar et al. 2003 Vorma et al. 2003). On the other hand, other studies of patients with panic disorder found that CBT facilitated the discontinuation of benzodiazepine use (Otto et al. 1993). Similarly, CBT may be superior to supportive medical management in preventing the reoccurrence of panic attacks in panic disorder patients in whom alprazolam has been tapered (Bruce etal. 1999). 

Alrasbi M, Sheikh A Comparison of international guidelines for the emergency medical management of anaphylaxis. Allergy 2007 62 838-841. 

Jauss M, Krieger D, Hornig C, Schramm J, Busse O. Surgical and medical management of patients with massive cerebellar infarctions results of the German-Austrian cerebellar infarction study. J Neurol 1999 246 257-264. 

Nohria A, Lewis E, Stevenson LW. Medical management of advanced heart failure. JAMA 2002 287 628-640. 

Administer for at least 9 months in medically managed patients with NSTE ACS (class I recommendation)... 

Steinlauf AF, Present DH. Medical management of the pregnant patient with inflammatory bowel disease. Gastroenterol Clin North Am 2004 33 361-385. 

Morris D, Grossman A. The medical management of Cushing s syndrome. Ann NY Acad Sci 2002 970 119-133. 

The medical management of dysmenorrhea should relieve the related pelvic pain. Effective management of dysmenorrhea also results in a reduction in lost school and work days. Table 46-2 identifies the agents used in the management of dysmenorrhea, their recommended doses, and their common side effects. Figure 46-5 is a treatment algorithm for the management of dysmenorrhea. 

Marberger M, Harkaway R, de la Rosette J. Optimising the medical management of benign prostatic hyperplasia. Eur Urol 2004 45 411-419. 

American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Recommendations for the medical management of osteoarthritis of the hip and knee 2000 update. Arthritis Rheum 2000 43 1905-1915. 

Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children. Guidelines for the use of antiretroviral agents in pediatric HIV infection. October 26, 2006. (http //aidsinfo.nih.gov)... 

Breitenstein BD. 1983. 1976 Hanford americium exposure incident Medical management and chelation therapy. Health Phys 45(4) 855-866. 

ATSDR. 1994. Hydrogen sulfide. Managing hazardous materials incidents. Volume III. Medical management guidelines for acute chemical exposures. Agency for Toxic Substances and Disease Registry, Atlanta, GA. 

Medical Management of Biological Casualties Handbook. Fort De trick, Frederick, MD US Army Medical Research Institute of Infectious Diseases, 1996. 

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