Medication evaluations

Medically evaluating, training, qualifying, and fit-testing workers for specific respirator types, checking 29 CFR 1910, Subpart Z, Toxic and Hazardous Substances, for any special respiratory protection requirements (e.g., for asbestos, lead, or cadmium) [3]... 

Concentrate intravenous medications ° Evaluate maintenance fluids ° Concentrate parenteral nutrition 0 Use concentrated enteral nutrition products Avoid and/or discontinue nephrotoxins wherever possible... 

Refer any patient presenting with red flag signs for medical evaluation. 

Assess the patient s symptoms, review patient and family history, and obtain initial medical evaluation to rule out other causes of psychosis. 

Obtain an initial medical evaluation to rule out other causes of mood episodes. 

Cardiac conduction 4- Dose or change medication Evaluate every 3 days until stable... 

CDC considers children to have an elevated level of lead if the amount of lead in the blood is at least 10 pg/dL. Medical evaluation and environmental investigation and remediation should be done for all children with blood lead levels equal or greater than 20 pg/dL. Medical treatment may be necessary in children if the lead concentration in blood is higher than 45 pg/dL. 

Other workers with flavoring-related BO were not appropriately diagnosed, even after reports of flavoring-related BO were published in the scientific literature (Kreiss et ah, 2002a Lockey et ah, 2002 Parmet and von Essen, 2002), public health commimications (CDC, 2002), and the press. Frequent misdiagnoses by physicians included asthma, bronchitis, and emphysema due to a presumptive diagnosis, an incomplete medical evaluation, and/or failure to make a coimection with occupational exposures. 

Prompt medical evaluation revealed that the Injury had spontaneously healed soon after the picture vas taken and no treatment was required According to LIC Ketchum, chief of the Clinical Medical Sciences Department "Words In themselves are not sufficient to describe this man s attitude tciuard the program ... 

Delirium. Delirium is an abrupt change in mental status often accompanied by agitation and seemingly psychotic symptoms that may resemble mania. Unlike mania, however, delirium is commonly characterized by a fluctuating level of consciousness and disorientation. The chief precipitants of delirium include infections, medications, and metabolic disturbances. Therefore, all patients who present in an acutely agitated state should undergo a comprehensive yet expeditious medical evaluation to rule out potential causes of delirium. This evaluation must include a thorough physical examination and a battery of laboratory tests. 

Psychotic Disorder Due to Generai Medical Condition. Certain medical illnesses occasionally present with symptoms of paranoid delnsions or hallucinations that resemble schizophrenia (Table 4.4). When these illnesses are snccessfully treated, fnll resolntion of the psychotic symptoms invariably occnrs. All patients presenting with new-onset psychosis shonld nndergo a thorongh medical evaluation including a physical exam, family and personal medical history, and laboratory stndies inclnding electrolytes, thyroid function tests, syphilis screen, vitamin B12 and folate levels, and a CT or MRI brain scan. A lumbar puncture (spinal tap) and electroencephalogram are sometimes also warranted. 

The referral for mental health care is often not made until an extensive medical evaluation has been completed. This medical assessment is often warranted, but a delay in recognizing the presence of panic disorder can result in an unending battery of expensive, unnecessary, and sometimes unpleasant medical tests. 

Other important components of the initial evaluation include a medical evaluation including both a medical history and physical examination. This can identify medical consequences of substance abuse, such as liver impairment from chronic alcohol abuse or sinus complications from cocaine use, as well as reveal needle tracks from a variety of self-injection sites that might not be readily apparent to casual observation. 

While the medical evaluation is being performed, treatment may be needed to control the patient. A frightened, combative, confused patient is dangerous both to him/herself and those trying to help. Therefore, medication may be needed to calm... 

Webb KB, et al Medical evaluation of subjects with known body levels of 2,3,7,8-tetrachlorodibenzo-p-dioxin. J Toxicol Environ Health 28(2) 183-193, 1989... 

In a NIOSH Health Hazard Evaluation of refrigeration workers exposed far below the threshold limit values (TLVs) for chloropentafluoroethane and chlorodifluoromethane, 27 workers were medically evaluated. Seventy-one percent complained of dizziness and lightheadedness compared with twenty-one percent of controls. Palpitations were reported in 36% of exposed and none of the non-exposed workers. No clinical neurological or electroneurophysiological abnormalities were detected in eight of the refrigeration repair workers followed for 3 years during continuous employment. ... 

Pancreatitis Cases of life-threatening pancreatitis have been reported in children and adults receiving valproate. Some of the cases have been described as hemorrhagic with rapid progression from initial symptoms to death. Some cases have occurred shortly after initial use as well as after several years of use. Warn patients and guardians that abdominal pain, nausea, vomiting, or anorexia can be symptoms of pancreatitis that require prompt medical evaluation. 

Lactic acidosis Lactic acidosis has been reported with the use of linezolid. In reported cases, patients experienced repeated episodes of nausea and vomiting. Patients who develop recurrent nausea or vomiting, unexplained acidosis, or a low bicarbonate level while receiving linezolid should receive immediate medical evaluation. 

Multiple chemical sensitivity (MCS) is characterized by a variety of adverse effects upon multiple organs that result from exposure to levels of common foods, drugs, and chemicals that do not affect most people. Symptoms include headaches, fatigue, lack of concentration, memory loss, asthma, and other often subjective responses following exposure. MCS has remained controversial because standard medical evaluations, such as blood biochemical screens, have failed to identify consistent physical or laboratory test abnormalities that would account for the symptoms. 

Ascertainment of treatment-emergent side effects requires a baseline symptom assessment before treatment is begun and at regular intervals thereafter. An ideal way to monitor side effects is to use medication-specific side effect scales that are designed for a particular drug class. These combine physical and behavioral symptoms with information obtained from the medical evaluation of the patient. Rating scales may help differentiate treatment-emergent side effects from an exacerbation of a symptom present at baseline, or from other causes of physical or behavioral symptoms. They may also help the family and the child accurately identify and label these side effects and then discuss them with the physician. 

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