By J. R. Playfer (auth.), M. Lye (eds.)
Most sufferers in constructed international locations with clinical difficulties requiring clinic care are aged. more and more the dividing line among normal inner medi cine and acute geriatric drugs is turning into extra blurred. it really is, however, obvious that a few aged sufferers on scientific or sub-specialty health facility wards develop 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 relating to a quicker entry to the long-stay beds of the geriatric unit. Even a quick research of sanatorium working information will convey this isn't and can't be the case. while geria tricians are requested to determine aged 'bed blockers' on colleagues' wards they method with anxiousness simply because those sufferers frequently need to be put on a protracted ready checklist for those scarce and intensely dear carrying on with care beds. Do geria tricians see diversified acute clinical difficulties in comparison with their colleagues? the answer's no longer instantly seen, notwithstanding geriatricians are inclined to obtain extra strength 'bed blockers' than their normal scientific colleagues. How is it then, that geriatricians appear to cope higher than their colleagues? All geriatricians have adventure of basic inner drugs however the contrary regrettably doesn't carry. This booklet is written within the desire of redressing the imbalance.
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Additional resources for Acute Geriatric Medicine
G. (1982). Is digoxin really important in the treatment of compensated heart failure? A placebo controlled crossover study in patients with sinus rhythm. , Mitchell-Heggs, P. and Guz, A. (1978). The clinical value of digoxin in patients with heart failure and sinus rhythm. Quarterly Journal oj Medicine, 47, 401-19 Montgomery, A. , Shepherd, A. N. and Emslie-Smith, D. (1982). Severe hyponatraemia and cardiac failure successfully treated with captopril. British Medical Journal, 284, 1085-6 Morgan, D.
Furthermore, it has been argued that hospital admission may be positively harmful. In fact it is thought-block amongst doctors rather than bed-blocking by patients that we need to fear most. We must rid ourselves of the absurd idea that a patient who has become acutely and severely disabled has been admitted to hospital for 'social' reasons. The problem is a medical one requiring diagnosis, assessment, medical and' nursing management and rehabilitation. A hospital bed that is occupied by a stroke patient who cannot be nursed at home is not being inappropriately used.
44 ACUTE GERIATRIC MEDICINE When CT scanning was first available, it was thought that it would revolutionize the management of cerebral haemorrhage by identifying haematomata to be evacuated. Sadly, with the important exception of cerebellar haematomas, the results are very poor and the procedure is not recommended for the elderly. Where an expanding intra-cerebellar haematoma is suspected, however, a CT scan is mandatory in a patient who is a reasonable neurosurgical risk. The development of vomiting, severe cerebellar ataxia and dysarthria with or without a facial palsy, gaze palsy, and small pupils in a patient who has relative retention of power and sensation and initial preservation of conscious level should raise the suspicion of the diagnosis.
Acute Geriatric Medicine by J. R. Playfer (auth.), M. Lye (eds.)