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

Most sufferers in constructed international locations with clinical difficulties requiring health center care are aged. more and more the dividing line among basic inner medi­ cine and acute geriatric medication is changing into extra blurred. it's, however, obvious that a few aged sufferers on scientific or sub-specialty medical institution 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 concerning a quicker entry to the long-stay beds of the geriatric unit. Even a short examine of sanatorium working data will convey this isn't and can't be the case. whilst geria­ tricians are requested to determine aged 'bed blockers' on colleagues' wards they method with nervousness simply because those sufferers usually need to be put on an extended ready checklist for those scarce and intensely dear carrying on with care beds. Do geria­ tricians see various acute clinical difficulties in comparison with their colleagues? the answer's no longer instantly noticeable, although geriatricians tend to obtain extra power 'bed blockers' than their basic clinical colleagues. How is it then, that geriatricians appear to cope larger than their colleagues? All geriatricians have adventure of common inner medication however the contrary regrettably doesn't carry. This ebook is written within the wish of redressing the imbalance.

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Having obtained control, can the diuretic dosage be reduced? Monitor body weight, plasma potassium and urea during this phase. Once stability has been achieved, monitoring periods during unchanged circumstances can be reduced. In particular, if the patient· has not developed hypokalaemia within one month of starting diuretics, he is most unlikely to do so in the future. The doctor should always be looking, however, to see if dosage can be reduced once the initial control has been achieved and cardiac function improved.

Other tests should not be undertaken unless the results are going to influence management. One should have a built-in reluctance to order expensive, sophisticated, hazardous, painful or potentially harmful investigations and before embarking on them have some idea of the likelihood of turning up a positive result. Table 7 Investigation of a stroke patient In all cases To be considered in selected cases Haemoglobin Haematocrit White count Erythrocyte sedimentation rate Blood glucose Urea and electrolytes Serum tests for syphilis Electrocardiogram Urine examination Chest X-ray Skull X-ray Neurological Isotope brain scan CT Scan EEG Lumbar puncture Cardiological Endocardiogram 24ECG Cardiac catheterisation Haematological Clotting studies Protein electrophoresis Other Blood cultures Temporal artery biopsy ANA, DNA binding Cervical spine X-ray Serum lipids, etc.

There is considerable controversy about the beneficial effects of hypotensive agents in the elderly and this will not be resolved until the European Working Party has reached its conclusions. There is no evidence that reducing blood pressure in the acute stage of a completed stroke or a stroke in evolution is beneficial and unless there is malignant hypertension, any treatment contemplated should be delayed several weeks. Only if blood pressure is persistently raised should hypotensive agents be used.

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