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They should be put on with awakening, before hydration forces result in edema. Patients with decreased ABPI should be managed in concert with a vascular surgeon. Compression stockings (12–18 mm Hg at the ankle) are effective in preventing edema and asymptomatic thrombosis associated with long airline flights in lowto medium-risk persons. Belcaro G et al: Prevention of edema, flight microangiopathy and venous thrombosis in long flights with elastic stockings. A randomized trial: the LONFLIT 4 Concorde Edema-SSL Study.
Collins SP et al: Diagnostic and prognostic usefulness of natriuretic peptides in emergency department patients with dyspnea. Ann Emerg Med 2003;41:532. 35 36 Jennings AL et al: A systematic review of the use of opioids in the management of dyspnea. Thorax 2002;57:929. ” JAMA 2001;285:1331. Mahler DA et al: Evaluation of dyspnea in the elderly. Clin Geriatr Med 2003;19:19. Straus SE et al: The accuracy of patient history, wheezing, and laryngeal measurements in diagnosing obstructive airway disease.
28 C. ANTIMICROBIAL THERAPY In most febrile patients, empirical antibiotic therapy should be deferred pending further evaluation. However, persons in whom a clinically significant infection is likely should be started on appropriate antibiotic therapy. Prompt broad-spectrum antimicrobials are also indicated for febrile patients who are clinically unstable, even before infection can be documented. These include patients with hemodynamic instability, those with neutropenia (neutrophils less than 500/ mcL), others who are asplenic (surgically or secondary to sickle cell disease) or immunosuppressed (including individuals taking systemic corticosteroids, azathioprine, cyclosporine, or other immunosuppressive medications), and those who are HIV infected (see Chapter 31).