Decision Making in Medicine: An Algorithmic Approach (Clinical Decision Making)

753 Pages·2009·21.59 MB·English

by  Stuart B. Mushlin MD

Decision
Making
in Medicine
An Algorithmic Approach
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Decision
Making in
Medicine
An Algorithmic Approach
Third Edition
Stuart B. Mushlin, MD, FACP, FACR
Assistant Professor of Medicine
Harvard Medical School
Master Clinician
Brigham and Women’s Hospital
Julian Cohen Teaching Scholar
Brigham and Women’s Hospital
Director of Primary Care, ad interim, Department of Medicine
Brigham and Women’s Hospital
Boston, Massachusetts
Harry L. Greene II, MD
Former Executive Vice President
Massachusetts Medical Society
Waltham, Massachusetts
Instructor in Medicine
Harvard Medical School
Boston, Massachusetts
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
DECISION MAKING IN MEDICINE: AN ALGORITHMIC ISBN: 978-0-323-04107-2
APPROACH, THIRD EDITION
Copyright © 2010 by Mosby, Inc., an affi liate of Elsevier Inc.
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Notice
Knowledge and best practice in this fi eld are constantly changing. As new research and expe-
rience broaden our understanding, changes in research methods, professional practices, or
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Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described herein.
In using such information or methods they should be mindful of their own safety and the
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With respect to any drug or pharmaceutical products identifi ed, readers are advised to
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To the fullest extent of the law, neither the Publisher nor the authors, contributors, or
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Previous editions copyrighted 1998, 1992
Library of Congress Cataloging-in-Publication Data
Decision making in medicine : an algorithmic approach / [edited by]
Stuart B. Mushlin, Harry L. Greene II. -- 3rd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-323-04107-2
1. Medical protocols. 2. Medicine--Decision making. I. Mushlin,
Stuart B. II. Greene, Harry L. (Harry Lemoine), 1942-
[DNLM: 1. Diagnosis. 2. Algorithms. 3. Decision Making.
4. Therapeutics. WB 141 D294 2009]
RC64.D43 2009
616--dc22
2009036313
Acquisitions Editor: Druanne Martin
Developmental Editor: Agnes Byrne
Publishing Services Manager: Mary Stermel
Design Direction: Steven Stave
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
To my wonderful wife, Francine. She is generous, wise, witty, literate, constructive, and
patient. There are many events we have forgone so that I may work on “the book.” I thank
her for believing in me and embracing the concept that every day we should strive to do more
than we thought we could do.
SBM
To my family: Linda Clark Greene, Harry L. Greene III, Evelyn Lockwood Greene,
Michele Greene Moynihan, Chris Moynihan, Hayden Moynihan, Jennifer Greene Reynoso,
and David Reynoso.
HLG
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SECTION EDITORS
Sherleen Chen, MD, FACS Ana Maria López, MD, MPH, FACP
Instructor in Ophthalmology, Harvard Medical School; Associate Dean for Outreach and Multicultural Affairs,
Director, Comprehensive Ophthalmology Service, Boston, Professor of Medicine and Pathology, Medical Director,
Massachusetts Arizona Telemedicine Program, University of Arizona,
Ocular Tucson, Arizona
Hematology/Oncology
Bradford C. Dickerson, MD
Instructor in Neurology, Harvard Medical School; Assistant Graham T. McMahon, MD, MMSc
in Neurology, Department of Neurology, Massachusetts Department of Endocrinology, Brigham and Women’s
General Hospital; Associate Neurologist, Division of Hospital, Boston, Massachusetts
Cognitive and Behavioral Neurology, Brigham and Endocrinology
Women’s Hospital, Boston, Massachusetts
Paul A. Monach, MD, PhD
Neurology
Assistant Professor of Medicine, Section of Rheuma-
M. Brian Fennerty, MD tology, Boston University School of Medicine, Boston,
Professor of Medicine, Division of Gastroenterology and Massachusetts
Hepatology, Health and Science University, Portland, Rheumatology
Oregon
Stuart B. Mushlin, MD, FACP, FACR
Gastroenterology
Assistant Professor of Medicine, Harvard Medical School;
John A. Fromson, MD Master Clinician, Brigham and Women’s Hospital; Julian
Assistant Clinical Professor of Psychiatry, Harvard Medical Cohen Teaching Scholar, Brigham and Women’s Hospital;
School; Chairman, Department of Psychiatry, Metro West Director of Primary Care, ad interim, Department
Medical Center, Boston, Massachusetts of Medicine, Brigham and Women’s Hospital, Boston
Behavioral Medicine Massachusetts
Women’s Health
Barbara A. Gilchrest, MD
Professor and Chair, Department of Dermatology, Boston Ajay K. Singh, MBBS, FRCP
University School of Medicine; Chief of Dermatology, Associate Professor of Medicine, Harvard Medical School;
Boston Medical Center, Boston, Massachusetts Renal Division, Brigham and Women’s Hospital, Boston,
Dermatology Massachusetts
Nephrology
Michael D. Katz, PharmD
Associate Professor, Department of Pharmacy Practice Graeme Steele, MD, FCS, FACS
and Service, University of Arizona, College of Pharmacy, Division of Urologic Surgery, Brigham and Women’s
Tucson, Arizona Hospital, Boston, Massachusetts
Pharmacology Urology
Lisa Kaufmann, MD Stephen D. Wiviott, MD
Professor of Medicine, SUNY Upstate Medical University, Assistant Professor of Medicine, Cardiovascular Division,
Syracuse, New York Department of Medicine, Harvard Medical School;
General Medicine Investigator, TIMI Study Group, Brigham and Women’s
Hospital, Boston, Massachusetts
Michael Klompas, MD, MPH, FRCPC
Cardiology
Associate Hospital Epidemiologist, Brigham and Women’s
Hospital, Boston, Massachusetts Richard D. Zane, MD, FAAEM
Infectious Diseases Assistant Professor of Medicine, Harvard Medical
School; Vice Chair, Department of Emergency Medicine,
Patricia Kritek, MD
Brigham and Women’s Hospital, Boston, Massachusetts
Pulmonary and Critical Care Medicine, Brigham and Emergency Medicine
Women’s Hospital, Boston, Massachusetts
Pulmonary Disease
vii
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CONTRIBUTORS
Sandeep K. Agarwal, MD, PhD Homeira Baghdadi, MD
Assistant Professor, Division of Rheumatology and Immu- Clinical Associate in Medicine, University of Arizona
nogenetics, University of Texas Medical School at College of Medicine, Tucson, Arizona
Houston, Houston, Texas Nipple Discharge
Scleroderma; Elevated Creatine Kinase Level
Juan Diego Baltodano, MD
Frederick R. Ahmann, MD Assistant Professor of Medicine, Virginia Commonwealth
Professor of Medicine and Surgery, University of Arizona, University, Division of Gastroenterology, Hepatology, and
Arizona Cancer Center, Tucson, Arizona Nutrition, Richmond, Virginia
Superior Vena Caval Syndrome Acute Abdominal Pain; Chronic Abdominal Pain; Nausea
and Vomiting; Dyspepsia; Jaundice; Ascites; Rectal
Essam Al-Ansari, MD Bleeding; Chronic Diarrhea; Asymptomatic Abnormal
Pulmonary Specialists-Northern, Florence, Kentucky Liver Aminotransferases
Dyspnea
Glen W. Barrisford, MD
Erik K. Alexander, MD Department of Urology, National Naval Medical Center,
Assistant Professor of Medicine, Harvard Medical School; Bethesda, Maryland
Department of Endocrinology, Brigham and Women’s Urinary Retention
Hospital, Boston, Massachusetts
Iris R. Bell, MD, PhD
Tests of Thyroid Function; Goiter; Thyroid Function Tests
in Nonthyroidal Illness Associate Professor, Department of Psychiatry, University
of Arizona College of Medicine; Director, Program in
Elaine J. Alpert, MD
Geriatric Psychiatry, Tucson VA Medical Center,
Formerly Associate Professor of Medicine, Boston Tucson, Arizona
University, Boston, Massachusetts Depression
Domestic Violence
Jeanne E. Bishop, MD
Nenad Antic, MD Associate Professor of Medicine, SUNY Upstate Medical
Arizona Center for Hematology and Oncology, Glendale, University, Syracuse, New York
Arizona Falls in Geriatric Patients
Polycythemia
Marc P. Bonaca, MD
Elliott M. Antman, MD Division of Cardiovascular Medicine, Brigham and
Professor of Medicine, Harvard Medical School; Women’s Hospital, Boston, Massachusetts
Department of Medicine, Brigham and Women’s Hospi- Stable Angina; Post–Myocardial Infarction Care and
tal, Boston, Massachusetts Counseling
Assessment and Initial Management of ST-Segment
Yvette M. Bordelon, MD, PhD
Elevation Myocardial Infarction
Assistant Professor, Department of Neurology, University
Mohammed Asmal, MD, PhD of California Medical School, Los Angeles, California
Division of Infectious Diseases, Brigham and Women’s Tremor; Hyperkinesias
Hospital, Boston, Massachusetts
Jessica Byron, MD
Encephalitis
Clinical Assistant Professor, Department of Obstetrics
Usman Baber, MD
and Gynecology, University of Arizona College of
Department of Medicine, University of Texas Southwestern Medicine, Tucson, Arizona
Medical School, Dallas, Texas Premenstrual Dysphoric Disorder
Hypertension
Christopher P. Cannon, MD
Aaron L. Baggish, MD
Associate Professor of Medicine, Harvard Medical
Division of Cardiology, Massachusetts General Hospital, School; TIMI Study Group, Brigham and Women’s
Boston, Massachusetts Hospital, Boston, Massachusetts
Systolic Murmurs; Diastolic Murmurs; Cardiac Dyspnea Unstable Angina/Non-ST-Elevation Myocardial Infarction
ix