Medical Complications in Physical Medicine and Rehabilitation

" The only book to combine the perspectives of both physical medicine and rehabilitation and internal medicine, this practical handbook provides physiatrists and residents in training with a concise description of common medical concerns that can disrupt or complicate therapy and rehabilitation. It focuses on the major diagnostic categories of disabilities that are admitted for in-patient rehabilitation such as stroke, spinal cord injury, brain injury, amputation, multiple major trauma, neurological disorders, burns, musculoskeletal trauma, cancer, and other diseases or disorders. For easy reference, the book is organized by both diagnostic category and specific medical complications. The first half of the book, organized by disability, provides an overview of the unique medical problems physiatrists are likely to encounter with each condition, when those complications will occur, and the best approaches to diagnosing and treating them early. The second part, written by acute care specialists, addresses the medical issues individually with more detailed chapters on specific complications and up-to-date information on treatment. These include urinary tract infection, osteomyelitis, antibiotic-associated diarrhea, hematologic complications, gastrointestinal complications, pulmonary complications, electrolyte disorders, and fever and sepsis. Key Features: Focuses on medical complications within major rehabilitation diagnostic groups Organized in two parts to allow readers to access information by condition or complication Provides clinical guidance for identifying and managing common medical complications encountered in rehabilitation settings Each rehabilitation topic chapter concludes with a summary ìTimelineî table detailing specific complications and likely occurrence A practical resource for physiatrists providing inpatient care or sharing call " Cover 1 Title 4 Copyright 5 Contents 6 Contributors 8 Preface 12 Part I: Medical Complications by Rehabilitation Diagnostic Categories 16 Chapter 1: Musculoskeletal Disorders 16 Total Hip Arthroplasty 17 Total Knee Arthroplasty 19 Rehabilitation of TJA 21 Complications During Acute Rehabilitation 24 Late Complications 33 References 39 Chapter 2: Spinal Cord Injury 44 Epidemiology of Traumatic Spinal Cord Injury 44 Early and Late Medical Complications 45 Musculoskeletal Complications 47 Pulmonary Complications 49 Cardiovascular Complications 54 Skin Complications 59 Posttraumatic Syringomyelia 64 Endocrine Complications 65 References 71 Chapter 3: Multiple Trauma and Burns 74 Multiple Trauma 76 Burns 84 Summary 95 References 96 Chapter 4: Stroke 102 Maintenance of Homeostasis 104 Complications of Immobility 106 Falls and Fractures/Trauma 108 Poststroke Pain Syndromes 110 Depression and Pseudobulbar Affect 113 Secondary Stroke Prevention 114 Summary 120 References 121 Chapter 5: Traumatic Brain Injury 128 Epidemiology of Traumatic Brain Injury 128 Etiology of TBI 129 Agitation 130 Posttraumatic Seizures 131 Posttraumatic Hydrocephalus 134 Autonomic Storming 136 Metabolic and Endocrine Disruption Following TBI 137 Upper Motor Neuron Syndrome 139 Acute and Chronic Pain 141 Respiratory Complications 144 Dysphagia 145 References 145 Chapter 6: Neurological and Rheumatological Disorders 151 Neurological Disorders 151 Rheumatologic Disorders 158 References 165 Chapter 7: Cancer Rehabilitation 166 Cancer 167 Selective Issues in Cancer Rehabilitation 169 Conclusion 177 References 179 Chapter 8: Amputations 181 Medical Complications in Patients with Amputations 182 References 190 Part II: Specific Medical Complications 191 Chapter 9: Fever 191 Background 191 Definitions 191 Terms Used to Describe Severe Infections 192 Etiology of Fever 193 Infectious Causes of Fever 194 Noninfectious Causes of Fever 196 Evaluation of the Febrile Patient 198 Special Considerations Regarding Microbiologic Cultures 198 Interpretation of Microbiologic Cultures 200 Management 202 Summary 202 References 203 Chapter 10: Acute Chest Pain 205 History and Physical Examination 205 Acute Coronary Syndromes 206 Electrocardiogram (ECG) 208 Chest Radiography 209 Laboratory Tests 210 A Stepwise Approach to Evaluation of Acute Chest Pain 210 References 211 Chapter 11: Common Laboratory Abnormalities 212 Hypoglycemia and Hyperglycemia 212 Hypokalemia and Hyperkalemia 213 Hyponatremia and Hypernatremia 215 Hypocalcemia and Hypercalcemia 218 Azotemia 220 Abnormal Liver Function Tests 221 Bibliography 222 Chapter 12: Urinary Tract Infection 224 Definitions 224 Epidemiology 227 Microbiology 228 Diagnosis 228 Prevention 229 Management 231 Funguria 233 Summary 234 References 235 Chapter 13: Pulmonary Disorders 239 Obstructive Lung Disease (Asthma and Chronic Obstructive Pulmonary Disease) 239 Interstitial Lung Disease 243 Neuromuscular Disease 246 Post-ICU Care 246 Pulmonary Complications in Rehabilitation 247 Pneumonia 247 References 252 Chapter 14: Osteomyelitis 253 Classification 253 Diagnosis 254 Microbiology 258 Treatment 258 Summary 260 References 260 Chapter 15: Clostridium Difficile Colitis 264 Antibiotic-Associated Diarrhea 265 Toxigenic Versus Nontoxigenic Clostridium Difficile 265 Changing Epidemiology 266 Risk Factors 266 Clinical Manifestations 268 Asymptomatic Carrier 269 Diarrhea with Colitis 269 Severe CDI Colitis 269 Laboratory Diagnosis 271 Treatment Options 274 Asymptomatic Colonization 274 Mild and Moderate Disease 275 Severe Disease 275 Recurrent or Relapsing Infection 276 Monoclonal Antibodies 277 Stool Transplantation 277 Prevention 278 References 278 Chapter 16: Hematological Disorders 283 Anemias 283 Thrombocytopenia 286 Leukopenia 288 Disorders Involving More than One Cell Line 288 High Levels of a Hematological Cell Line 289 Activity Levels in Patients with Hematologic Abnormalities 289 Summary 289 References 290 Chapter 17: Gastrointestinal Bleeding 291 Upper GIB 291 Lower GIB 293 Critical Illness, Aortic Repair, and Increased Intracranial Pressure 294 Evaluation and Management of Patients with GIB 295 Prevention of GI Bleed 297 References 297 Index 300

The only book to combine the perspectives of both physical medicine and rehabilitation and internal medicine, this practical handbook provides physiatrists and residents in training with a concise description of common medical concerns that can disrupt or complicate therapy and rehabilitation. It focuses on the major diagnostic categories of disabilities that are admitted for in-patient rehabilitation such as stroke, spinal cord injury, brain injury, amputation, multiple major trauma, neurological disorders, burns, musculoskeletal trauma, cancer, and other diseases or disorders. For easy reference, the book is organized by both diagnostic category and specific medical complications.

The first half of the book, organized by disability, provides an overview of the unique medical problems physiatrists are likely to encounter with each condition, when those complications will occur, and the best approaches to diagnosing and treating them early. The second part, written by acute care specialists, addresses the medical issues individually with more detailed chapters on specific complications and up-to-date information on treatment. These include urinary tract infection, osteomyelitis, antibiotic-associated diarrhea, hematologic complications, gastrointestinal complications, pulmonary complications, electrolyte disorders, and fever and sepsis.

Key Features:

• Focuses on medical complications within major rehabilitation diagnostic groups
• Organized in two parts to allow readers to access information by condition or complication
• Provides clinical guidance for identifying and managing common medical complications encountered in rehabilitation settings
• Each rehabilitation topic chapter concludes with a summary ìTimelineî table detailing specific complications and likely occurrence
• A practical resource for physiatrists providing inpatient care or sharing call

This book is intended to provide physicians and residents training in physical medicine and rehabilitation with a concise description of common medical complications encountered on an in-patient medical rehabilitation unit or free-standing facility. It will focus on the major diagnostic categories of disabilities that are admitted for in-patient rehabilitation such as stroke, spinal cord injury, brain injury, amputation, multiple major trauma, neurological disorders, burns, and other diseases or disorders. Divided into two sections, the first half of the book is organized by diagnostic category and will provide an overview of the unique medical problems physiatrists are likely to encounter with each condition. The second part then breaks down the medical issues individually with more detailed chapters on the specific complications. Taking a collaborative approach, each chapter will pair a physiatrist with an internist or other medical specialist in each area. Currently, there is no similar text available that covers this material from a physical medicine and rehabilitation perspective. Medical Complications in Physical Medicine and Rehabilitation features: Focuses on medical complications within major rehabilitation diagnostic groups Organized in two parts to allow readers to access information by condition or complication Contains material not normally addressed in standard PM & R textbooks Multi-specialty authorship-each chapter pairs a physiatrist with an internist or other specialist