دانلود کتاب اطلس سندرم های درد رایج

Recently, one of my medical students told me that after several weeks of being really sick and being treated for myriad respiratory ills, she was finally diagnosed with pertussis. Now keep in mind that we are located in Kansas City, USA, not a developing country and cases of pertussis are few and far between. In trying to figure out what went wrong in the care of my student, I asked her several questions: “Were you immunized as a child?” Yes. “Had you recently traveled abroad?” No. “What was the pertussis like?” Horrible! Having never seen a case of pertussis, I then asked the question that really had me puzzled. “How did they come up with the diagnosis of pertussis?” The student told me that initially she thought that she had picked up a bad case of bronchitis while on her pediatrics rotation. She took a Z-Pak without improvement and then completeda course of moxifloxacin. She did not see much improvement from the antibiotics so she went to the student health service on two separate occasions. Both times the physician concurred with the working diagnosis of bronchitis or early pneumonia. A subsequent trip to the local emergency department yielded the same diagnosis and she was discharged tohome. As the evening progressed, she found that she was having difficulty breathing and returned to the emergency room. She was admitted to the intensive care unit with a working diagnosis of respiratory failure. Antibiotics were given, and breathing treatments administered, yet diagnosis remained elusive. The next morning on rounds, a second-year medical student suggested that perhaps all this coughing was the result of whooping cough, which the student had just read about in her medical microbiology class. At first, everyone laughed and rolled their eyes… two beats… silence, and then… the “ah ha” moment….and the correct diagnosis was finally made. You may be wondering why I include this story in the preface to a book about pain management. It seems to me that as medical practitioners, we tend to limit ourselves to specific, personalized constructs that we devise to simplify the diagnosis of painful conditions. Within these constructs are the frequent admonitions against hunting for zebras whenever we hear hoof beats. These constructs pressure us to move toward the center of the diagnostic bell-shaped curve, to cleave to evidence-based medicine, etc. However, if taken to extremes, these parameters have the potential to severely limit how we process our patients’ histories and come to a diagnosis. It is my hope that this fifth edition of Atlas of Common Pain Syndromes will help clinicians recognize, diagnose, and treat painful conditions they otherwise would not have even thought of…..and as a result……. provide more effective care for their patients who are in pain.