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Emergency Medicine Clinics of North America

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https://www.readbyqxmd.com/read/28987438/time-critical-vascular-disasters
#1
EDITORIAL
Alex Koyfman, Brit Long
No abstract text is available yet for this article.
November 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28987437/vascular-emergencies
#2
EDITORIAL
Amal Mattu
No abstract text is available yet for this article.
November 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28987436/ischemic-stroke-advances-in-diagnosis-and-management
#3
REVIEW
Courtney R Cassella, Andy Jagoda
Acute ischemic stroke carries the risk of morbidity and mortality. Since the advent of intravenous thrombolysis, there have been improvements in stroke care and functional outcomes. Studies of populations once excluded from thrombolysis have begun to elucidate candidates who might benefit and thus should be engaged in the process of shared decision-making. Imaging is evolving to better target the ischemic penumbra salvageable with prompt reperfusion. Availability and use of computed tomography angiography identifies large-vessel occlusions, and new-generation endovascular therapy devices are improving outcomes in these patients...
November 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28987435/acute-limb-ischemia-an-emergency-medicine-approach
#4
REVIEW
Jamie R Santistevan
Acute limb ischemia is a medical emergency with significant morbidity and mortality. Rapid diagnosis is required because it is a time-sensitive condition. Timely treatment is necessary to restore blood flow to the extremity and prevent complications. The differential diagnosis of acute limb ischemia is broad. Classification of severity of acute limb ischemia is based on clinical variables. A suspicion of acute ischemia based on history and physical examination warrants heparin administration and vascular surgery consultation...
November 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28987434/mesenteric-ischemia-a-deadly-miss
#5
REVIEW
Manpreet Singh, Brit Long, Alex Koyfman
Mesenteric ischemia has 4 etiologies: arterial embolus, arterial thrombosis, venous thrombosis, and nonocclusive. No history or physical examination finding can definitively diagnose the condition. A wide variety of presentations occur. Pain out of proportion and gut emptying may occur early, with minimal tenderness. Once transmural infarction occurs, peritoneal findings and tenderness to palpation may occur. Physicians must be suspicious of pain out of proportion and scrutinize risk factors. Computed tomography angiography is the best imaging modality...
November 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28987433/cerebral-venous-thrombosis-a-challenging-neurologic-diagnosis
#6
REVIEW
Brit Long, Alex Koyfman, Michael S Runyon
Headache is a common emergency department chief complaint. Although most are benign, emergency physicians must rapidly identify and manage the uncommon, sometimes subtle, presentation of headache from a life-threatening cause. Cerebral venous thrombosis imparts significant morbidity and mortality, and can be a challenging diagnosis. It most commonly occurs in those under 50 years of age with thrombosis of the cerebral veins/sinuses. Diagnosis is frequently delayed. The disease can present with 1 or more clinical syndromes, including intracranial hypertension with headaches, focal neurologic deficits, seizures, and encephalopathy...
November 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28987432/abdominal-aortic-emergencies
#7
REVIEW
Christie Lech, Anand Swaminathan
This article discusses abdominal aortic emergencies. There is a common thread of risk factors and causes of these diseases, including age, male gender, hypertension, dyslipidemia, and connective tissue disorders. The most common presenting symptom of these disorders is pain, usually in the chest, flank, abdomen, or back. Computed tomography scan is the gold standard for diagnosis of pathologic conditions of the aorta in the hemodynamically stable patient. Treatment consists of a combination of blood pressure and heart rate control and, in many cases, emergent surgical intervention...
November 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28987431/spontaneous-intracerebral-hemorrhage
#8
REVIEW
Stephen Alerhand, Cappi Lay
Although commonly arising from poorly controlled hypertension, spontaneous intracerebral hemorrhage may occur secondary to several other etiologies. Clinical presentation to the emergency department ranges from headache with vomiting to coma. In addition to managing the ABCs, the crux of emergency management lies in stopping hematoma expansion and other complications to prevent clinical deterioration. This may be achieved primarily through anticoagulation reversal, blood pressure, empiric management of intracranial pressure, and early neurosurgical consultation for posterior fossa hemorrhage...
November 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28987430/subarachnoid-hemorrhage-updates-in-diagnosis-and-management
#9
REVIEW
Brit Long, Alex Koyfman, Michael S Runyon
Subarachnoid hemorrhage (SAH) is a neurologic emergency due to bleeding into the subarachnoid space. Mortality can reach 50%. The clinical presentation is most often in the form of headache, classically defined as maximal at onset and worst of life. The most common cause is traumatic; approximately 80% of nontraumatic SAH are due to aneurysmal rupture, with the remainder from idiopathic peri-mesencephalic hemorrhage or other less common causes. Noncontrast brain computed tomography (CT) performed within 6 hours of symptom onset has sensitivity approaching 100%...
November 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28987429/penetrating-vascular-injury-diagnosis-and-management-updates
#10
REVIEW
Richard Slama, Frank Villaume
Penetrating vascular injury is becoming increasingly common in the United States and abroad. Much of the current research and treatment is derived from wartime and translation to the civilian sector has been lacking. Penetrating vascular injury can be classified as extremity, junctional, or noncompressible. Diagnosis can be obvious but at other times subtle and difficult to diagnose. Although there are numerous modalities, computed tomography angiography is the diagnostic study of choice. It is hoped that care will be improved by using an algorithmic approach integrating experience from military and civilian research...
November 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28987428/vascular-access-complications-an-emergency-medicine-approach
#11
REVIEW
Erica Marie Simon, Shane Matthew Summers
Millions of central venous and arterial catheters are placed across the United States annually as mechanisms of obtaining advanced hemodynamic monitoring and facilitating acute resuscitation. Although presumably life saving or sustaining in many circumstances, current literature identifies the preprocedural and postprocedural complications of infection, thrombosis, embolism, and iatrogenic injury as resulting in patient morbidity and mortality. Today, through the application of aseptic technique, performance of operator training, and the utilization of ultrasound, emergency physicians may limit vascular access complications and improve patient outcomes...
November 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28987427/deep-venous-thrombosis
#12
REVIEW
Mark Olaf, Robert Cooney
Deep venous thrombosis (DVT) is a frequently encountered condition that is often diagnosed and treated in the outpatient setting. Risk stratification is helpful and recommended in the evaluation of DVT. An evidence-based diagnostic approach is discussed here. Once diagnosed, the mainstay of DVT treatment is anticoagulation. The specific type and duration of anticoagulation depend upon the suspected etiology of the venous thromboembolism, as well as risks of bleeding and other patient comorbidities. Both specific details and a standardized approach to this vast treatment landscape are presented...
November 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28987426/extracranial-cervical-artery-dissections
#13
REVIEW
Jennifer J Robertson, Alex Koyfman
Cervical artery dissections (CeAD) include both internal carotid and vertebral artery dissections. They are rare but important causes of stroke, especially in younger patients. CeAD should be considered in patients with strokelike symptoms, a new-onset headache and/or neck pain, and/or other risk factors. Early imaging with computed tomography (CT) or magnetic resonance imaging (MRI) is key to making the diagnosis. Treatment may vary depending on the extent of the dissection, timing of the dissection, and other comorbidities...
November 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28987425/thoracic-aortic-syndromes
#14
REVIEW
Reuben J Strayer
Aortic dissection (AD) is a lethal, treatable disruption of the aortic vessel wall. It often presents without classic features, mimicking symptoms of other conditions, and diagnosis is often delayed. Established high-risk markers of AD should be sought and indicate advanced aortic imaging with CT, MRI, or TEE. Treatment is immediate surgical evaluation, aggressive symptom relief, and reduction of the force of blood against the aortic wall by control of heart rate, followed by blood pressure.
November 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28711134/observation-medicine-providing-safe-and-cost-effective-care-beyond-the-emergency-department
#15
EDITORIAL
Christopher W Baugh, R Gentry Wilkerson
No abstract text is available yet for this article.
August 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28711133/observation-medicine
#16
EDITORIAL
Amal Mattu
No abstract text is available yet for this article.
August 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28711132/additional-conditions-amenable-to-observation-care
#17
REVIEW
Matthew A Wheatley
ED observation units (EDOUs) are designed for patients who require diagnostics or therapeutics beyond the initial ED visit to determine the need for hospital admission. Best evidence is that this care be delivered via ordersets or protocols. Occasionally, patients present with conditions that are amenable to EDOU care but fall outside the commonly used protocols. This article details a few of these conditions: abnormal uterine bleeding, allergic reaction, alcohol intoxication, acetaminophen overdose and sickle cell vaso-occlusive crisis...
August 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28711131/care-of-special-populations-in-an-observation-unit-pediatrics-and-geriatrics
#18
REVIEW
Sharon E Mace
Infants and children and the elderly comprise a large and growing (especially the elderly) segment of the US population. The benefits of observation medicine have been documented in these two age groups: Based on the success of observation medicine, and recognizing the growth of these special populations, it is likely that observation medicine will be expanding in the future, especially within the pediatric and geriatric populations. Future studies should be able to provide further evidence regarding the value of observation medicine in these two diverse population age groups...
August 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28711130/care-of-traumatic-conditions-in-an-observation-unit
#19
REVIEW
Christopher G Caspers
Patients presenting to the emergency department with certain traumatic conditions can be managed in observation units. The evidence base supporting the use of observation units to manage injured patients is smaller than the evidence base supporting the management of medical conditions in observation units. The conditions that are eligible for management in an observation unit are not limited to those described in this article, and investigators should continue to identify types of conditions that may benefit from this type of health care delivery...
August 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28711129/care-of-infectious-conditions-in-an-observation-unit
#20
REVIEW
Pawan Suri, Taruna K Aurora
Infectious conditions such as skin and soft tissue infections (SSTIs), Urogenital infections and peritonsillar abscesses frequently require care beyond emergency stabilization and are well-suited for short term care in an observation unit. SSTIs are a growing problem, partly due to emergence of strains of methicillin-resistant S. aureus (MRSA). Antibiotic choice is guided by the presence of purulence and site of infection. Purulent cellulitis is much more likely to be associated with MRSA. Radiographic imaging should be considered to aid in management in patients who are immunosuppressed, have persistent symptoms despite antibiotic therapy, recurrent infections, sepsis or diabetes...
August 2017: Emergency Medicine Clinics of North America
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