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Emergency Medicine Practice

Julianna Jung
Patient survival after cardiac arrest can be improved significantly with prompt and effective resuscitative care. This systematic review analyzes the basic life support factors that improve survival outcome, including chest compression technique and rapid defibrillation of shockable rhythms. For patients who are successfully resuscitated, comprehensive postresuscitation care is essential. Targeted temperature management is recommended for all patients who remain comatose, in addition to careful monitoring of oxygenation, hemodynamics, and cardiac rhythm...
October 2016: Emergency Medicine Practice
Gillian A Beauchamp, Matthew Valento
Identifying patients with potential toxic alcohol exposure and initiating appropriate management is critical to avoid significant patient morbidity. Sources of toxic alcohol exposure include ethylene glycol, methanol, diethylene glycol, propylene glycol, and isopropanol. Treatment considerations include the antidotes fomepizole and ethanol, and hemodialysis for removal of the parent compound and its toxic metabolites. Additional interventions include adjunctive therapies that may improve acidosis and enhance clearance of the toxic alcohol or metabolites...
September 2016: Emergency Medicine Practice
Jeremy Samuel Faust, Andreea Nemes
Transient global amnesia is a clinically distinct syndrome characterized by the acute inability to form new memories. It can last up to 24 hours. The diagnosis is dependent on eliminating other more serious etiologies including toxic ingestions, acute strokes, complex partial seizures, and central nervous system infections. Transient global amnesia confers no known long-term risks; however, when abnormal signs or symptoms are present, they take precedence and guide the formulation of a differential diagnosis and investigation...
August 2016: Emergency Medicine Practice
Rhonda Cadena
Cervical artery dissections involve the carotid or vertebral arteries. Although the overall incidence is low, they remain a common cause of stroke in children, young adults, and trauma patients. Symptoms such as headache, neck pain, and dizziness are commonly seen in the emergency department, but may not be apparent in the obtunded trauma patient. A missed diagnosis of cervical artery dissection can result in devastating neurological sequelae, so emergency clinicians must act quickly to recognize this event and begin treatment as soon as possible while neurological consultation is obtained...
July 2016: Emergency Medicine Practice
Eric J Morley, Scott Johnson, Evan Leibner, Jawad Shahid
The majority of blunt chest injuries are minor contusions or abrasions; however, life-threatening injuries, including tension pneumothorax, hemothorax, and aortic rupture can occur and must be recognized early. This review focuses on the diagnosis, management, and disposition of patients with blunt injuries to the ribs and lung. Utilization of decision rules for chest x-ray and computed tomography are discussed, along with the emerging role of bedside lung ultrasonography. Management controversies presented include the limitations of needle thoracostomy us¬ing standard needle, chest tube placement, and chest tube size...
June 2016: Emergency Medicine Practice
Rachel S Wightman, Kevin B Read, Robert S Hoffman
Caustics are common in household and industrial products, and, when ingested, they can pose a significant public health risk. Caustic exposures in adults typically present in the setting of occupational exposure or suicide attempt; exposures in children occur most often by unintentional ingestion. Caustics cause local damage upon contact with tissue surfaces and can lead to systemic toxicity. Endoscopy is recommended in all intentional ingestions (and many unintentional ingestions) to grade injury severity, determine treatment options, and assess prognosis; however, it is generally best performed within 24 hours post ingestion to avoid risk of perforation...
May 2016: Emergency Medicine Practice
Mary Ann Edens, Jose A Michel, Nathaniel Jones
Half of all Americans will experience a mammalian bite at some time in their life, and the cost of caring for these injuries has reached $160 million annually. Emergency clinicians must consider many factors when making decisions regarding care of these injuries: risk of infection, cost of antibiotics, time of wound healing, cosmetic and functional result, and risk of other injuries or diseases. Knowledge of the current literature and practice guidelines facilitates care for these injuries in the most cost-effective and clinically sound manner...
April 2016: Emergency Medicine Practice
Nadia Maria Shaukat, Nikolai Copeli, Poonam Desai
Pelvic trauma accounts for only 3% of all skeletal injuries but may have mortality as high as 45% in cases of severe trauma. Significant high-grade-mechanism trauma to the pelvis must always take the abdomen into consideration for evaluation. The focused assessment with sonography for trauma (FAST) examination has been shown to be a valuable tool in assessing the unstable trauma patient with blunt abdominal injury, though its diagnostic utility is much less well-defined than in primary pelvic trauma. This systematic review explores the utility and limitations of the FAST examination in patients with blunt pelvic trauma and discusses the timing for the examination during the trauma survey...
March 2016: Emergency Medicine Practice
David L Gutteridge, Daniel J Egan
The care of the HIV-infected patient in the emergency department has changed since the development of highly active antiretroviral therapy. This therapy has resulted in longer life expectancies and increased quality of life for HIV-infected patients, and in cases of treatment compliance and success, virtual elimination of AIDS-associated opportunistic infections. As a result, the emergency clinician is now more often confronted with adverse events related to medication and the diseases associated with aging and chronic disease...
February 2016: Emergency Medicine Practice
Megan L Rischall, Andrea Rowland-Fisher
Accidental hypothermia is defined as an unintentional drop in core body temperature below 35°C. It can present in any climate and in any season, as it is not always a result of environmental exposure; underlying illnesses or coexisting pathology can play important roles. Although there is some variability in clinical presentation, hypothermia produces a predictable pattern of physiologic responses and clinical manifestations, and effective treatment has yielded many impressive survival case reports. Treatment strategies focus on prevention of further heat loss, volume resuscitation, implementation of appropriate rewarming techniques, and management of cardiac dysrhythmia...
January 2016: Emergency Medicine Practice
Natalie Kreitzer, Opeolu Adeoye
Spontaneous intracerebral hemorrhage is a true neurological emergency, and its management is made more complicated when patients are anticoagulated, as reversal of anticoagulation must be initiated simultaneously with diagnosis, treatment, and disposition. Recent advances such as newer laboratory testing and rapid computed tomography for diagnosis, blood pressure reduction to reduce hematoma expansion, and new anticoagulant reversal agents may allow for improved outcomes. Management of intracranial pressure is particularly important in anticoagulated patients, as is identifying patients who may benefit from rapid neurosurgical intervention and/or emergent transport to facilities capable of managing this disease...
December 2015: Emergency Medicine Practice
Anne M Messman
Ocular injuries are common in the emergency department, and they are the most frequent cause of noncongenital monocular blindness in children and adults. This review provides evidence-based recommendations for the diagnosis, treatment, and disposition of patients with all types of ocular trauma, including pain management, the use of antibiotics, cycloplegics, steroids, antifibrinolytics, and patching. Bedside ocular ultrasound has profoundly expanded diagnostic capability, particularly for the multiply injured patient, and routine management and disposition of patients with corneal abrasions has evolved significantly as well...
November 2015: Emergency Medicine Practice
Nelson Wong, Gallane Abraham
Delirium represents the complex junction between vulnerable patients, medical conditions, and environmental factors. Given the varied presentations of this disorder and the emergency department clinical environment, recognition and treatment may be challenging. Delirium can be diagnosed using validated standardized screening tools such as the Confusion Assessment Method. Management of delirium is directed towards rapidly treating the underlying medical condition while preventing and managing the behavioral symptoms with nonpharmacological (first-line) and pharmacological (second-line) interventions...
October 2015: Emergency Medicine Practice
Amy F Hildreth, Sukhjit Takhar, Mark Andrew Clark, Benjamin Hatten
Pharyngitis is a common presentation, but it can also be associated with life-threatening processes, including sepsis and airway compromise. Other conditions, such as thyroid disease and cardiac disease, may mimic pharyngitis. The emergency clinician must sort through the broad differential for this complaint using a systematic approach that protects against early closure of the diagnosis. This issue reviews the various international guidelines for pharyngitis and notes controversies in diagnostic and treatment strategies, specifically for management of suspected bacterial, viral, and fungal etiology...
September 2015: Emergency Medicine Practice
Elizabeth Singer, David Zodda
Allergic reactions and anaphylaxis are potentially life-threatening processes that present with a variety of clinical symptoms. Emergency clinicians must be able to recognize these presentations and make prompt clinical decisions regarding management of a patient's airway, treatment options, and disposition of a patient who improves after initial presentation. Furthermore, emergency clinicians may be faced with patients who have atypical presentations or require special consideration, such as high-risk patients with comorbid conditions and patients who do not respond to first-line treatments...
August 2015: Emergency Medicine Practice
Ian S deSouza, Alanna C Peterson, Keith A Marill
Wide-complex tachycardia is a rare disease entity among patients presenting to the emergency department. However, due to its potential life-threatening nature, emergency clinicians must know how to assess and manage this condition. Wide-complex tachycardia encompasses a range of cardiac dysrhythmias, some of which can be difficult to distinguish and may require specific treatment approaches. This review summarizes the etiology and pathophysiology of wide-complex tachycardia, describes the differential diagnosis, and presents an evidence-based approach to identification of the different types of tachycardias through the use of a thorough history and physical examination, vagal maneuvers, electrocardiography, and adenosine...
July 2015: Emergency Medicine Practice
Joseph H Yanta, Greg S Swartzentruber, Anthony F Pizon
Alcoholism is a prevalent medical and psychiatric disease, and, consequently, alcohol withdrawal is encountered frequently in the emergency department. This issue reviews the pathophysiology of the alcohol withdrawal syndrome, describes the 4 manifestations of alcohol withdrawal, and looks at the available evidence for optimal treatment of alcohol withdrawal in its diverse presentations. Patients commonly manifest hyperadrenergic signs and symptoms, necessitating admission to the intensive care unit, intravenous benzodiazepines, and, frequently, adjunctive pharmacotherapy...
June 2015: Emergency Medicine Practice
Andrew Schmidt, Justin Sempsrott
Drowning is a global problem that affects all populations. The events leading up to and the sequelae from a drowning incident vary greatly based on numerous factors, but the primary physiologic insult is always hypoxia. This is the starting point for all morbidity and mortality, and it must remain the focus of treatment. This issue discusses the initial resuscitation and treatment of adult drowning patients in the emergency department. Primary focus is placed on the key components of pathophysiology that require immediate attention...
May 2015: Emergency Medicine Practice
Matthew DeLaney, Christopher James Greene
Upper gastrointestinal bleeding results from a variety of conditions that may vary in severity from merely bothersome to imminently life-threatening. While stabilization is standard for nearly all causes of bleeding, identifying whether the bleed is from variceal or nonvariceal sources is critical. Testing and treatments such as nasogastric lavage, antibiotics, somatostatin analogues, proton pump inhibitors, and emergent endoscopy may benefit some patients, depending upon the bleeding source and other clinical factors; however, some therapies that are routinely used have very little evidence demonstrating effectiveness...
April 2015: Emergency Medicine Practice
Kar-Mun C Woo, Jacob K Goertz
Although the clinical presentations of deep venous thrombosis are notoriously subtle and nonspecific, risk stratification tools such as the Wells clinical model have improved the efficiency of the diagnostic evaluation. The emergency clinician may be guided down several pathways, including D-dimer assays and/ or ultrasonography. New oral anticoagulants offer alternatives to the traditional heparins and vitamin K antagonists in the treatment of deep venous thrombosis. This review examines the current literature, evidence, and guidelines in the diagnosis and management of deep venous thrombosis...
March 2015: Emergency Medicine Practice
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