collection
https://read.qxmd.com/read/31757249/the-emergent-evaluation-and-treatment-of-neck-and-back-pain
#1
REVIEW
Brian N Corwell, Natalie L Davis
Neck and back pain are among the most common symptom-related complaints for visits to the emergency department (ED). They contribute to high levels of lost work days, disability, and health care use. The goal of ED assessment of patients with neck and back pain is to evaluate for potentially dangerous causes that could result in significant morbidity and mortality. This article discusses the efficient and effective evaluation, management, and treatment of patients with neck and back pain in the ED. Emphasis is placed on vertebral osteomyelitis, epidural abscess, acute transverse myelitis, epidural compression syndrome, spinal malignancy, and spinal stenosis...
February 2020: Emergency Medicine Clinics of North America
https://read.qxmd.com/read/32981616/postarrest-interventions-that-save-lives
#2
REVIEW
Alexis Steinberg, Jonathan Elmer
Patients resuscitated from cardiac arrest require complex management. An organized approach to early postarrest care can improve patient outcomes. Priorities include completing a focused diagnostic work-up to identify and reverse the inciting cause of arrest, stabilizing cardiorespiratory instability to prevent rearrest, minimizing secondary brain injury, evaluating the risk and benefits of transfer to a specialty care center, and avoiding early neurologic prognostication.
November 2020: Emergency Medicine Clinics of North America
https://read.qxmd.com/read/32981617/fluid-resuscitation-history-physiology-and-modern-fluid-resuscitation-strategies
#3
REVIEW
David Gordon, Rory Spiegel
Intravenous (IV) fluids are among the most common interventions performed in the emergency department. They are at times lifesaving, but if used recklessly can be harmful. Given their ubiquity, it is important to understand the history, physiology, and current strategies that govern the use of IV fluids during the resuscitation of the critically ill.
November 2020: Emergency Medicine Clinics of North America
https://read.qxmd.com/read/32981618/emergency-transfusions
#4
REVIEW
Michael S Farrell, Woon Cho Kim, Deborah M Stein
Successful emergency transfusions require early recognition and activation of resources to minimize treatment delays. The initial goals should focus on replacement of blood in a balanced fashion. There is an ongoing debate regarding the best approach to transfusions, with some advocating for resuscitation with a fixed ratio of blood products and others preferring to use viscoelastic assays to guide transfusions. Whole-blood transfusion also is a debated strategy. Despite these different approaches, it generally is accepted that transfusions should be started early and crystalloid infusions limited...
November 2020: Emergency Medicine Clinics of North America
https://read.qxmd.com/read/32981619/updates-in-sepsis-resuscitation
#5
REVIEW
Timothy Ellender, Nicole Benzoni
Sepsis care has evolved significantly since the initial early goal-directed therapy (EGDT) trials. Early fluid resuscitation, source control, and antibiotic therapy remain cornerstones of care but overall understanding is more nuanced, particularly regarding fluid selection, vasopressors, and inotropic support. Timely nutrition therapy and ventilatory support tend to receive less attention but also are important. Recent research has explored immunomodulation, β-blockade, and vitamin supplementation. A renewed emphasis on early, aggressive resuscitation reaffirms the importance of emergency medicine providers knowledgeable and skilled in sepsis management...
November 2020: Emergency Medicine Clinics of North America
https://read.qxmd.com/read/32981623/massive-gastrointestinal-hemorrhage
#6
REVIEW
Katrina D'Amore, Anand Swaminathan
Massive gastrointestinal hemorrhage is a life-threatening condition that can result from numerous causes and requires skilled resuscitation to decrease patient morbidity and mortality. Successful resuscitation begins with placement of large-bore intravenous or intraosseous access; early blood product administration; and early consultation with a gastroenterologist, interventional radiologist, and/or surgeon. Activate a massive transfusion protocol when initial red blood cell transfusion does not restore effective perfusion or the patient's shock index is greater than 1...
November 2020: Emergency Medicine Clinics of North America
https://read.qxmd.com/read/32981622/the-crashing-obese-patient
#7
REVIEW
Sara Manning
The obesity pandemic now affects hundreds of millions of people worldwide. As obesity rates continue to increase, emergency physicians are called on with increasing frequency to resuscitate obese patients. This article discusses important anatomic, physiologic, and practical challenges imposed by obesity on resuscitative care. Impacts on hemodynamic monitoring, airway and ventilator management, and pharmacologic therapy are discussed. Finally, several important clinical scenarios (trauma, cardiac arrest, and sepsis), in which alterations to standard treatments may benefit obese patients, are highlighted...
November 2020: Emergency Medicine Clinics of North America
https://read.qxmd.com/read/31295763/avoiding-misdiagnosis-in-patients-with-posterior-circulation-ischemia-a-narrative-review
#8
REVIEW
Kiersten L Gurley, Jonathan A Edlow
Posterior circulation strokes represent 20% of all acute ischemic strokes. Posterior circulation stroke patients are misdiagnosed twice as often compared to those with anterior events. Misdiagnosed patients likely have worse outcomes than correctly diagnosed patients because they are at risk for complications of the initial stroke as well as recurrent events due to lack of secondary stroke prevention and failure to treat the underlying vascular pathology. Understanding important anatomic variants, the clinical presentations, relevant physical examination findings, and the limitations of acute brain imaging may help reduce misdiagnosis...
November 2019: Academic Emergency Medicine
https://read.qxmd.com/read/31251423/factors-predicting-difficult-endotracheal-intubation
#9
JOURNAL ARTICLE
Brit Long, Alex Koyfman, Michael Gottlieb
No abstract text is available yet for this article.
November 2019: Academic Emergency Medicine
https://read.qxmd.com/read/30732981/clinical-practice-guideline-for-emergency-department-procedural-sedation-with-propofol-2018-update
#10
JOURNAL ARTICLE
Kelsey A Miller, Gary Andolfatto, James R Miner, John H Burton, Baruch S Krauss
We update an evidence-based clinical practice guideline for the administration of propofol for emergency department procedural sedation. Both the unique considerations of using this drug in the pediatric population and the substantial new research warrant revision of the 2007 advisory. We discuss the indications, contraindications, personnel requirements, monitoring, dosing, coadministered medications, and adverse events for propofol sedation.
May 2019: Annals of Emergency Medicine
https://read.qxmd.com/read/30579941/early-management-of-severe-pelvic-injury-first-24-hours
#11
REVIEW
Pascal Incagnoli, Alain Puidupin, Sylvain Ausset, Jean Paul Beregi, Jacques Bessereau, Xavier Bobbia, Julien Brun, Elodie Brunel, Clément Buléon, Jacques Choukroun, Xavier Combes, Jean Stephane David, François-Régis Desfemmes, Delphine Garrigue, Jean-Luc Hanouz, Isabelle Plénier, Fréderic Rongieras, Benoit Vivien, Tobias Gauss, Anatole Harrois, Pierre Bouzat, Eric Kipnis
OBJECTIVE: Pelvic fractures represent 5% of all traumatic fractures and 30% are isolated pelvic fractures. Pelvic fractures are found in 10 to 20% of severe trauma patients and their presence is highly correlated to increasing trauma severity scores. The high mortality of pelvic trauma, about 8 to 15%, is related to actively bleeding pelvic injuries and/or associated injuries to the head, abdomen or chest. Regardless of the severity of pelvic trauma, diagnosis and treatment must proceed according to a strategy that does not delay the management of the most severely injured patients...
April 2019: Anaesthesia, Critical Care & Pain Medicine
https://read.qxmd.com/read/29622326/what-to-do-when-babies-turn-blue-beyond-the-basic-brief-resolved-unexplained-event
#12
REVIEW
Anna McFarlin
The term "brief resolved unexplained event" was created to replace "apparent life-threatening event," narrowing the definition and providing evidence-based guidelines for management. The emphasis is placed on using clinical clues to classify patients as low risk or exclude them from the categorization altogether. Infants who meet low-risk classification can be briefly observed in the emergency department and be discharged home. Infants who demonstrate elements suggestive of a specific etiology should be evaluated and treated accordingly...
May 2018: Emergency Medicine Clinics of North America
https://read.qxmd.com/read/29622332/emergency-department-management-of-pediatric-shock
#13
REVIEW
Jenny Mendelson
Shock, a state of inadequate oxygen delivery to tissues resulting in anaerobic metabolism, lactate accumulation, and end-organ dysfunction, is common in children in emergency department. Shock can be divided into 4 categories: hypovolemic, distributive, cardiogenic, and obstructive. Early recognition of shock can be made with close attention to historical clues, physical examination and vital sign abnormalities. Early and aggressive treatment can prevent or reverse organ dysfunction and improve morbidity and mortality...
May 2018: Emergency Medicine Clinics of North America
https://read.qxmd.com/read/29622333/emergency-care-of-pediatric-burns
#14
REVIEW
Ashley M Strobel, Ryan Fey
Although the overall incidence of and mortality rate associated with burn injury have decreased in recent decades, burns remain a significant source of morbidity and mortality in children. Children with major burns require emergent resuscitation. Resuscitation is similar to that for adults, including pain control, airway management, and administration of intravenous fluid. However, in pediatrics, fluid resuscitation is needed for burns greater than or equal to 15% of total body surface area (TBSA) compared with burns greater than or equal to 20% TBSA for adults...
May 2018: Emergency Medicine Clinics of North America
https://read.qxmd.com/read/29622335/pediatric-thoracic-trauma-recognition-and-management
#15
REVIEW
Stacy L Reynolds
Thoracic injuries account for less than one-tenth of all pediatric trauma-related injuries but comprise 14% of pediatric trauma-related deaths. Thoracic trauma includes injuries to the lungs, heart, aorta and great vessels, esophagus, tracheobronchial tree, and structures of the chest wall. Children have unique anatomic features that change the patterns of observed injury compared with adults. This review article outlines the clinical presentation, diagnostic testing, and management principles required to successfully manage injured children with thoracic trauma...
May 2018: Emergency Medicine Clinics of North America
https://read.qxmd.com/read/29622334/pediatric-major-head-injury-not-a-minor-problem
#16
REVIEW
Aaron N Leetch, Bryan Wilson
Traumatic brain injury is a highly prevalent and devastating cause of morbidity and mortality in children. A rapid, stepwise approach to the traumatized child should proceed, addressing life-threatening problems first. Management focuses on preventing secondary injury from physiologic extremes such as hypoxemia, hypotension, prolonged hyperventilation, temperature extremes, and rapid changes in cerebral blood flow. Initial Glasgow Coma Score, hyperglycemia, and imaging are often prognostic of outcome. Surgically amenable lesions should be evacuated promptly...
May 2018: Emergency Medicine Clinics of North America
https://read.qxmd.com/read/30037445/anticoagulation-reversal
#17
REVIEW
Erica M Simon, Matthew J Streitz, Daniel J Sessions, Colin G Kaide
Today a variety of anticoagulants and antiplatelet agents are available on the market. Given the propensity for bleeding among patients prescribed these medications, the emergency medicine physician must be equipped with a working knowledge of hemostasis, and anticoagulant and antiplatelet reversal. This article reviews strategies to address bleeding complications occurring secondary to warfarin, low-molecular-weight heparin, and direct oral anticoagulant therapy.
August 2018: Emergency Medicine Clinics of North America
https://read.qxmd.com/read/30297002/musculoskeletal-infections-in%C3%A2-the%C3%A2-emergency-department
#18
REVIEW
Daniel C Kolinsky, Stephen Y Liang
Bone and joint infections are potentially limb-threatening or even life-threatening diseases. Emergency physicians must consider infection when evaluating musculoskeletal complaints, as misdiagnosis can have significant consequences. Patients with bone and joint infections can have heterogeneous presentations with nonspecific signs and symptoms. Staphylococcus aureus is the most commonly implicated microorganism. Although diagnosis may be suggested by physical examination, laboratory testing, and imaging, tissue sampling for Gram stain and microbiologic culture is preferable, as pathogen identification and susceptibility testing help optimize long-term antibiotic therapy...
November 2018: Emergency Medicine Clinics of North America
https://read.qxmd.com/read/30297001/skin-and-soft-tissue-infections-in-the-emergency-department
#19
REVIEW
Amelia Breyre, Bradley W Frazee
This article covers the diagnosis and treatment of skin and soft tissue infections commonly encountered in the emergency department: impetigo, cutaneous abscesses, purulent cellulitis, nonpurulent cellulitis, and necrotizing skin and soft tissue infections. Most purulent infections in the United States are caused by methicillin-resistant Staphylococcus aureus. For abscesses, we emphasize the importance of incision and drainage. Nonpurulent infections are usually caused by streptococcal species and initial empiric antibiotics need not cover methicillin-resistant Staphylococcus aureus...
November 2018: Emergency Medicine Clinics of North America
https://read.qxmd.com/read/30297003/management-of-patients-with-sexually-transmitted-infections-in-the-emergency-department
#20
REVIEW
SueLin M Hilbert, Hilary E L Reno
Sexually transmitted infections (STI) are very common infections in the United States. Most patients with STIs are evaluated and treated in primary care settings; however, many also present to the Emergency Department (ED) for initial care. Management of STIs in the ED includes appropriate testing and treatment per CDC Sexually Transmitted Diseases Treatment Guidelines. Although most patients with STIs are asymptomatic or may only exhibit mild symptoms, serious complications from untreated infection are possible...
November 2018: Emergency Medicine Clinics of North America
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