MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Emergency Medicine Clinics of North America' source. Sat, 20 Mar 2010 14:11:15 +0100 http://www.medworm.com/index.php?rid=3041278&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001473%2Fabstract%3Frss%3Dyes (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3041278 Tue, 01 Dec 2009 14:43:34 +0100 3041278 http://www.medworm.com/index.php?rid=3041277&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001242%2Fabstract%3Frss%3Dyes This article highlights potentially high-risk situations and describes corresponding mitigation tactics. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3041277 Tue, 01 Dec 2009 14:43:34 +0100 3041277 http://www.medworm.com/index.php?rid=3041276&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001230%2Fabstract%3Frss%3Dyes The focus of this article is first-trimester bleeding. Vaginal bleeding during the first 3 months of pregnancy is a common event. It is important that the emergency physicians recognize patients with vaginal bleeding who may have an adverse outcome if misdiagnosed or not treated appropriately in the emergency department. Causes of first-trimester vaginal bleeding include implantation bleeding, spontaneous abortions, ectopic pregnancy, and lesions involving the female reproductive system and perineal area infections. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3041276 Tue, 01 Dec 2009 14:43:34 +0100 3041276 http://www.medworm.com/index.php?rid=3041275&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001229%2Fabstract%3Frss%3Dyes There are few conditions in emergency medicine as potentially challenging and high-risk as the difficult or failed airway. The emergency physician must be able to anticipate the difficult or failed airway, recognize associated physiologic deficits, and plan accordingly. Preparation, pretreatment strategies, and selection of alternative airway devices may mitigate the potential morbidity and management failure associated with the high-risk airway. There are a myriad of airway devices new to emergency medicine, which can increase the chance of successful airway management and rescue. Understanding why the airway is potentially difficult and assessing whether oxygenation can be maintained can guide the clinician's strategy and technique for successful management of the high-risk airway. (Sour... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3041275 Tue, 01 Dec 2009 14:43:34 +0100 3041275 http://www.medworm.com/index.php?rid=3041274&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001205%2Fabstract%3Frss%3Dyes Risk stratification and management of the patient with low-risk chest pain continues to be challenging despite the considerable effort of numerous investigators. Evidence exists that a specific subset of young patients can be defined as low risk in whom further testing may not be necessary. A high index of suspicion of acute coronary syndrome (ACS) and an understanding of the many, subtle, and atypical presentations of ischemic heart disease are required. The initial history, electrocardiogram (ECG), and biomarkers are important, but serial ECGs and biomarkers improve sensitivity in detecting ACS. Unless chest pain is clearly explained, objective testing, such as exercise treadmill testing, nuclear scintigraphy, stress echocardiography, or coronary computed tomography angiogram, should be ... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3041274 Tue, 01 Dec 2009 14:43:34 +0100 3041274 http://www.medworm.com/index.php?rid=3041273&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001187%2Fabstract%3Frss%3Dyes This article illustrates the challenges practitioners face evaluating shortness of breath, a common emergency department complaint. Through a series of patient encounters, pitfalls in the evaluation of shortness of breath are reviewed and discussed. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3041273 Tue, 01 Dec 2009 14:43:34 +0100 3041273 http://www.medworm.com/index.php?rid=3041272&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001163%2Fabstract%3Frss%3Dyes This article describes select antidotes, and discusses their indications and potential pitfalls. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3041272 Tue, 01 Dec 2009 14:43:34 +0100 3041272 http://www.medworm.com/index.php?rid=3041271&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS073386270900114X%2Fabstract%3Frss%3Dyes Headache is the fifth most common primary complaint of patients presenting to an emergency department (ED) in the United States. The emergency physician (EP) plays a unique role in the management of these patients, one that differs from that of the primary care physician, the neurologist, and other specialists. Diagnostic nomenclature used in the ED is necessarily less specific, as care is more appropriately focused on the relief of symptoms and the identification of life-threatening causes. By seeking a limited number of specific critical features on history and physical examination, the EP can minimize the risk of overlooking one of these dangerous causes of headache. When certain features are present, empirical therapies and diagnostic testing should be initiated in the ED. The most fre... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3041271 Tue, 01 Dec 2009 14:43:34 +0100 3041271 http://www.medworm.com/index.php?rid=3041270&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001126%2Fabstract%3Frss%3Dyes This article discusses the diagnosis and management of common and uncommon conditions in infants and children who may present with airway obstruction. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3041270 Tue, 01 Dec 2009 14:43:34 +0100 3041270 http://www.medworm.com/index.php?rid=3041269&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001102%2Fabstract%3Frss%3Dyes This article discusses the value of presenting signs, symptoms, laboratory testing, and the rational use of various imaging modalities, such as CT scanning and ultrasound. Challenges of special populations, such as children, the elderly, and pregnant patients, are also discussed. Although appendicitis continues to be a source of medical legal risk and misdiagnosis, a clear understanding of the strengths and limitations of all tests in suspected appendicitis can improve the emergency physician's diagnostic accuracy in this high-risk disease. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3041269 Tue, 01 Dec 2009 14:43:34 +0100 3041269 http://www.medworm.com/index.php?rid=3041268&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001151%2Fabstract%3Frss%3Dyes This article focuses on key diagnoses that are frequently mismanaged. These diagnoses require specific knowledge to execute appropriate treatment. Pediatric fractures, compartmental syndrome, bone and joint infection, limp and non-accidental trauma are reviewed. Approach to the workup of these patients and treatment algorithms are discussed. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3041268 Tue, 01 Dec 2009 14:43:34 +0100 3041268 http://www.medworm.com/index.php?rid=3041267&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001096%2Fabstract%3Frss%3Dyes Fever is defined as a rectal temperature greater than 38.0°C (>100.4°F). A recently documented fever at home should be considered the same as a fever in the ED and should be managed similarly. All febrile infants younger than 28 days should receive a “full sepsis workup” and be admitted for parenteral antibiotic therapy. Clinical and laboratory criteria can be used to identify a low-risk population of febrile infants aged 1 to 4 months who have not received 2 doses of conjugate vaccines for bacterial meningitis. Children with sickle cell disease are at high risk and require special evaluation. MRSA infections are now common and should be considered in all patients with pyoderma, severe pneumonia, and catheter-related sepsis. HSV infection of the CNS should be considered whenever a p... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3041267 Tue, 01 Dec 2009 14:43:34 +0100 3041267 http://www.medworm.com/index.php?rid=3041266&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001138%2Fabstract%3Frss%3Dyes This article reviews the physiologic definition of shock, the importance of early intervention, and the clinical and diagnostic signs that emergency department providers can use to identify patients in shock. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3041266 Tue, 01 Dec 2009 14:43:34 +0100 3041266 http://www.medworm.com/index.php?rid=3041265&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001175%2Fabstract%3Frss%3Dyes The RUSH exam (Rapid Ultrasound in SHock examination), presented in this article, represents a comprehensive algorithm for the integration of bedside ultrasound into the care of the patient in shock. By focusing on a stepwise evaluation of the shock patient defined here as “Pump, Tank, and Pipes,” clinicians will gain crucial anatomic and physiologic data to better care for these patients. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3041265 Tue, 01 Dec 2009 14:43:34 +0100 3041265 http://www.medworm.com/index.php?rid=3041264&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001199%2Fabstract%3Frss%3Dyes The management of the trauma patient presents the practitioner with a host of challenges, and the pace, variety of venues, and multidisciplinary nature of the field combine to create a system complexity that is laden with potential pitfalls. This review summarizes some of the general principles of medical errors and examines some of the more common pitfalls encountered in the initial resuscitation and evaluation of the major trauma patient. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3041264 Tue, 01 Dec 2009 14:43:33 +0100 3041264 http://www.medworm.com/index.php?rid=3041263&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001382%2Fabstract%3Frss%3Dyes Every specialty has its high-risk diagnoses, but emergency medicine is its own high-risk diagnosis—doctoring performed emergently and with limited information carries increased risk for provider and patient. Long-term patient relationships in the emergency department are measured in hours and critical decisions made in a fraction of a second. There are sudden sporadic surges in patient volume and acuity, and the majority of care (76%) is delivered during “off hours.” Patient-physician communication may be limited by logistics or linguistics, inebriation or intoxication, time constraints or bizarre complaints. In other words, some would argue that emergency medicine and “high-risk” medicine are redundant terms. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3041263 Tue, 01 Dec 2009 14:43:33 +0100 3041263 http://www.medworm.com/index.php?rid=3041262&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001370%2Fabstract%3Frss%3Dyes A common teaching in emergency medicine is that the first goal in patient evaluation is to rule out the worst possible condition. Once this goal has been accomplished, whether by history and physical examination alone or with additional testing, one can then proceed to evaluate the patient for the non–life threats and consider discharging the patient for outpatient follow-up. To rule out these high-risk conditions, however, the treating health care provider must first have a sound knowledge of what the life-threats are, the typical and (especially) the atypical presentations of these conditions, and their optimal treatment modalities. The provider must also be aware of the common pitfalls that may occur during the evaluation and treatment process: To avoid a trap, one must first know wha... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3041262 Tue, 01 Dec 2009 14:43:33 +0100 3041262 http://www.medworm.com/index.php?rid=3041261&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001515%2Fabstract%3Frss%3Dyes (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3041261 Tue, 01 Dec 2009 14:43:33 +0100 3041261 http://www.medworm.com/index.php?rid=3041260&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS073386270900145X%2Fabstract%3Frss%3Dyes (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3041260 Tue, 01 Dec 2009 14:43:33 +0100 3041260 http://www.medworm.com/index.php?rid=3041259&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001448%2Fabstract%3Frss%3Dyes (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3041259 Tue, 01 Dec 2009 14:43:33 +0100 3041259 http://www.medworm.com/index.php?rid=3020309&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001333%2Fabstract%3Frss%3Dyes (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3020309 Sun, 01 Nov 2009 00:00:00 +0100 3020309 http://www.medworm.com/index.php?rid=3020308&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001072%2Fabstract%3Frss%3Dyes Emergency physicians care for a high volume of critically ill and injured patients, generally with no prior knowledge of patients' histories and, usually, with little or no warning of patients' arrival. Despite the careful, knowledgeable, compassionate practice of most emergency physicians, bad outcomes will occur. There is no way to completely avoid being named in a malpractice suit because a patient, patient's family, or patient's estate may sue despite the emergency physician's best efforts. However, there are some principles that may help minimize adverse outcomes and avoid litigation. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3020308 Sun, 01 Nov 2009 00:00:00 +0100 3020308 http://www.medworm.com/index.php?rid=3020307&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS073386270900073X%2Fabstract%3Frss%3Dyes This article provides an overview of the diagnosis and management of several high-risk abdominal and extremity complaints, including appendicitis, abdominal aortic aneurysm, mesenteric ischemia, bowel obstruction, retained foreign body, hand and finger lacerations, fractures, and compartment syndrome. Each section focuses primarily on the pitfalls in diagnosis by highlighting the limitations of history, physical examination findings, and diagnostic testing and provides specific risk management strategies. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3020307 Sun, 01 Nov 2009 00:00:00 +0100 3020307 http://www.medworm.com/index.php?rid=3020306&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001047%2Fabstract%3Frss%3Dyes This article addresses some of the high-risk chief complaints of the head and neck regarding diagnosis and management. These complaints include headache, seizure, acute focal neurologic deficits, throat and neck pain, ocular emergencies, and the difficult airway. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3020306 Sun, 01 Nov 2009 00:00:00 +0100 3020306 http://www.medworm.com/index.php?rid=3020305&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000741%2Fabstract%3Frss%3Dyes Chest pain is one of the most frequently seen chief complaints in patients presenting to emergency departments, and is considered to be a “high-risk” chief complaint. The differential diagnosis for chest pain is broad, and potential causes range from the benign to the immediately life-threatening. Although many (if not most) emergency department patients with chest pain do not have an immediately life-threatening condition, correct diagnoses can be difficult to make, incorrect diagnoses may lead to catastrophic therapies, and failure to make a timely diagnosis may contribute to significant morbidity and mortality. Several atraumatic “high-risk” causes of chest pain are discussed in this article, including myocardial infarction and ischemia, thoracic aortic dissection, and pulmonary... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3020305 Sun, 01 Nov 2009 00:00:00 +0100 3020305 http://www.medworm.com/index.php?rid=3020304&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000728%2Fabstract%3Frss%3Dyes Patients presenting to the emergency department (ED) with behavioral disturbances account for approximately 6% of all ED visits. Emergency physicians are often responsible for the initial assessment of these patients' psychiatric complaints, which might include homicidal and suicidal behavior and acute psychosis. The emergency physician might be asked to provide medical clearance before transfer to definitive psychiatric care. The purpose of the medical screening is to identify medical conditions that might be causing or contributing to the psychiatric emergency or that might be dangerous or inappropriate to treat in a psychiatric facility. Appropriate treatment in the ED is essential to avoid morbidity and mortality resulting from misdiagnosis of medical conditions as psychiatric illnesse... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3020304 Sun, 01 Nov 2009 00:00:00 +0100 3020304 http://www.medworm.com/index.php?rid=3020303&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000704%2Fabstract%3Frss%3Dyes This article examines these techniques and the need for and risks of physical and chemical restraints in managing patients in the emergency department. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3020303 Sun, 01 Nov 2009 00:00:00 +0100 3020303 http://www.medworm.com/index.php?rid=3020302&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000753%2Fabstract%3Frss%3Dyes This article focuses on the unique environment of the emergency department (ED) and the issues that place the provider at increased risk of liability actions. Patient care, quality, and safety should always be the primary focus of ED providers. However, the ED chart is the only lasting record of an ED visit, and attention must be paid to proper and accurate documentation. This article introduces the important aspects of ED documentation and communication, with specific focus on key areas of medico-legal risk, the advantages and disadvantages of the available types of ED medical records, the critical transition points of patient handoffs and changes of shift, and the ideal manner to craft effective discharge and follow-up instructions. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3020302 Sun, 01 Nov 2009 00:00:00 +0100 3020302 http://www.medworm.com/index.php?rid=3020301&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001035%2Fabstract%3Frss%3Dyes Medical control of prehospital emergency services, triage in the emergency department, and the dual duties within the Emergency Medical Treatment and Active Labor Act challenge emergency medicine physicians with both statutory obligations and liabilities. Each independently may seem to present a definable boundary of liability for the practitioner. Under the Emergency Medical Treatment and Active Labor Act, the sequential duties of the medical screening examination and subsequent stabilization or transfer are confounded by the potential for tremendous sanction for a mechanistic violation. Nevertheless, the true obligation is to provide appropriate care to all who present to the emergency department and not simply weigh the totality of risk to the emergency medicine physician. (Source: Emer... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3020301 Sun, 01 Nov 2009 00:00:00 +0100 3020301 http://www.medworm.com/index.php?rid=3020300&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001023%2Fabstract%3Frss%3Dyes This article (1) provides the background history of assessing health care quality; (2) presents an overview of current interest and importance of measuring physician competency and performance, including requirements related to certifying bodies and those integral to pay-for-performance programs; (3) describes some of the current methods of evaluating the practice performance of emergency physicians, including peer review and use of health care quality measures; and (4) discusses the state of the literature as it pertains to health care quality and individual emergency physician performance. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3020300 Sun, 01 Nov 2009 00:00:00 +0100 3020300 http://www.medworm.com/index.php?rid=3020299&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001059%2Fabstract%3Frss%3Dyes This article focuses on those times that the emergency physician (EP) and patient do not agree on a treatment option. Attention is placed on the risk management issues relevant to the patient's unexpected choice. Emphasis is placed on determining a patient's competency or capability of making clinical decisions, with particular focus on the EP deciding that patient competency requires a formal evaluation. The EP should have a strategy for assessing clinical decision-making capability and an understanding of what circumstances should act as a trigger for considering such an assessment. Attention to documentation issues around informed consent, common barriers to consent, refusal of care, and ED discharge against medical advice are examined. (Source: Emergency Medicine Clinics of North Ameri... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3020299 Sun, 01 Nov 2009 00:00:00 +0100 3020299 http://www.medworm.com/index.php?rid=3020298&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000716%2Fabstract%3Frss%3Dyes This article gives a basic blueprint for successfully making hospital-wide changes using principles of operational management. It briefly covers the causes, significance, and dangers of overcrowding, and then focuses primarily on specific solutions. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3020298 Sun, 01 Nov 2009 00:00:00 +0100 3020298 http://www.medworm.com/index.php?rid=3020297&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000765%2Fabstract%3Frss%3Dyes Being named in a malpractice case may be one of the most stressful events in a physician's career and participating in a trial is likely to be remembered for a lifetime. Despite the climate of tort reform, it is a system that is unlikely to change anytime soon. By understanding and knowing the system and proactively participating in one's own defense, the traumatic experience of being named in a malpractice case may be mitigated. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3020297 Sun, 01 Nov 2009 00:00:00 +0100 3020297 http://www.medworm.com/index.php?rid=3020296&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000698%2Fabstract%3Frss%3Dyes This article introduces the emergency physician to professional liability insurance: the type of insurance, whether it is the only type available in the region, and, if claims-made insurance, whether the tail coverage rate is reasonable; the limits of liability and whether these are appropriate for emergency medicine in the region; the policy exclusions and restrictions; the insurance company's financial strength; whether an attorney is provided for a claim, whether fees are covered by the policy, whether they are subtracted from the policy limit, whether the physician can choose a defense attorney, and whether the physician's consent is required for the insurance company to settle a case. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3020296 Sun, 01 Nov 2009 00:00:00 +0100 3020296 http://www.medworm.com/index.php?rid=3020295&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000686%2Fabstract%3Frss%3Dyes This article explores clinical practice guidelines affecting emergency physicians, such as those published by the American College of Emergency Physicians and other medical specialty organizations, such as the American Heart Association. Examples of such guidelines include algorithms, such as those published in Advanced Cardiac Life Support, clinical decision rules, such as the Ottawa ankle rules, and pathways that describe the treatment of critical diseases such as acute myocardial infarction. This article discusses the relevance of these guidelines, algorithms, and protocols to the practicing emergency medicine specialist. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3020295 Sun, 01 Nov 2009 00:00:00 +0100 3020295 http://www.medworm.com/index.php?rid=3020294&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001060%2Fabstract%3Frss%3Dyes The vast majority of emergency physicians are well trained, highly skilled, competent, and compassionate. Nevertheless, litigation is a constant threat to the practicing emergency physician. The very nature of the practice of emergency medicine makes adverse outcomes unavoidable. We often have no knowledge of the preexisting medical conditions of the patients we treat. Many of our patients have no access to essential medical care, causing them to present late in the course of disease. Further complicating the picture is the high number of repeat emergency department patients who often lull us into a false sense of security because of absence of serious medical conditions on prior visits. Lack of an ongoing relationship with the patient and family makes litigation more likely when adverse o... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3020294 Sun, 01 Nov 2009 00:00:00 +0100 3020294 http://www.medworm.com/index.php?rid=3020293&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001084%2Fabstract%3Frss%3Dyes Emergency medicine is a high-risk specialty. “High-risk” implies danger to patients—typical conditions that are worked up and diagnosed in an emergency department (ED) include acute cardiac ischemia or infarction, stroke, intracranial bleeds, appendicitis, aortic catastrophes, meningitis, sepsis, multisystem trauma, life-threatening asthma, and so forth. Every patient that presents to an ED must be assumed at risk for serious morbidity or mortality. Patients are not the only people at risk in an ED, however; every physician-patient encounter represents not only health risk for the patient but also legal risk for the physician. The constant threat of malpractice in the US health care system, especially in high-risk specialties, such as emergency medicine, is an ever-present issue that... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3020293 Sun, 01 Nov 2009 00:00:00 +0100 3020293 http://www.medworm.com/index.php?rid=3020292&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001217%2Fabstract%3Frss%3Dyes (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3020292 Sun, 01 Nov 2009 00:00:00 +0100 3020292 http://www.medworm.com/index.php?rid=3020291&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS073386270900131X%2Fabstract%3Frss%3Dyes (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3020291 Sun, 01 Nov 2009 00:00:00 +0100 3020291 http://www.medworm.com/index.php?rid=3020290&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709001308%2Fabstract%3Frss%3Dyes (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3020290 Sun, 01 Nov 2009 00:00:00 +0100 3020290 http://www.medworm.com/index.php?rid=2659099&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000856%2Fabstract%3Frss%3Dyes (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2659099 Fri, 31 Jul 2009 23:00:00 +0100 2659099 http://www.medworm.com/index.php?rid=2659098&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000674%2Fabstract%3Frss%3Dyes The above article, which appeared in the August 2007 issue on “Current Concepts in the Management of the Trauma Patient,” contains an error on page 777 regarding the descriptions of the “Monteggia's Fracture” and the “Galeazzi's Fracture.” (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2659098 Fri, 31 Jul 2009 23:00:00 +0100 2659098 http://www.medworm.com/index.php?rid=2659097&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000340%2Fabstract%3Frss%3Dyes This article reviews the concepts involved in the evaluation and management of febrile, neutropenic, pediatric cancer patients. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2659097 Fri, 31 Jul 2009 23:00:00 +0100 2659097 http://www.medworm.com/index.php?rid=2659096&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000364%2Fabstract%3Frss%3Dyes This article reviews the common causes of isolated thrombocytopenia and anemia in infancy and childhood. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2659096 Fri, 31 Jul 2009 23:00:00 +0100 2659096 http://www.medworm.com/index.php?rid=2659095&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000376%2Fabstract%3Frss%3Dyes Tumor lysis syndrome is most often seen after the treatment of blood and solid malignancies. The resultant hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia can lead to life threatening complications. Expeditious evaluation and therapy are paramount in preventing the most serious sequelae of acute renal failure and fatal dysrhythmias. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2659095 Fri, 31 Jul 2009 23:00:00 +0100 2659095 http://www.medworm.com/index.php?rid=2659094&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000352%2Fabstract%3Frss%3Dyes This article reviews the most common presentations of childhood cancer and the appropriate initial management in the Emergency Department. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2659094 Fri, 31 Jul 2009 23:00:00 +0100 2659094 http://www.medworm.com/index.php?rid=2659093&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000285%2Fabstract%3Frss%3Dyes Myeloproliferative disorders and the serum hyperviscosity syndrome can rapidly manifest with emergent presentations. Hyperviscosity occurs from pathologic elevations of either the cellular or acellular (protein) fractions of the circulating blood. Classic hyperviscosity syndrome presents with the triad of bleeding diathesis, visual disturbances and focal neurologic signs. Emergency medicine providers should be aware of these conditions and be prepared to rapidly initiate supportive and early definitive management, including plasma exchange and apharesis. Early consultation with a hematologist is essential to managing these complex patients. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2659093 Fri, 31 Jul 2009 23:00:00 +0100 2659093 http://www.medworm.com/index.php?rid=2659092&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000303%2Fabstract%3Frss%3Dyes This article reviews the diagnosis and management of the most common cancer-related thrombotic problem; deep venous thrombosis, pulmonary embolism, and catheterrelated thrombosis. Rarer entities, such as cerebral vein thrombosis and Budd-Chiari syndrome, are also reviewed. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2659092 Fri, 31 Jul 2009 23:00:00 +0100 2659092 http://www.medworm.com/index.php?rid=2659091&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000315%2Fabstract%3Frss%3Dyes Cancer patients can have acquired bleeding problems for many reasons. In this review, an approach to the bleeding patient in the Emergency Department is discussed. Specific issue including coagulation defects, thrombocytopenia, platelet dysfunction, bleeding complications of specific hematological malignancies and due to anticoagulation, are discussed. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2659091 Fri, 31 Jul 2009 23:00:00 +0100 2659091 http://www.medworm.com/index.php?rid=2659090&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000297%2Fabstract%3Frss%3Dyes Neutropenic enterocolitis, also known as typhlitis or ileocecal syndrome, is a rare but important complication of neutropenia associated with malignancy. It occurs as a result of chemotherapeutic damage to the intestinal mucosa in the context of an absolute neutropenia, and can rapidly progress to intestinal perforation, multisystem organ failure, and sepsis. Presenting signs and symptoms may include fever, abdominal pain, nausea, vomiting, and diarrhea. Rapid identification by emergency physicians and timely, aggressive medical and/or surgical intervention are the cornerstones of survival for these patients. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2659090 Fri, 31 Jul 2009 23:00:00 +0100 2659090 http://www.medworm.com/index.php?rid=2659089&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000327%2Fabstract%3Frss%3Dyes This article reviews the pathogenesis, diagnostic criteria, grading, and management of hepatic encephalopathy. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2659089 Fri, 31 Jul 2009 23:00:00 +0100 2659089 http://www.medworm.com/index.php?rid=2659088&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000339%2Fabstract%3Frss%3Dyes This article focuses specifically on patients with cancer who present with an acute abdomen, and it discusses how a concurrent malignancy can shape the differential diagnosis in these cases. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2659088 Fri, 31 Jul 2009 23:00:00 +0100 2659088 http://www.medworm.com/index.php?rid=2659087&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000388%2Fabstract%3Frss%3Dyes Gastrointestinal bleeding is a common occurrence in patients with cancer and is a frequent indicator of a gastrointestinal malignancy. Rapid evaluation and treatment is key for the hemodynamically unstable patient. Endoscopy remains the cornerstone of diagnosis and management for cancer patients with gastrointestinal bleeding. The emergency physician should also be aware of other diagnostic and treatment modalities that may be needed to take care of these patients. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2659087 Fri, 31 Jul 2009 23:00:00 +0100 2659087 http://www.medworm.com/index.php?rid=2659086&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000662%2Fabstract%3Frss%3Dyes This issue of Emergency Medicine Clinics of North America, the second one dedicated to cancer emergencies, focuses on malignancies that affect children along with hematologic and gastrointestinal emergencies related to cancer that present to the emergency department (ED). (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2659086 Fri, 31 Jul 2009 23:00:00 +0100 2659086 http://www.medworm.com/index.php?rid=2659085&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000650%2Fabstract%3Frss%3Dyes Anybody who has worked in emergency medicine for more than a few years has undoubtedly noticed a marked increase in the number of patients reporting a past medical history notable for cancer. This change can largely be attributable to 3 major factors. First, diagnostic testing for cancer has improved dramatically during the past decade, resulting in earlier detection of many neoplasms. Second, advances in therapy have increased the lifespan of many patients with cancer, turning the condition from a rapid killer in many cases into a chronic and often manageable disease. Third, advances in diagnosis and management of the 2 other major causes of mortality in the developed world, heart disease and stroke, are essentially allowing greater numbers of patients to live long enough to inevitably de... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2659085 Fri, 31 Jul 2009 23:00:00 +0100 2659085 http://www.medworm.com/index.php?rid=2659084&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000832%2Fabstract%3Frss%3Dyes (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2659084 Fri, 31 Jul 2009 23:00:00 +0100 2659084 http://www.medworm.com/index.php?rid=2659083&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000820%2Fabstract%3Frss%3Dyes (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2659083 Fri, 31 Jul 2009 23:00:00 +0100 2659083 http://www.medworm.com/index.php?rid=2418918&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000480%2Fabstract%3Frss%3Dyes (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2418918 Fri, 01 May 2009 04:00:00 +0100 2418918 http://www.medworm.com/index.php?rid=2418917&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000194%2Fabstract%3Frss%3Dyes Cancer-related visits to the emergency department (ED) can be expected to increase in the next decade as the population ages. Some of the these patients and their caregivers will come to the ED without prior end-of-life care planning, and others will require modification of prior plans based on disease progression. In this article, we discuss some of these end-of-life issues related to and including those of legal documents, transmission of patient wishes, limiting factors in implementing those wishes, and the new horizon of palliative care in the ED. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2418917 Fri, 01 May 2009 04:00:00 +0100 2418917 http://www.medworm.com/index.php?rid=2418916&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000182%2Fabstract%3Frss%3Dyes Patients with malignancy and caregivers can present to the emergency department (ED) under stress and fatigue as a result of the intensity of energy required to cope with the physical, psychological, social, and spiritual aspects of their illness. When interacting with patients and families, emergency clinicians should be aware of patient, family, and caregiver coping, which may be impaired due to the chronic, serious illness. The emergency clinician should not be surprised that conflicts may arise between patients and providers as a result of fatigue and stress. Strategies to manage conflict can be employed. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2418916 Fri, 01 May 2009 04:00:00 +0100 2418916 http://www.medworm.com/index.php?rid=2418915&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000170%2Fabstract%3Frss%3Dyes As a vast majority of oncologic treatments are being administered in the outpatient setting, emergency department (ED) physicians are increasingly encountering patients who present with a wide array of toxicities that are a direct effect of chemotherapy. This review aims to highlight the most often encountered and clinically relevant toxicities of the more commonly administered chemotherapeutic drugs. In addition, because stem cell transplantation is being used increasingly for various malignancies, a brief introduction to post-transplant complications is included. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2418915 Fri, 01 May 2009 04:00:00 +0100 2418915 http://www.medworm.com/index.php?rid=2418914&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000236%2Fabstract%3Frss%3Dyes This article is designed to acquaint emergency medicine physicians with common, expected, and potential acute and late complications of RT. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2418914 Fri, 01 May 2009 04:00:00 +0100 2418914 http://www.medworm.com/index.php?rid=2418913&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000145%2Fabstract%3Frss%3Dyes This article focuses on several of these etiologies, such as tumor lysis syndrome (TLS) and thrombotic microangiopathy (TMA), which are unique threats faced by the oncologic patient. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2418913 Fri, 01 May 2009 04:00:00 +0100 2418913 http://www.medworm.com/index.php?rid=2418912&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000212%2Fabstract%3Frss%3Dyes Normal function of the adrenal gland can be disrupted not only by metastases of nonadrenal cancers but also by their treatment. In addition, tumors of the adrenal gland itself can cause disease by hypersecretion of a variety of hormones, adrenal gland destruction with inadequate production of cortisol, and by metastasis to other sites. Although rare, abnormal adrenal function should be considered in the appropriate clinical settings as failure to recognize and treat can result in significant morbidity and mortality. The adrenal “incidentaloma” is a frequent finding of abdominal radiologic studies. All patients with an unexpected adrenal mass should be referred for further evaluation. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2418912 Fri, 01 May 2009 04:00:00 +0100 2418912 http://www.medworm.com/index.php?rid=2418911&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000200%2Fabstract%3Frss%3Dyes A thorough working knowledge of the diagnosis and treatment of life-threatening electrolyte abnormalities in cancer patients, especially hyponatremia, hypoglycemia, and hypercalcemia, is essential to the successful practice of emergency medicine. Although most minor abnormalities have no specific treatment, severe clinical manifestations of several notable electrolytes occur with significant frequency in the setting of malignancy. The treatment of life-threatening electrolyte abnormalities is reviewed here. Promising future treatments directed at the underlying physiology are also introduced. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2418911 Fri, 01 May 2009 04:00:00 +0100 2418911 http://www.medworm.com/index.php?rid=2418910&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000169%2Fabstract%3Frss%3Dyes Superior vena cava syndrome (SVCS) is a common complication of malignancy. The epidemiology, presentation, and diagnostic evaluation of patients presenting with the syndrome are reviewed. Management options including chemotherapy and radiation therapy (RT) and the role of endovascular stents are discussed along with the evidence for each of the therapeutic options. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2418910 Fri, 01 May 2009 04:00:00 +0100 2418910 http://www.medworm.com/index.php?rid=2418909&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000224%2Fabstract%3Frss%3Dyes Acute obstruction of the airway in the emergent situation results from a wide variety of malignant and benign disease processes. Acute management involves establishing a secure and patent route for adequate gas exchange. This requires rapid determination of the location of the obstruction and nature of the obstruction followed by a thoughtful management approach based on findings. Difficult anatomy, hemorrhage, dense secretions, inflammation, and bulky tumor mass can significantly complicate the task of clearing the airway. Obstruction of the central airways by malignant tumor is associated with poor prognosis, but quality of life is considerably improved by restoration of adequate central airways. For both the patient and the clinician, the presentation can be frightening, and advanced in... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2418909 Fri, 01 May 2009 04:00:00 +0100 2418909 http://www.medworm.com/index.php?rid=2418908&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS073386270900025X%2Fabstract%3Frss%3Dyes This article reviews common neuro-oncologic syndromes that may lead to urgent evaluation in the emergency department, including cerebral edema, altered mental status, seizures, acute stroke, leptomeningeal metastases, and paraneoplastic neurologic syndromes. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2418908 Fri, 01 May 2009 04:00:00 +0100 2418908 http://www.medworm.com/index.php?rid=2418907&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000248%2Fabstract%3Frss%3Dyes Malignant epidural spinal cord compression (MESCC) is a common neurologic complication of cancer. MESCC is a medical emergency that needs rapid diagnosis and treatment to prevent paraplegia. Patients with malignancy who present with new onset of neurologic signs and symptoms should undergo emergent evaluation including magnetic resonance imaging of the entire spine. If MESCC is diagnosed, corticosteroids should be administered. Simultaneously, spine surgery and oncology teams should be immediately consulted. If indicated, patients should undergo maximal tumor resection and stabilization, followed by postoperative radiotherapy. Emerging treatment options such as stereotactic radiosurgery and vertebroplasty may be able to provide some symptomatic relief for patients who are not surgical cand... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2418907 Fri, 01 May 2009 04:00:00 +0100 2418907 http://www.medworm.com/index.php?rid=2418906&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000157%2Fabstract%3Frss%3Dyes Patients and families struggling with cancer fear pain more than any other physical symptom. There are also significant barriers to optimal pain management in the emergency setting, including lack of knowledge, inexperienced clinicians, myths about addiction, and fears of complications after discharge. In this article, we review the assessment and management options for cancer-related pain based on the World Health Organization (WHO) 3-step approach. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2418906 Fri, 01 May 2009 04:00:00 +0100 2418906 http://www.medworm.com/index.php?rid=2418905&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000261%2Fabstract%3Frss%3Dyes Cancer will affect one in three people at some point in their lifetime and is primarily a disease of those over the age of 50. As emergency department (ED) physicians and providers see increasing numbers of cancer patients as the population ages, they need to be well prepared to deal with cancer-specific emergencies. Since the last clinics issue dedicated to this topic in 1993, there have been many advances in cancer treatment (palliative and curative), including more targeted therapies that will hopefully maximize benefit and reduce side effects. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2418905 Fri, 01 May 2009 04:00:00 +0100 2418905 http://www.medworm.com/index.php?rid=2418904&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS073386270900039X%2Fabstract%3Frss%3Dyes Anybody who has worked in emergency medicine for more than a few years has undoubtedly noticed a marked increase in the number of patients reporting a past medical history notable for cancer. This change can largely be attributable to three major factors. First, diagnostic testing for cancer has improved dramatically over the past decade, resulting in earlier detection of many neoplasms. Second, advances in therapy have increased the lifespan of many patients with cancer, turning the condition from a rapid killer in many cases into a chronic and often manageable disease. Third, advances in diagnosis and management of the two other major causes of mortality in the developed world, heart disease and stroke, are essentially allowing greater numbers of patients to live long enough to inevitabl... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2418904 Fri, 01 May 2009 04:00:00 +0100 2418904 http://www.medworm.com/index.php?rid=2418903&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000467%2Fabstract%3Frss%3Dyes (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2418903 Fri, 01 May 2009 04:00:00 +0100 2418903 http://www.medworm.com/index.php?rid=2418902&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000455%2Fabstract%3Frss%3Dyes (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2418902 Fri, 01 May 2009 04:00:00 +0100 2418902 http://www.medworm.com/index.php?rid=2350397&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000108%2Fabstract%3Frss%3Dyes (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2350397 Sun, 01 Feb 2009 05:00:00 +0100 2350397 http://www.medworm.com/index.php?rid=2350396&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862708000916%2Fabstract%3Frss%3Dyes This article reviews the epidemiology of the problem, relevant pathophysiology, the use of tight glycemic control therapy in other populations, and the potential for tight glycemic control as a way to improve outcomes after acute neurologic illness and injury. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2350396 Sun, 01 Feb 2009 05:00:00 +0100 2350396 http://www.medworm.com/index.php?rid=2350395&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS073386270800076X%2Fabstract%3Frss%3Dyes This review briefly discusses induced therapeutic hypothermia (TH), which represents the intentional induction of a lowered core body temperature of 35 °C or less. The focus is on resuscitative or postarrest hypothermia, the data that support it, and the practical issues pertaining to TH implementation. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2350395 Sun, 01 Feb 2009 05:00:00 +0100 2350395 http://www.medworm.com/index.php?rid=2350394&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862708000758%2Fabstract%3Frss%3Dyes This article reviews the history of tPA use in stroke as a case study of a breakdown of knowledge translation in emergency medicine. It reviews knowledge translation concepts and theory and explores practical community–academic collaborative methods based on these tenets to enhance acute stroke care delivery in the community setting. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2350394 Sun, 01 Feb 2009 05:00:00 +0100 2350394 http://www.medworm.com/index.php?rid=2350393&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862708001272%2Fabstract%3Frss%3Dyes Current thinking about the acute treatment of status epilepticus (SE) emphasizes a more aggressive clinical approach to this common life-threatening neurologic emergency. In this review, the authors consider four concepts that can accelerate effective treatment of SE. These include (1) updating the definition of SE to make it more clinically relevant, (2) consideration of faster ways to initiate first-line benzodiazepine therapy in the prehospital environment, (3) moving to second-line agents more quickly in refractory status in the emergency department, and (4) increasing detection and treatment of unrecognized nonconvulsive SE in comatose neurologic emergency patients. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2350393 Sun, 01 Feb 2009 05:00:00 +0100 2350393 http://www.medworm.com/index.php?rid=2350392&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862708000771%2Fabstract%3Frss%3Dyes This article describes the changing pattern and epidemiology of a variety of common central nervous system infections, including meningitis, encephalitis, and brain abscesses, and reviews pathophysiology and the most current approach to clinical diagnosis, treatment, and disposition from the emergency physician perspective. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2350392 Sun, 01 Feb 2009 05:00:00 +0100 2350392 http://www.medworm.com/index.php?rid=2350391&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862708000989%2Fabstract%3Frss%3Dyes This article reviews the diagnostic criteria and management strategies for the primary headache disorders. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2350391 Sun, 01 Feb 2009 05:00:00 +0100 2350391 http://www.medworm.com/index.php?rid=2350390&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS073386270800093X%2Fabstract%3Frss%3Dyes Patients who have a transient ischemic attack (TIA) represent a group that may appear well but are at high risk for stroke within 90 days. Management of patients who have a TIA requires an understanding of the short-term risk for stroke to guide acute management and the long-term benefits to medical and surgical therapies. The initial emergency department (ED) evaluation may be supplemented with simple TIA stroke risk scores to estimate short-term stroke risk. The addition of MRI provides yet more information regarding stroke risks, while identifying some specific causes of TIA. Extended testing may not be feasible in the ED, and to address this limitation, new outpatient strategies for patients who have a TIA have been developed, such as the use of an ED observation unit or an outpatient ... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2350390 Sun, 01 Feb 2009 05:00:00 +0100 2350390 http://www.medworm.com/index.php?rid=2350389&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862708000965%2Fabstract%3Frss%3Dyes Understanding three peripheral vestibular disorders—vestibular neuritis, benign paroxysmal positional vertigo, and Meniere's disease—is the key to the evaluation and management of vertigo and dizziness presentations in the emergency department. Each of these benign disorders is a common cause of a broad category of dizziness presentation. In addition, each of these disorders has characteristic features that allow for a bedside diagnosis. An effective strategy for “ruling-out” a serious disorder, such as stroke, is “ruling-in” a peripheral vestibular disorder. In this article a focus is on the key features of these disorders. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2350389 Sun, 01 Feb 2009 05:00:00 +0100 2350389 http://www.medworm.com/index.php?rid=2350388&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862708000928%2Fabstract%3Frss%3Dyes This article examines the role of prognostication early after neuroemergencies, the potential impact of early treatment limitations, and how these may relate to communication with patients and surrogate decision makers in the context of these acute neurologic events. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2350388 Sun, 01 Feb 2009 05:00:00 +0100 2350388 http://www.medworm.com/index.php?rid=2350387&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862708000941%2Fabstract%3Frss%3Dyes This article reviews the special questions and issues in critical care transport related specifically to the care of patients who have neurologic emergencies. It first considers potential indications for transport and reviews attempts to create a hierarchical stroke center system akin to that developed for trauma care. It then discusses therapeutic concerns relating to the transport environment and the use of specific interventions, including the effects of end-tidal CO2 monitoring on intracranial pressure, patient outcomes after traumatic brain injury, and opportunities to initiate therapeutic hypothermia in comatose survivors of cardiac arrest during transport. Finally, the cost of critical care transport of patients who have neurologic emergencies is considered. (Source: Emergency Medic... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2350387 Sun, 01 Feb 2009 05:00:00 +0100 2350387 http://www.medworm.com/index.php?rid=2350386&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862708000746%2Fabstract%3Frss%3Dyes This article discusses how to direct the history and examination in patients who have focal complaints, possible strokes affecting the anterior or posterior circulations, neck or back pain, neuromuscular complaints, global symptoms, or nonanatomic complaints. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2350386 Sun, 01 Feb 2009 05:00:00 +0100 2350386 http://www.medworm.com/index.php?rid=2350385&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862708001296%2Fabstract%3Frss%3Dyes Neurological emergencies are a common presentation, with more than 1 in 14 visits to the emergency department resulting from symptoms referable to the nervous system or in diagnoses of a nonpsychiatric disease of the nervous system or neurotrauma. Moreover, neurological emergencies represent a huge burden of disease. Eight conditions (acute ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, traumatic brain injury, spinal cord injury, bacterial meningitis, status epilepticus, and hypoxic ischemic encephalopathy) affect 1.1 million patients per year and are responsible for 250,000 deaths annually in the United States. Patients with these conditions who live have substantial functional impairment. Collectively, these neurologic conditions are the leading cause of permanent ad... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2350385 Sun, 01 Feb 2009 05:00:00 +0100 2350385 http://www.medworm.com/index.php?rid=2350384&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862708001284%2Fabstract%3Frss%3Dyes For generations of physicians, the brain has long been considered the “black box” of the human body. Physicians' inability to understand the inner workings of the brain has limited our ability to treat many common neurologic conditions. As a result, for many years there were significant portions of neurology that were simply focused on supportive therapy and rehabilitation: in essence, “damage control.” However, recent advances in neuroimaging, increased understanding of neuropathology, and advances in neuropharmacology have dramatically changed the field of neurology from one in which a diagnosis was used to determine the type of supportive therapy, to one in which the diagnosis is used to determine immediate life- or limb-saving therapy. Localization of the lesion is no longer a ... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2350384 Sun, 01 Feb 2009 05:00:00 +0100 2350384 http://www.medworm.com/index.php?rid=2350383&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS073386270900008X%2Fabstract%3Frss%3Dyes (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2350383 Sun, 01 Feb 2009 05:00:00 +0100 2350383 http://www.medworm.com/index.php?rid=2350382&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862709000078%2Fabstract%3Frss%3Dyes (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2350382 Sun, 01 Feb 2009 05:00:00 +0100 2350382 http://www.medworm.com/index.php?rid=2199305&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19218013%26dopt%3DAbstract Authors: Mattu A PMID: 19218013 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2199305 Sun, 01 Feb 2009 05:00:00 +0100 2199305 http://www.medworm.com/index.php?rid=2199304&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19218014%26dopt%3DAbstract Authors: Silbergleit R, Geocadin RG PMID: 19218014 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2199304 Sun, 01 Feb 2009 05:00:00 +0100 2199304 http://www.medworm.com/index.php?rid=2194366&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19218013%26dopt%3DAbstract Authors: Mattu A PMID: 19218013 [PubMed - as supplied by publisher] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2194366 Sun, 01 Feb 2009 05:00:00 +0100 2194366 http://www.medworm.com/index.php?rid=2194365&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19218014%26dopt%3DAbstract Authors: Silbergleit R, Geocadin RG PMID: 19218014 [PubMed - as supplied by publisher] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2194365 Sun, 01 Feb 2009 05:00:00 +0100 2194365 http://www.medworm.com/index.php?rid=2194364&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19218015%26dopt%3DAbstract This article discusses how to direct the history and examination in patients who have focal complaints, possible strokes affecting the anterior or posterior circulations, neck or back pain, neuromuscular complaints, global symptoms, or nonanatomic complaints. PMID: 19218015 [PubMed - as supplied by publisher] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2194364 Sun, 01 Feb 2009 05:00:00 +0100 2194364 http://www.medworm.com/index.php?rid=2194363&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19218016%26dopt%3DAbstract This article reviews the special questions and issues in critical care transport related specifically to the care of patients who have neurologic emergencies. It first considers potential indications for transport and reviews attempts to create a hierarchical stroke center system akin to that developed for trauma care. It then discusses therapeutic concerns relating to the transport environment and the use of specific interventions, including the effects of end-tidal CO(2) monitoring on intracranial pressure, patient outcomes after traumatic brain injury, and opportunities to initiate therapeutic hypothermia in comatose survivors of cardiac arrest during transport. Finally, the cost of critical care transport of patients who have neurologic emergencies is considered. PMID: 19218016 [Pu... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2194363 Sun, 01 Feb 2009 05:00:00 +0100 2194363 http://www.medworm.com/index.php?rid=2194362&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19218017%26dopt%3DAbstract This article examines the role of prognostication early after neuroemergencies, the potential impact of early treatment limitations, and how these may relate to communication with patients and surrogate decision makers in the context of these acute neurologic events. PMID: 19218017 [PubMed - as supplied by publisher] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2194362 Sun, 01 Feb 2009 05:00:00 +0100 2194362 http://www.medworm.com/index.php?rid=2194361&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19218018%26dopt%3DAbstract Authors: Kerber KA Understanding three peripheral vestibular disorders-vestibular neuritis, benign paroxysmal positional vertigo, and Meniere's disease-is the key to the evaluation and management of vertigo and dizziness presentations in the emergency department. Each of these benign disorders is a common cause of a broad category of dizziness presentation. In addition, each of these disorders has characteristic features that allow for a bedside diagnosis. An effective strategy for "ruling-out" a serious disorder, such as stroke, is "ruling-in" a peripheral vestibular disorder. In this article a focus is on the key features of these disorders. PMID: 19218018 [PubMed - as supplied by publisher] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2194361 Sun, 01 Feb 2009 05:00:00 +0100 2194361 http://www.medworm.com/index.php?rid=2194360&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19218019%26dopt%3DAbstract Authors: Ross M, Nahab F Patients who have a transient ischemic attack (TIA) represent a group that may appear well but are at high risk for stroke within 90 days. Management of patients who have a TIA requires an understanding of the short-term risk for stroke to guide acute management and the long-term benefits to medical and surgical therapies. The initial emergency department (ED) evaluation may be supplemented with simple TIA stroke risk scores to estimate short-term stroke risk. The addition of MRI provides yet more information regarding stroke risks, while identifying some specific causes of TIA. Extended testing may not be feasible in the ED, and to address this limitation, new outpatient strategies for patients who have a TIA have been developed, such as the use of an ED obser... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2194360 Sun, 01 Feb 2009 05:00:00 +0100 2194360 http://www.medworm.com/index.php?rid=2194359&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19218020%26dopt%3DAbstract This article reviews the diagnostic criteria and management strategies for the primary headache disorders. PMID: 19218020 [PubMed - as supplied by publisher] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2194359 Sun, 01 Feb 2009 05:00:00 +0100 2194359 http://www.medworm.com/index.php?rid=2194358&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19218021%26dopt%3DAbstract This article describes the changing pattern and epidemiology of a variety of common central nervous system infections, including meningitis, encephalitis, and brain abscesses, and reviews pathophysiology and the most current approach to clinical diagnosis, treatment, and disposition from the emergency physician perspective. PMID: 19218021 [PubMed - as supplied by publisher] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2194358 Sun, 01 Feb 2009 05:00:00 +0100 2194358 http://www.medworm.com/index.php?rid=2194357&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19218022%26dopt%3DAbstract Authors: Millikan D, Rice B, Silbergleit R Current thinking about the acute treatment of status epilepticus (SE) emphasizes a more aggressive clinical approach to this common life-threatening neurologic emergency. In this review, the authors consider four concepts that can accelerate effective treatment of SE. These include (1) updating the definition of SE to make it more clinically relevant, (2) consideration of faster ways to initiate first-line benzodiazepine therapy in the prehospital environment, (3) moving to second-line agents more quickly in refractory status in the emergency department, and (4) increasing detection and treatment of unrecognized nonconvulsive SE in comatose neurologic emergency patients. PMID: 19218022 [PubMed - as supplied by publisher] (Source: Emergency... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2194357 Sun, 01 Feb 2009 05:00:00 +0100 2194357 http://www.medworm.com/index.php?rid=2194356&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19218023%26dopt%3DAbstract This article reviews the history of tPA use in stroke as a case study of a breakdown of knowledge translation in emergency medicine. It reviews knowledge translation concepts and theory and explores practical community-academic collaborative methods based on these tenets to enhance acute stroke care delivery in the community setting. PMID: 19218023 [PubMed - as supplied by publisher] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2194356 Sun, 01 Feb 2009 05:00:00 +0100 2194356 http://www.medworm.com/index.php?rid=2194355&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19218024%26dopt%3DAbstract Authors: Dine CJ, Abella BS This review briefly discusses induced therapeutic hypothermia (TH), which represents the intentional induction of a lowered core body temperature of 35 degrees C or less. The focus is on resuscitative or postarrest hypothermia, the data that support it, and the practical issues pertaining to TH implementation. PMID: 19218024 [PubMed - as supplied by publisher] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2194355 Sun, 01 Feb 2009 05:00:00 +0100 2194355 http://www.medworm.com/index.php?rid=2194354&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19218025%26dopt%3DAbstract This article reviews the epidemiology of the problem, relevant pathophysiology, the use of tight glycemic control therapy in other populations, and the potential for tight glycemic control as a way to improve outcomes after acute neurologic illness and injury. PMID: 19218025 [PubMed - as supplied by publisher] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2194354 Sun, 01 Feb 2009 05:00:00 +0100 2194354 http://www.medworm.com/index.php?rid=2111901&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19059085%26dopt%3DAbstract Authors: Mattu A PMID: 19059085 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2111901 Sat, 01 Nov 2008 04:00:00 +0100 2111901 http://www.medworm.com/index.php?rid=2111900&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19059086%26dopt%3DAbstract Authors: Mace SE PMID: 19059086 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2111900 Sat, 01 Nov 2008 04:00:00 +0100 2111900 http://www.medworm.com/index.php?rid=2025930&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19059085%26dopt%3DAbstract Authors: Mattu A PMID: 19059085 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2025930 Sat, 01 Nov 2008 04:00:00 +0100 2025930 http://www.medworm.com/index.php?rid=2025929&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19059086%26dopt%3DAbstract Authors: Mace SE PMID: 19059086 [PubMed - as supplied by publisher] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2025929 Sat, 01 Nov 2008 04:00:00 +0100 2025929 http://www.medworm.com/index.php?rid=2025928&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19059087%26dopt%3DAbstract Authors: Callahan JM Although the recognition of hypoxemia is greatly enhanced through the proper and informed use of the pulse oximeter, the device can never be relied on to take the place of the clinician at the bedside who makes sure that the data provided matches the clinical picture with which he or she is presented. PMID: 19059087 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2025928 Sat, 01 Nov 2008 04:00:00 +0100 2025928 http://www.medworm.com/index.php?rid=2025927&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19059088%26dopt%3DAbstract Authors: Nagler J, Krauss B Capnography provides continuous, dynamic assessment of the ventilatory status of patients. Carbon dioxide physiology and the technology utilized in end-tidal carbon dioxide monitor devices are reviewed. Clinical applications with regard to ventilation and airway management are discussed, including: verification of endotracheal tube placement, continuous monitoring of tube position, monitoring during procedural sedation and in the obtunded patient, and assessment of patients with respiratory illnesses. Current guidelines for use of capnography within emergency medicine are included. Potential future applications are also presented. PMID: 19059088 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2025927 Sat, 01 Nov 2008 04:00:00 +0100 2025927 http://www.medworm.com/index.php?rid=2025926&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19059089%26dopt%3DAbstract This article reviews the pathophysiology of NO in asthma, evidence for the use of exhaled NO in acute asthma exacerbations, and the potential utility of devices available to emergency physicians for measuring exhaled NO. PMID: 19059089 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2025926 Sat, 01 Nov 2008 04:00:00 +0100 2025926 http://www.medworm.com/index.php?rid=2025925&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19059090%26dopt%3DAbstract Authors: McGarvey JM, Pollack CV Helium-oxygen ("heliox") mixtures have been used for decades in the treatment of various respiratory problems ranging from acute upper airway obstructions to lower airway derangements, such as asthma and exacerbations of chronic bronchitis. This review presents a brief history of helium and helium-oxygen mixtures and their potential clinical uses, summarizes the results of past research into heliox in respiratory applications, explains the physiology of heliox, and presents more recent literature relating to heliox in the clinical setting. PMID: 19059090 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2025925 Sat, 01 Nov 2008 04:00:00 +0100 2025925 http://www.medworm.com/index.php?rid=2025924&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19059091%26dopt%3DAbstract Authors: Turell DC In this article, the physiology of surfactant is reviewed along with the research that lead to its current clinical uses. Acute lung injury (ALI) and Acute Respiratory Distress Syndrome (ARDS) will also be reviewed because they represent pulmonary disease processes in which secondary deficiency and surfactant inactivation occur, for which surfactant may prove to be an effective treatment. Finally, research using surfactant as a treatment for other pulmonary diseases, such as bronchiolitis and asthma, will be briefly highlighted. These studies may one day lead to new treatment opportunities in the realm of emergency medicine. PMID: 19059091 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2025924 Sat, 01 Nov 2008 04:00:00 +0100 2025924 http://www.medworm.com/index.php?rid=2025923&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19059092%26dopt%3DAbstract Authors: Hostetler MA To optimize the successful use of noninvasive positive-pressure ventilation (NPPV) in the emergency department (ED), clinicians must acquire the necessary knowledge, experience, and skill in its proper application. The purpose of this article is to provide a concise but thorough review of the current state of knowledge relating to the proper application of NPPV pertaining to its use in the ED. PMID: 19059092 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2025923 Sat, 01 Nov 2008 04:00:00 +0100 2025923 http://www.medworm.com/index.php?rid=2025922&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19059093%26dopt%3DAbstract Authors: Rogovik A, Goldman R Mechanical ventilation using high tidal volume (VT) and transpulmonary pressure can damage the lung, causing ventilator-induced lung injury. Permissive hypercapnia, a ventilatory strategy for acute respiratory failure in which the lungs are ventilated with a low inspiratory volume and pressure, has been accepted progressively in critical care for adult, pediatric, and neonatal patients requiring mechanical ventilation and is one of the central components of current protective ventilatory strategies. PMID: 19059093 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2025922 Sat, 01 Nov 2008 04:00:00 +0100 2025922 http://www.medworm.com/index.php?rid=2025921&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19059094%26dopt%3DAbstract Authors: Ayad O, Dietrich A, Mihalov L ECMO is an important tool to provide oxygen delivery and carbon dioxide removal in addition to cardiac support for patients with intractable reversible respiratory or cardiovascular collapse unresponsive to conventional treatment. Even though ECMO can be a life-saving modality, it is expensive and labor-intensive and carries a significant complication risk. Early recognition and prompt referral of patients who may benefit from ECMO in addition to careful patient selection, continuous communication between ECMO centers and their referral base, and meticulous care can improve the outcome of these critically ill patients who previously had no chance of survival. PMID: 19059094 [PubMed - in process] (Source: Emergency Medicine Clinics of North Ame... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2025921 Sat, 01 Nov 2008 04:00:00 +0100 2025921 http://www.medworm.com/index.php?rid=2025920&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19059095%26dopt%3DAbstract This article reviews the pediatric airway, highlighting the anatomic and physiologic differences between infant, pediatric and adult airways, and how these differences impact assessment and management of the pediatric airway. PMID: 19059095 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2025920 Sat, 01 Nov 2008 04:00:00 +0100 2025920 http://www.medworm.com/index.php?rid=2025919&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19059096%26dopt%3DAbstract Authors: Mace SE Management of the airway is the first priority in any patient. Dealing with a difficult airway can be a challenge, whether or not it involves facemask ventilation, an intermediate airway device, laryngoscopy and intubation, or a surgical airway. Various scales predict which patient is likely to have a difficult airway. The goal of rapid sequence intubation (RSI) is to eliminate or mitigate untoward reflex responses to intubation. Although controversy has arisen regarding the various steps in RSI, it remains an essential component of emergency medicine practice. PMID: 19059096 [PubMed - as supplied by publisher] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2025919 Sat, 01 Nov 2008 04:00:00 +0100 2025919 http://www.medworm.com/index.php?rid=2025918&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19059097%26dopt%3DAbstract This article describes the use of laryngoscopy for tracheal intubation. Maneuvers basic to successful orotracheal laryngoscopic intubation are described, which should be incorporated into the skill sets of individuals called on to manage the airway in an emergency. PMID: 19059097 [PubMed - as supplied by publisher] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2025918 Sat, 01 Nov 2008 04:00:00 +0100 2025918 http://www.medworm.com/index.php?rid=2025917&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19059098%26dopt%3DAbstract Authors: Marco CA, Marco AP Airway management is an essential component of the emergency medicine skill set. Management of the difficult airway may include airway adjuncts, including variants of laryngoscopic blades, supraglottic devices, stylets, and video laryngoscopy. These various airway adjuncts have certain advantages and disadvantages, and factors to be considered include ease of use, cost, maintenance, storage, and portability. Selection of a subset of the numerous products available can aid the clinician in the development of expertise with airway adjunct devices that can be reliably used in urgent situations. PMID: 19059098 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2025917 Sat, 01 Nov 2008 04:00:00 +0100 2025917 http://www.medworm.com/index.php?rid=2025916&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19059099%26dopt%3DAbstract Authors: Burbulys D, Kiai K Airway management in the emergency department is a critical skill that must be mastered by emergency physicians. When rapid-sequence induction with oral-tracheal intubation performed by way of direct laryngoscopy is difficult or impossible due to a variety of circumstances, an alternative method or device must be used for a rescue airway. Retrograde intubation requires little equipment and has few contraindications. This technique is easy to learn and has a high level of skill retention. Familiarity with this technique is a valuable addition to the airway-management armamentarium of emergency physicians caring for ill or injured patients. Variations of the technique have been described, and their use depends on the individual circumstances. PMID: 1905909... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2025916 Sat, 01 Nov 2008 04:00:00 +0100 2025916 http://www.medworm.com/index.php?rid=2025915&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19059100%26dopt%3DAbstract Authors: Mace SE Rapid sequence intubation is the process involving administration of a sedative (eg, induction agent) followed almost immediately by a neuromuscular blocking agent to facilitate endotracheal intubation The purpose of emergency RSI is to make emergent intubation easier and safer, thereby increasing the success rate of intubation while decreasing the complications. Possible disadvantages are complications from the additional drugs, prolonged intubation with hypoxia, and precipitating an emergent or crash airway. Controversy has arisen regarding various steps in RSI; however, RSI remains the standard of care in emergency medicine airway management. PMID: 19059100 [PubMed - as supplied by publisher] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2025915 Sat, 01 Nov 2008 04:00:00 +0100 2025915 http://www.medworm.com/index.php?rid=2025914&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19059101%26dopt%3DAbstract Authors: Barata I The LMA now has a well-established role in airway management. There are several different types of LMAs to accommodate many different patient needs. The LMA has become one of the most important and versatile tools in the management of patients with difficult airways. PMID: 19059101 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2025914 Sat, 01 Nov 2008 04:00:00 +0100 2025914 http://www.medworm.com/index.php?rid=2025913&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19059102%26dopt%3DAbstract Authors: Mace SE, Khan N Needle cricothyrotomy with percutaneous translaryngeal ventilation (PTLV) can be a life-saving procedure when an emergency airway is needed. Needle cricothyrotomy is preferred over surgical cricothyrotomy in infants and young children. Appropriate ventilatory parameters using a high-flow oxygen source and an adequate expiratory time (inhalation-exhalation ratio) may limit the complications of barotrauma and allow for a more extended time of ventilation. Preliminary reports suggest that PTLV may be also useful in the endotracheal intubation of patients who have a difficult or failed airway and may help prevent aspiration, although further studies are needed. The emergency physician should be familiar with the indications, contraindications, complications, and pr... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2025913 Sat, 01 Nov 2008 04:00:00 +0100 2025913 http://www.medworm.com/index.php?rid=1788195&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18655935%26dopt%3DAbstract Authors: Mattu A PMID: 18655935 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1788195 Fri, 01 Aug 2008 04:00:00 +0100 1788195 http://www.medworm.com/index.php?rid=1788194&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18655936%26dopt%3DAbstract Authors: DeBlieux PM, Osborn TM PMID: 18655936 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1788194 Fri, 01 Aug 2008 04:00:00 +0100 1788194 http://www.medworm.com/index.php?rid=1663451&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18655935%26dopt%3DAbstract Authors: Mattu A PMID: 18655935 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1663451 Wed, 30 Jul 2008 09:30:18 +0100 1663451 http://www.medworm.com/index.php?rid=1663450&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18655936%26dopt%3DAbstract Authors: Deblieux PM, Osborn TM PMID: 18655936 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1663450 Wed, 30 Jul 2008 09:30:16 +0100 1663450 http://www.medworm.com/index.php?rid=1663449&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18655937%26dopt%3DAbstract Authors: Catenacci MH, King K With an increasing incidence of sepsis, increasing use of the emergency department by populations at risk, and an increase in time spent in the emergency department awaiting hospital admission, emergency medicine practitioners are offered a valuable opportunity to make a significant difference in the fight against sepsis. By administering appropriate antibiotics in a timely fashion, removing possible sources of infection, practicing early goal-directed hemodynamic optimization, using lung-protective ventilation strategies, and judiciously using corticosteroids and intensive insulin therapy, the goal of reducing mortality from sepsis can be achieved. PMID: 18655937 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1663449 Wed, 30 Jul 2008 09:30:13 +0100 1663449 http://www.medworm.com/index.php?rid=1663448&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18655938%26dopt%3DAbstract Authors: Bonatti H, Calland JF In terms of cost and years of potential lives lost, injury arguably remains the most important public health problem facing the United States. Care of traumatically injured patients depends on early surgical intervention and avoiding delays in the diagnosis of injuries that threaten life and limb. In the critical care phase, successful outcomes after injury depend almost solely on diligence, attention to detail, and surveillance for iatrogenic infections and complications. PMID: 18655938 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1663448 Wed, 30 Jul 2008 09:30:09 +0100 1663448 http://www.medworm.com/index.php?rid=1663447&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18655939%26dopt%3DAbstract This article focuses on the clinical presentation, diagnosis, and management of veno-thromboembolism, including deep venous thrombosis (DVT) and pulmonary embolism (PE), from the perspective of the emergency physician. The discussion is divided into two sections: DVT and PE. Because veno-thromboembolism is a continuum, certain aspects, such as background, incidence, the use of D dimer, and anticoagulation of both DVT and PE, are discussed together. Heavier emphasis is placed on topics germane to the emergency physician, and considerations for special populations are reviewed. PMID: 18655939 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1663447 Wed, 30 Jul 2008 09:30:06 +0100 1663447 http://www.medworm.com/index.php?rid=1663446&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18655940%26dopt%3DAbstract This article focuses on several critical care aspects of these unstable ACS patients. The management of cardiogenic shock can be particularly challenging because the mechanical defects are varied in cause, severity, and specific treatment. Complications of fibrinolytic therapy are potentially deadly and arrhythmias are relatively common in the ACS patients. Discussions on the management of these problems should help the emergency physician more effectively to treat critically ill patients with ACS. PMID: 18655940 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1663446 Wed, 30 Jul 2008 09:30:02 +0100 1663446 http://www.medworm.com/index.php?rid=1663445&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18655941%26dopt%3DAbstract This article reviews emergency medicine evaluation and management performance standards for cerebrovascular event patients and provides a practical process for ensuring high quality care. Areas of practice that most frequently generate questions and controversy are highlighted. The term "cerebrovascular event" is used throughout the text when both stroke and transient ischemic attack apply to the discussion. Recommendations are based on literature review and the author's experience with the successful certification of multiple primary stroke centers and appointments in neurology, emergency medicine, and nursing specialties. PMID: 18655941 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1663445 Wed, 30 Jul 2008 09:29:59 +0100 1663445 http://www.medworm.com/index.php?rid=1663444&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18655942%26dopt%3DAbstract This article reviews the general approach and management of the critically poisoned patient. Specific clinical characteristics are identified that may clue the clinician into a specific toxin class as a diagnosis. Appropriate testing in the poisoned patient is reviewed. Complications of poisoning that may bring a rapid demise of the critically ill poisoned patient are highlighted and the management of those complications is discussed. PMID: 18655942 [PubMed - as supplied by publisher] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1663444 Wed, 30 Jul 2008 09:29:56 +0100 1663444 http://www.medworm.com/index.php?rid=1663443&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18655943%26dopt%3DAbstract Authors: Winters ME, McCurdy MT, Zilberstein J Many critically ill patients are remaining in the emergency department for extended periods of time, and delays in diagnosis and/or therapy may increase patient morbidity and mortality. All emergency physicians use monitoring modalities in critically ill patients to detect early cardiovascular compromise and impaired oxygen delivery before disastrous collapse occurs. The authors hope the discussion in this article regarding the monitoring of oxygenation, ventilation, arterial perfusion pressure, intravascular volume, markers of tissue hypoxia, and cardiac output will help the EP provide optimal care for this complicated patient population. PMID: 18655943 [PubMed - as supplied by publisher] (Source: Emergency Medicine Clinics of North A... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1663443 Wed, 30 Jul 2008 09:29:52 +0100 1663443 http://www.medworm.com/index.php?rid=1663442&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18655944%26dopt%3DAbstract This article focuses on the basic pathophysiology of shock states and reviews the rationale regarding vasoactive drug therapy for cardiovascular support of shock within an emergency environment. PMID: 18655944 [PubMed - as supplied by publisher] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1663442 Wed, 30 Jul 2008 09:29:48 +0100 1663442 http://www.medworm.com/index.php?rid=1663441&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18655945%26dopt%3DAbstract This article discusses the use of portable imaging techniques such as bedside ultrasound and radiography as well as CT and CT angiography in the diagnosis and care of critically ill patients. PMID: 18655945 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1663441 Wed, 30 Jul 2008 09:29:43 +0100 1663441 http://www.medworm.com/index.php?rid=1663440&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18655946%26dopt%3DAbstract Authors: Volles DF, Branan TN Antibiotic resistance is increasing faster than the drug industry can develop and market new antibiotics. Medical personnel commonly must deal with the resistant gram-positive pathogens including MRSA and VRE, in addition to the problem gram-negative bacteria, Pseudomonas, Acinetobacter, and ESBL producing strains of Klebsiella and E. coli. Clinicians should be familiar with treatment strategies for these resistant pathogens. Because of the lack of novel agents to treat resistant infections, clinicians must use antibiotics judiciously and appropriately to limit further development of resistance. Early, appropriate cultures of the blood, urine, sputum and suspected source, ideally obtained before antibiotic initiation, allow for future de-escalation of anti... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1663440 Wed, 30 Jul 2008 09:29:39 +0100 1663440 http://www.medworm.com/index.php?rid=1663439&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18655947%26dopt%3DAbstract This article addresses the rationale and mechanism of action for NPPV. A review of the indications for using NPPV and a discussion detailing the initiation of NPPV follows. NPPV has been shown to decrease length of hospital stay and the need for intubation in patients who have chronic obstructive pulmonary disease and acute cardiogenic pulmonary edema. NPPV should be considered for most patients who have respiratory distress who are being considered for intubation. After NPPV is initiated, very close monitoring and follow-up must be employed to identify those patients who are at risk for treatment failure. PMID: 18655947 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1663439 Wed, 30 Jul 2008 09:23:52 +0100 1663439 http://www.medworm.com/index.php?rid=1663438&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18655948%26dopt%3DAbstract This article reviews the common modes of mechanical ventilation, new technologies, and specific ventilator strategies that have been shown to be beneficial. In addition, it reviews the steps that should be taken when troubleshooting a ventilator. PMID: 18655948 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1663438 Wed, 30 Jul 2008 08:44:13 +0100 1663438 http://www.medworm.com/index.php?rid=1554140&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18406972%26dopt%3DAbstract Authors: Mattu A PMID: 18406972 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1554140 Thu, 01 May 2008 04:00:00 +0100 1554140 http://www.medworm.com/index.php?rid=1554139&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18406973%26dopt%3DAbstract Authors: Martin DR PMID: 18406973 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1554139 Thu, 01 May 2008 04:00:00 +0100 1554139 http://www.medworm.com/index.php?rid=1373108&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18406972%26dopt%3DAbstract Authors: Mattu A PMID: 18406972 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1373108 Tue, 15 Apr 2008 19:40:44 +0100 1373108 http://www.medworm.com/index.php?rid=1373107&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18406973%26dopt%3DAbstract Authors: Martin DR PMID: 18406973 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1373107 Tue, 15 Apr 2008 19:40:41 +0100 1373107 http://www.medworm.com/index.php?rid=1373106&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18406974%26dopt%3DAbstract Authors: Pines JM The importance of antibiotic timing is a common clinical question encountered in emergency medicine practice for patients who have severe infections. Various studies in the medical literature have reported associations between early antibiotic timing and improved survival for meningitis, pneumonia, and septic shock. Understanding the evidence behind antibiotic timing and survival is vital to emergency physicians, because they must balance the potential benefits of early antibiotic administration and the potential for antibiotic overuse and misuse. The measurement of antibiotic timing in pneumonia has been shown to be associated with antibiotic misuse in emergency departments. Quality organizations should study carefully the intended and unintended consequences of meas... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1373106 Tue, 15 Apr 2008 19:40:39 +0100 1373106 http://www.medworm.com/index.php?rid=1373105&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18406975%26dopt%3DAbstract This article discusses early identification and treatment for several rapidly fatal infections, including two newly identified travel-related illnesses. PMID: 18406975 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1373105 Tue, 15 Apr 2008 19:40:37 +0100 1373105 http://www.medworm.com/index.php?rid=1373104&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18406976%26dopt%3DAbstract This article highlights methods of diagnosis, differential diagnoses, treatment options, and complications of treating bacterial meningitis. PMID: 18406976 [PubMed - as supplied by publisher] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1373104 Tue, 15 Apr 2008 19:40:35 +0100 1373104 http://www.medworm.com/index.php?rid=1373103&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18406977%26dopt%3DAbstract Authors: Caterino JM A significant proportion of elderly emergency department visits are for acute infections. The elderly are more likely than younger patients to have nonspecific signs and symptoms of infection, more severe disease, and resistant microorganisms. As a result, emergency physicians must maintain a high index of suspicion for infection, even in the face of nonspecific symptoms, and should tailor empiric antibiotic therapies to the expected pathogens in this population. Appropriate emergency department evaluation and treatment of infections in the elderly requires consideration of these unique aspects of the geriatric patient population. PMID: 18406977 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1373103 Tue, 15 Apr 2008 19:40:32 +0100 1373103 http://www.medworm.com/index.php?rid=1373102&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18406978%26dopt%3DAbstract Authors: Gorgas DL Infections in pregnancy and in the postpartum period represent an important knowledge base that emergency physicians should have. Being able to understand the risk that pregnancy-related infections have on maternal and fetal health in addition to the initiation of appropriate treatment for these infections is crucial. In the postpartum period, most infections (94%) are likely to manifest after hospital discharge; therefore, patients frequently present to the emergency department. PMID: 18406978 [PubMed - in process] (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=1373102 Tue, 15 Apr 2008 19:40:30 +0100 1373102