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. Wed, 08 Feb 2012 14:35:37 +0100 http://www.medworm.com/index.php?rid=5432156&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711001301%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=5432156 Tue, 22 Nov 2011 07:35:40 +0100 5432156 http://www.medworm.com/index.php?rid=5432138&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711001349%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=5432138 Tue, 22 Nov 2011 07:35:40 +0100 5432138 http://www.medworm.com/index.php?rid=5432137&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711001283%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=5432137 Tue, 22 Nov 2011 07:35:39 +0100 5432137 http://www.medworm.com/index.php?rid=5432136&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711001271%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=5432136 Tue, 22 Nov 2011 07:35:39 +0100 5432136 http://www.medworm.com/index.php?rid=5432135&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS073386271100126X%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=5432135 Tue, 22 Nov 2011 07:35:39 +0100 5432135 http://www.medworm.com/index.php?rid=5361378&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711001040%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=5361378 Mon, 31 Oct 2011 22:44:25 +0100 5361378 http://www.medworm.com/index.php?rid=5361377&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000708%2Fabstract%3Frss%3Dyes Pediatric congenital heart disease comprises a wide spectrum of structural defects. These lesions present in a limited number of ways. An infant presenting with profound shock, cyanosis, or evidence of congestive heart failure should raise the suspicion of congenital heart disease. Although most congenital lesions are diagnosed in utero, the emergency physician must be aware of these cardinal presentations because many patients present in the postnatal period around the time that the ductus arteriosus closes. Aggressive management of cardiopulmonary instability combined with empiric use of prostaglandin E1 and early pediatric cardiology consultation is essential for positive outcomes. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5361377 Mon, 31 Oct 2011 22:44:25 +0100 5361377 http://www.medworm.com/index.php?rid=5361376&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000666%2Fabstract%3Frss%3Dyes This article focuses on the valve-related issues the emergency physician will face, from the trauma patient with a mechanical valve who may need his or her anticoagulation reversed to the febrile patient with a new murmur. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5361376 Mon, 31 Oct 2011 22:44:24 +0100 5361376 http://www.medworm.com/index.php?rid=5361375&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000885%2Fabstract%3Frss%3Dyes Aortic emergencies present a diagnostic and treatment challenge for emergency physicians. Both acute aortic dissection and abdominal aortic aneurysms can be difficult to recognize, and a missed or delayed diagnosis may be fatal. A high clinical suspicion and rapid patient evaluation are important. Although many patients ultimately require surgical intervention, early and aggressive attention to hemodynamic stability by the emergency physician can provide a window to definitive treatment. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5361375 Mon, 31 Oct 2011 22:44:24 +0100 5361375 http://www.medworm.com/index.php?rid=5361369&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000897%2Fabstract%3Frss%3Dyes This article reviews the current evidence and guidelines for the treatment of patients along the continuum of ACS. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5361369 Mon, 31 Oct 2011 22:44:24 +0100 5361369 http://www.medworm.com/index.php?rid=5361367&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000691%2Fabstract%3Frss%3Dyes Postdischarge mortality and morbidity from acute heart failure syndrome (AHFS) are high, affecting nearly half of all discharged patients within 90 days. Emergency department therapy remains largely empiric, with minimal evidence to support definitive recommendations to guide therapy. However, lessons learned from recent registries and trials suggest an approach to initial management based on clinical profiles, as defined by high, normal, or low blood pressure. Clinicians are provided with a practical and consensus-driven approach to everyday AHFS management. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5361367 Mon, 31 Oct 2011 22:44:23 +0100 5361367 http://www.medworm.com/index.php?rid=5361366&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000952%2Fabstract%3Frss%3Dyes There was a time in the long distant past when a cardiac emergency meant it was time to call a cardiologist. Then along came “time is muscle” and with it a stunning recognition that there was a different group of physicians who worked under the mantra of “Any Patient, Any Time” and who could commonly attend to the patient in five minutes or less. The stage was set and it became apparent that the care of acute cardiovascular conditions was squarely within the purview of Emergency Medicine. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5361366 Mon, 31 Oct 2011 22:44:23 +0100 5361366 http://www.medworm.com/index.php?rid=5361365&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000939%2Fabstract%3Frss%3Dyes Ask any emergency physician to list the most common chief complaints among emergency department (ED) patients and chest pain is certain to show up as a top complaint. Ask those same emergency physicians to list the most deadly conditions in the ED and you’re likely to see acute myocardial infarction, dysrhythmias, and perhaps an assortment of other cardiac conditions. Next, ask risk managers and malpractice lawyers for their “top 5” list of causes of malpractice in emergency medicine and, once again, you’re certain to see cardiac conditions on that list. In short, cardiac conditions are common, deadly, and high risk from a medicolegal standpoint. A sound knowledge of emergency cardiology is an absolute prerequisite to the successful practice of emergency medicine. (Source: Emergenc... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5361365 Mon, 31 Oct 2011 22:44:23 +0100 5361365 http://www.medworm.com/index.php?rid=5361364&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS073386271100109X%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=5361364 Mon, 31 Oct 2011 22:44:23 +0100 5361364 http://www.medworm.com/index.php?rid=5361363&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711001027%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=5361363 Mon, 31 Oct 2011 22:44:22 +0100 5361363 http://www.medworm.com/index.php?rid=5361362&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711001015%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=5361362 Mon, 31 Oct 2011 22:44:22 +0100 5361362 http://www.medworm.com/index.php?rid=5361361&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711001003%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=5361361 Mon, 31 Oct 2011 22:44:22 +0100 5361361 http://www.medworm.com/index.php?rid=5432151&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000848%2Fabstract%3Frss%3Dyes Caring in the emergency department for the patient with return of spontaneous circulation after cardiac arrest is challenging. A coordinated and systematic approach to post–cardiac arrest care can improve the mortality and the chance of meaningful neurologic recovery. By achieving appropriate targets for oxygenation, ventilation, and hemodynamic parameters, along with initiating therapeutic hypothermia and arranging early percutaneous coronary intervention, the emergency physician can have the most significant impact on patients who have just been revived from death. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432151 Mon, 24 Oct 2011 04:00:00 +0100 5432151 http://www.medworm.com/index.php?rid=5432141&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000915%2Fabstract%3Frss%3Dyes In April 2011, a 51-year-old man boards a plane with his wife for a well-deserved vacation. One hour into the flight, the man’s wife is yelling for a doctor. The man is slumped over in his seat, unresponsive. Miraculously, another passenger comes to the rescue, performs CPR, and uses the plane’s defibrillator to resuscitate the man to the cheers of passengers. Approximately 22 minutes later, the flight crew safely lands the plane, and the patient is able to thank his rescuer as he is taken to the hospital, where he fully recovers. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432141 Mon, 24 Oct 2011 04:00:00 +0100 5432141 http://www.medworm.com/index.php?rid=5432140&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000927%2Fabstract%3Frss%3Dyes Medical resuscitation has been around for many thousands of years. The physician has performed resuscitation on a multitude of patients, using many methods, in a range of settings. Over these many millennia, the science of resuscitation has guided the clinician in the art of medical care. We have progressed from early methods, such as hanging an inverted patient from a tree limb and using a bellows inserted into the rectum, to more refined (and effective) contemporary interventions and strategies. Undoubtedly, clinicians of the future will look back at us with similar disbelief—“can you believe it…they were actually pushing on the patient’s chest…and shocking the heart!” Nonetheless, the science of resuscitation has progressed to the point that we are now beginning to apply the... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432140 Mon, 24 Oct 2011 04:00:00 +0100 5432140 http://www.medworm.com/index.php?rid=5432139&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000940%2Fabstract%3Frss%3Dyes “Cardiac arrest!” These two simple words conjure up images in our minds of sirens and flashing lights, doctors and nurses running, intubation, defibrillations, and an assortment of other similarly dramatic activities. It’s unlikely that there’s any other condition in medicine that has been the source of more research, teaching, discussion, and infatuation. The treatment of cardiac arrest, after all, is essentially to bring a dead patient back to life. It is in some respects man’s attempt to play God…to bring back the dead is certainly the greatest achievement in the practice of medicine! (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432139 Mon, 24 Oct 2011 04:00:00 +0100 5432139 http://www.medworm.com/index.php?rid=5432155&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000757%2Fabstract%3Frss%3Dyes This article reviews several adjuncts and mechanical alternatives to conventional CPR for use during cardiac arrest. Recent clinical studies comparing conventional resuscitation techniques with the use of devices during cardiac arrest are reviewed, with a focus on clinical implications and directions for future research. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432155 Wed, 19 Oct 2011 04:00:00 +0100 5432155 http://www.medworm.com/index.php?rid=5432152&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS073386271100085X%2Fabstract%3Frss%3Dyes Rapid response systems (RRS) are both intuitive and supported by data, but the institution of an RRS is not a panacea for in-hospital cardiac arrest or unexpected deaths. RRS implementation should be one component of an institution-wide effort to improve patient safety that includes adequate nursing education and staffing, availability and involvement of a patient’s primary caregivers, and hospital provision of sufficient resources and efficiency. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432152 Mon, 17 Oct 2011 04:00:00 +0100 5432152 http://www.medworm.com/index.php?rid=5432150&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000745%2Fabstract%3Frss%3Dyes Solutions to improve care provided during cardiac arrest resuscitation attempts must be multifaceted and targeted to the diverse number of care providers to be successful. In this article, new approaches to improving cardiac arrest resuscitation performance are reviewed. The focus is on a continuous quality improvement paradigm highlighting improving training methods before actual cardiac arrest events, monitoring quality during resuscitation attempts, and using quantitative debriefing programs after events to educate frontline care providers. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432150 Mon, 17 Oct 2011 04:00:00 +0100 5432150 http://www.medworm.com/index.php?rid=5432142&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000769%2Fabstract%3Frss%3Dyes This article reviews out-of-hospital cardiac arrest from a public health perspective. Case definitions are discussed. Incidence, outcome, and fixed and modifiable risk factors for cardiac arrest are described. There is a large variation in survival between communities that is not explained by patient or community factors. Study of variation in outcome in other related conditions suggest that this is due to differences in organizational culture rather than processes of care. A public health approach to improving outcomes is recommended that includes ongoing monitoring and improvement of processes and outcome of care. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432142 Mon, 17 Oct 2011 04:00:00 +0100 5432142 http://www.medworm.com/index.php?rid=5361371&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000903%2Fabstract%3Frss%3Dyes Patients who present to the ED with chest pain (or its equivalent) but have no electrocardiographic changes or elevation in cardiac biomarkers after an appropriate interval can be considered low risk for acute coronary syndrome. Combined with a low demographic risk for coronary artery disease (eg, using Framingham criteria), such patients can be said to be “low risk” for a subsequent coronary event. Whether there is a role for further risk stratification with provocative testing and/or coronary imaging before discharge remains open to debate. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5361371 Fri, 14 Oct 2011 04:00:00 +0100 5361371 http://www.medworm.com/index.php?rid=5432154&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000873%2Fabstract%3Frss%3Dyes In certain cardiac arrest situations, modifications to current cardiac resuscitation algorithms may improve patient outcome. These situations are often rare, but when they occur they house the potential for severe time and resource use, and in some cases specialized skill sets. The decision to apply these modifications to standard care for the cardiac arrest patient may be obvious in some cases or may be applied due to suspicion from the presenting medical history, history of present illness, or physical examination. However, with rare exception, general care of any cardiac arrest patient should include continuous high-quality chest compressions and appropriate airway and ventillatory management. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432154 Thu, 13 Oct 2011 04:00:00 +0100 5432154 http://www.medworm.com/index.php?rid=5432147&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000812%2Fabstract%3Frss%3Dyes The goal of treating patients who present with cardiac arrest is to intervene as quickly as possible to affect the best possible outcome. The mainstays of these interventions, including early activation of the emergency response team, early initiation of cardiopulmonary resuscitation, and early defibrillation, are essential components with demonstrated positive impact on resuscitation outcomes. Conversely, the use of the code drugs as a component of advanced life support has not benefited these patients to the same extent as the basic interventions in a general. Although short-term outcomes are improved as a function of these medications, the final outcome has not been altered significantly in most instances. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432147 Thu, 13 Oct 2011 04:00:00 +0100 5432147 http://www.medworm.com/index.php?rid=5432144&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000782%2Fabstract%3Frss%3Dyes In-hospital sudden cardiac arrest and resuscitation is distinct from out-of-hospital sudden cardiac arrest (OOHSCA) and warrants specific attention. Sudden cardiac arrest (SCA) is a manifestation of an underlying process rather than a disease itself. The complex, multiorgan system dysfunction common among the inpatient population can precipitate SCA by both similar and very different mechanisms than OOHSCA. The diagnostic and treatment algorithms of SCA remain largely the same between the inpatient and outpatient arenas. The application of complex diagnostic and therapeutic interventions is permissible, but such tools must not interrupt or delay the important basics of cardiac arrest management in the inpatient setting, including adequate chest compressions and timely defibrillation when a... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432144 Thu, 13 Oct 2011 04:00:00 +0100 5432144 http://www.medworm.com/index.php?rid=5432153&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000861%2Fabstract%3Frss%3Dyes This article discusses strategies to increase the chance of survival to discharge. These strategies focus on suggestions for organizing a system prepared to care for critically ill children, incorporating the 2010 American Heart Association resuscitation guidelines into clinical practice, and encouraging physicians to become advocates of decreasing the occurrence of pediatric cardiac arrest. Providing the best-prepared system available to care for critically ill children will, it is hoped, decrease the number of preventable deaths in children. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432153 Mon, 10 Oct 2011 04:00:00 +0100 5432153 http://www.medworm.com/index.php?rid=5432149&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000836%2Fabstract%3Frss%3Dyes This article explores several factors that aid in determining prognosis after cardiac arrest. It is broadly divided into prearrest factors, intra-arrest factors, and postarrest factors. Prearrest factors predominantly concern the presence or absence of a shockable rhythm. Intra-arrest factors look at the partial pressure of end-tidal CO2 and the presence of cardiac standstill on ultrasound. Postarrest factors include early outcome measures as well as a more comprehensive algorithmic approach to predicting neurologic outcome. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432149 Mon, 10 Oct 2011 04:00:00 +0100 5432149 http://www.medworm.com/index.php?rid=5432148&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000824%2Fabstract%3Frss%3Dyes This article reviews the current state of the literature regarding airway management of the patient in cardiac arrest. Ventilatory management strategies are also discussed. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432148 Mon, 10 Oct 2011 04:00:00 +0100 5432148 http://www.medworm.com/index.php?rid=5432146&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000800%2Fabstract%3Frss%3Dyes This article focuses on the use of electrical therapies, including defibrillation, cardiac pacing, and automated external defibrillators, in cardiac arrest. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432146 Mon, 10 Oct 2011 04:00:00 +0100 5432146 http://www.medworm.com/index.php?rid=5432143&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000770%2Fabstract%3Frss%3Dyes This article reviews access and presentations, demographics, OHCA outcomes, and response systems and processes in treatment of patients with arrest in this setting. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432143 Tue, 04 Oct 2011 04:00:00 +0100 5432143 http://www.medworm.com/index.php?rid=5432145&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000794%2Fabstract%3Frss%3Dyes Cardiopulmonary resuscitation (CPR) is vital therapy in cardiac arrest care by lay and trained rescuers. Chest compressions are the key component of CPR. Ventilation and airway management should be secondary to high-quality and continuous chest compressions in patients receiving CPR. Only after the patient has had return of spontaneous circulation or completed a cycle of CPR with defibrillation (if appropriate) should attempts at securing an advanced airway be made. Even then, interruptions of chest compressions should be minimized to maintain cardiocerebral perfusion and increase survival. Finally, the ventilation rate should be no more than 8 to 10 breaths per minute. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432145 Mon, 03 Oct 2011 04:00:00 +0100 5432145 http://www.medworm.com/index.php?rid=5361373&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000733%2Fabstract%3Frss%3Dyes This article discusses recommendations that are derived from a combination of existing guidelines, additional evidence, and consensus. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5361373 Wed, 28 Sep 2011 04:00:00 +0100 5361373 http://www.medworm.com/index.php?rid=5361374&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000678%2Fabstract%3Frss%3Dyes This article provides an evidence-based discussion of the common uses of emergency transthoracic echocardiography, as well as its benefits and limitations in the current practice of emergency medicine. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5361374 Mon, 26 Sep 2011 04:00:00 +0100 5361374 http://www.medworm.com/index.php?rid=5361370&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS073386271100068X%2Fabstract%3Frss%3Dyes With the release of the 2010 American Heart Association (AHA) Guidelines for cardiopulmonary resuscitation and emergency cardiac care, evidence regarding management of out-of-hospital cardiac arrest suggests a more fundamental approach. To aid in understanding and learning, this article proposes a method that optimizes the timing and delivery of evidence-proven therapies with a 3-phase approach for out-of-hospital resuscitation from ventricular fibrillation and pulseless ventricular tachycardia. Although this model is not a new concept, it is largely based on the 2010 AHA Guidelines, enhancing the philosophy of the “CAB” concept (Chest compressions/Airway management/Breathing rescue). (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5361370 Thu, 22 Sep 2011 04:00:00 +0100 5361370 http://www.medworm.com/index.php?rid=5361368&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS073386271100071X%2Fabstract%3Frss%3Dyes This article discusses clinical presentations and diagnostic approaches to acute coronary syndrome 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=5361368 Thu, 22 Sep 2011 04:00:00 +0100 5361368 http://www.medworm.com/index.php?rid=5361372&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000721%2Fabstract%3Frss%3Dyes This article discusses the differential diagnosis and treatment of adult patients presenting with primary bradyarrhythmias and tachyarrhythmias, with the exception of atrial fibrillation and atrial flutter, covered elsewhere in this issue. A concise approach to diagnosis and determination of appropriate therapy is presented. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5361372 Fri, 09 Sep 2011 04:00:00 +0100 5361372 http://www.medworm.com/index.php?rid=5053314&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000587%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=5053314 Sat, 23 Jul 2011 16:41:42 +0100 5053314 http://www.medworm.com/index.php?rid=5053313&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS073386271100037X%2Fabstract%3Frss%3Dyes This article addresses a variety of congenital and acquired pediatric genitourinary disorders. Genitourinary emergencies include paraphismosis, priapism, serious infection, significant traumatic injury and gonadal torsion. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5053313 Sat, 23 Jul 2011 16:41:42 +0100 5053313 http://www.medworm.com/index.php?rid=5053312&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000381%2Fabstract%3Frss%3Dyes This article reviews pediatric UTI and addresses epidemiology, diagnosis, treatment, and imaging, and their importance to the practicing emergency medicine provider. Accurate and timely diagnosis of pediatric UTI can prevent short-term complications, such as severe pyelonephritis or sepsis, and long-term sequelae including scarring of the kidneys, hypertension, and ultimately chronic renal insufficiency and need for transplant. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5053312 Sat, 23 Jul 2011 16:41:41 +0100 5053312 http://www.medworm.com/index.php?rid=5053310&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000460%2Fabstract%3Frss%3Dyes This article discusses the emergency medicine approach to history taking, physical examination, evidence collection, chain of custody, psychological and medical treatment, and appropriate follow-up. Special circumstances discussed include intimate partner violence, male examinations, pediatric examinations, suspect examinations, and drug-facilitated assaults. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5053310 Sat, 23 Jul 2011 16:41:41 +0100 5053310 http://www.medworm.com/index.php?rid=5053309&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000423%2Fabstract%3Frss%3Dyes This article provides an overview of STIs encountered in the ED and recommendations for their treatment. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5053309 Sat, 23 Jul 2011 16:41:41 +0100 5053309 http://www.medworm.com/index.php?rid=5053308&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000393%2Fabstract%3Frss%3Dyes This article reviews basic renal physiology, discusses the differential diagnosis and approach to therapy, as well as strategies to prevent further renal injury, for adult patients who present to the ED with renal injury or failure. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5053308 Sat, 23 Jul 2011 16:41:41 +0100 5053308 http://www.medworm.com/index.php?rid=5053306&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000356%2Fabstract%3Frss%3Dyes This article discusses treatment options in light of bacterial resistance in the twenty-first century. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5053306 Sat, 23 Jul 2011 16:41:40 +0100 5053306 http://www.medworm.com/index.php?rid=5053305&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000411%2Fabstract%3Frss%3Dyes Urolithiasis commonly presents to the emergency department with acute, severe, unilateral flank pain. Patients with a suspected first-time stone or atypical presentation should be evaluated with a noncontrast computed tomography scan to confirm the diagnosis and rule out alternative diagnoses. Narcotics remain the mainstay of pain management but in select patients, nonsteroidal anti-inflammatories alone or in combination with narcotics provide safe and effective analgesia in the emergency department. Whereas most kidney stones can be managed with pain control and expectant management, obstructing kidney stones with a suspected proximal urinary tract infection are urological emergencies requiring emergent decompression, antibiotics, and resuscitation. (Source: Emergency Medicine Clinics of ... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5053305 Sat, 23 Jul 2011 16:41:40 +0100 5053305 http://www.medworm.com/index.php?rid=5053304&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000435%2Fabstract%3Frss%3Dyes Injury to the genitourinary (GU) tract occurs in up to 10% of all traumas, with the kidneys being the most frequently affected. Trauma to different areas of the GU tract can be caused in a variety of ways, and the diagnostics and management of the injuries vary widely depending on the mechanism and location. Overall, fatalities from GU trauma are not common. However, significant morbidity can occur without prompt recognition and appropriate intervention. A basic understanding of urologic trauma is necessary for all emergency practitioners when caring for trauma patients. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5053304 Sat, 23 Jul 2011 16:41:40 +0100 5053304 http://www.medworm.com/index.php?rid=5053303&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS073386271100040X%2Fabstract%3Frss%3Dyes This article discusses emergent penile complaints in adults, with emphasis on the most serious and common conditions. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5053303 Sat, 23 Jul 2011 16:41:40 +0100 5053303 http://www.medworm.com/index.php?rid=5053302&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000459%2Fabstract%3Frss%3Dyes This article reviews the evaluation and management of the acute scrotum 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=5053302 Sat, 23 Jul 2011 16:41:39 +0100 5053302 http://www.medworm.com/index.php?rid=5053301&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000484%2Fabstract%3Frss%3Dyes Genitourinary (GU) complaints can be quite distressing for the patient, parent, or caretaker (and even, at times, for the health care provider!). Presentations may be delayed as a result of embarrassment or apprehension. The emergency care provider must remain particularly sensitive to both the emotional and the physical needs of the patient. Furthermore, certain GU conditions such as testicular torsion are particularly high risk from a medicolegal perspective. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5053301 Sat, 23 Jul 2011 16:41:39 +0100 5053301 http://www.medworm.com/index.php?rid=5053300&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000496%2Fabstract%3Frss%3Dyes One of my former medical school professors once referred to the genitourinary (GU) system as the most important system of the human body. He went on to describe the GU system as the reason that we all can live as well as the reason that we all want to live. Without a properly functioning GU system, waste products would build up and cause us to die within days. The GU system also is responsible for mankind’s ability to reproduce and carry on the species. His point was well-taken. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5053300 Sat, 23 Jul 2011 16:41:39 +0100 5053300 http://www.medworm.com/index.php?rid=5053299&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000629%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=5053299 Sat, 23 Jul 2011 16:41:39 +0100 5053299 http://www.medworm.com/index.php?rid=5053298&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000563%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=5053298 Sat, 23 Jul 2011 16:41:39 +0100 5053298 http://www.medworm.com/index.php?rid=5053297&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000551%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=5053297 Sat, 23 Jul 2011 16:41:39 +0100 5053297 http://www.medworm.com/index.php?rid=5053296&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS073386271100054X%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=5053296 Sat, 23 Jul 2011 16:41:39 +0100 5053296 http://www.medworm.com/index.php?rid=5053311&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000368%2Fabstract%3Frss%3Dyes Lower abdominal and pelvic pains are common symptoms in women who present to the emergency department (ED). Once pregnancy has been ruled out, attention should focus on other potential life or fertility threats. Ultrasound remains the most helpful initial diagnostic modality. Time-sensitive and serious conditions, such as large ovarian masses or abnormal vaginal bleeding, need gynecologic consultation. Because many patients do not have access to primary care, ED physicians should be familiar with the treatment of sexually transmitted diseases. However, most nonpregnant women with pelvic complaints can safely be managed in the outpatient setting after ED evaluation. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5053311 Thu, 16 Jun 2011 23:00:00 +0100 5053311 http://www.medworm.com/index.php?rid=5053307&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000447%2Fabstract%3Frss%3Dyes This article covers the various imaging options, with a discussion of the advantages and disadvantages of each of these different modalities. Special emphasis is placed on point-of-care EM ultrasound performed by the EM specialist at the patient bedside. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5053307 Sun, 12 Jun 2011 23:00:00 +0100 5053307 http://www.medworm.com/index.php?rid=4748924&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000265%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=4748924 Tue, 26 Apr 2011 14:29:27 +0100 4748924 http://www.medworm.com/index.php?rid=4748923&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000071%2Fabstract%3Frss%3Dyes This article focuses on two specific populations: patients with altered immunologic function and postprocedural patients. Recognition of life-threatening abdominal diseases may be delayed in immunosuppressed patients because of the atypical presentations of these conditions. In postprocedural patients, evaluation of acute abdominal symptoms requires an understanding of the complications of procedures often performed by others. The unique characteristics of abdominal pain in these two populations and, more specifically, which diseases to consider and how to use appropriate testing to detect life-threatening conditions, are discussed. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4748923 Tue, 26 Apr 2011 14:29:27 +0100 4748923 http://www.medworm.com/index.php?rid=4748922&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000137%2Fabstract%3Frss%3Dyes Abdominal pain in older adults is a concerning symptom common to a variety of diagnoses with high morbidity and mortality. Organizing the differential into categories based on pathology (inflammatory, obstructive, vascular, or other causes) provides a framework for the history, physical, and diagnostic studies. An organized approach and treatment and considerations specific to the geriatric population are discussed. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4748922 Tue, 26 Apr 2011 14:29:27 +0100 4748922 http://www.medworm.com/index.php?rid=4748921&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000022%2Fabstract%3Frss%3Dyes This article highlights several pediatric diagnoses presenting as abdominal pain, including surgical emergencies, nonsurgical diagnoses, and extraabdominal processes, and reviews the clinical presentation, diagnostic evaluation, and management of each. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4748921 Tue, 26 Apr 2011 14:29:27 +0100 4748921 http://www.medworm.com/index.php?rid=4748920&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000101%2Fabstract%3Frss%3Dyes Of all ingested foreign bodies (FBs) brought to the attention of physicians (probably a small minority of the total), 80% to 90% pass spontaneously; however, 10% to 20% require endoscopic removal, and about 1% require surgery. The article divides the GI tract into regions in which the anatomy, presentation, clinical findings, and management of FBs are distinct. The final third of this article describes the management of anorectal emergencies. An understanding of anatomy and common pathological conditions allows the emergency physician to make a diagnosis and provide relief and/or resolution in most cases. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4748920 Tue, 26 Apr 2011 14:29:26 +0100 4748920 http://www.medworm.com/index.php?rid=4748919&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000034%2Fabstract%3Frss%3Dyes This article details an ED-based approach to each of these disease entities. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4748919 Tue, 26 Apr 2011 14:29:26 +0100 4748919 http://www.medworm.com/index.php?rid=4748918&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000058%2Fabstract%3Frss%3Dyes This article discusses bowel obstruction, adynamic ileus, acute colonic pseudo-obstruction, and abdominal hernias, with particular emphasis on the management of patients in the emergency department (ED). Although the diagnostic approach to bowel obstruction often requires imaging, abdominal hernia may be identified in most circumstances by history and physical examination alone. Urgent surgical consultation is indicated when there is a concern for bowel ischemia, strangulation, or complete obstruction. This article reviews an ED-based approach to the patient presenting with symptoms of bowel obstruction or hernia. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4748918 Tue, 26 Apr 2011 14:29:26 +0100 4748918 http://www.medworm.com/index.php?rid=4748917&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000095%2Fabstract%3Frss%3Dyes This article examines hepatic emergencies including alcoholic hepatitis, spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatic encephalopathy. In addition, the authors review the presentation, evaluation, and management of acute biliary tract disorders with some emphasis on bedside ultrasonography. Evaluation and treatment of pancreatitis and its complications in the ED are discussed. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4748917 Tue, 26 Apr 2011 14:29:26 +0100 4748917 http://www.medworm.com/index.php?rid=4748916&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000083%2Fabstract%3Frss%3Dyes The pathophysiology of esophageal and gastric disorders is complicated and broad and includes iatrogenic, structural, inflammatory, neuromuscular, neoplastic, and infectious causes. Symptoms can be nonspecific and are often initially attributed to cardiac or respiratory causes. These disorders have both acute and chronic presentations that require different approaches to diagnosis and management. A thorough history and physical examination enable emergency physicians to initiate evaluation of gastroesophageal disorders. Complete evaluation often requires a combination of emergent screening to rule out life-threatening problems as well as coordinated outpatient testing. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4748916 Tue, 26 Apr 2011 14:29:26 +0100 4748916 http://www.medworm.com/index.php?rid=4748915&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000150%2Fabstract%3Frss%3Dyes Patients with nonspecific abdominal pain can have any one of many disease processes. The physical examination may not reveal clear abnormalities, making the diagnosis more difficult. Vascular abdominal emergencies are not common but, when present, may be catastrophic, with significant morbidity and, frequently, mortality. Most of the conditions are time sensitive, leaving the integrity of organ blood flow at risk. Thromboembolic disease leads to ischemia and eventual infarction of the intra-abdominal organs. Aneurismal dilation of the aorta with rupture leads to rapid hypovolemic shock and death if not diagnosed. A high index of suspicion is critical to the successful diagnosis. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4748915 Tue, 26 Apr 2011 14:29:26 +0100 4748915 http://www.medworm.com/index.php?rid=4748914&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000046%2Fabstract%3Frss%3Dyes Gastrointestinal bleeding is a common complaint encountered in the emergency department and frequent cause of hospitalization. Important diagnostic factors that increase morbidity and mortality include advanced age, serious comorbid conditions, hemodynamic instability, esophageal varices, significant hematemesis or melena, and marked anemia. Because gastrointestinal bleeding carries a 10% overall mortality rate, emergency physicians must perform timely diagnosis, aggressive resuscitation, risk stratification, and early consultation 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=4748914 Tue, 26 Apr 2011 14:29:26 +0100 4748914 http://www.medworm.com/index.php?rid=4748913&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS073386271100006X%2Fabstract%3Frss%3Dyes Diseases that cause vomiting, diarrhea, constipation, and gastroenteritis are major problems for populations worldwide. Patients, particularly infants, elderly, and immunocompromised individuals, may present at any point in a wide spectrum of disease states, underscoring the need for the clinician to treat these ailments aggressively. Several promising new treatment modalities, from oral rehydration solutions to antiemetic therapies, have been introduced over the past decade. Future directions include the use of probiotic agents and better tolerated rehydration solutions. Gastrointestinal disease will continue to be a focus worldwide in the search for better ways to cure illnesses associated with vomiting and diarrhea. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4748913 Tue, 26 Apr 2011 14:29:26 +0100 4748913 http://www.medworm.com/index.php?rid=4748912&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000125%2Fabstract%3Frss%3Dyes This article discusses the most important and common of these causes, namely the metabolic/endocrine causes, hematologic causes, inflammatory causes, infectious causes, functional causes, and the neurogenic causes. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4748912 Tue, 26 Apr 2011 14:29:25 +0100 4748912 http://www.medworm.com/index.php?rid=4748911&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000113%2Fabstract%3Frss%3Dyes When discussing which laboratory tests or imaging to order in the setting of acute abdominal pain, it is practical to organize information by disease process (eg, acute appendicitis, cholecystitis). Because studies on the accuracy of diagnostic tests are of necessity related to the presence or absence of specific diagnoses, and because clinicians frequently look to tests to help them rule in or rule out specific conditions, this article is organized by region of pain and common abdominal diagnoses. It focuses on the contributions that laboratory testing and imaging make in the emergency management of abdominal complaints. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4748911 Tue, 26 Apr 2011 14:29:25 +0100 4748911 http://www.medworm.com/index.php?rid=4748910&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000149%2Fabstract%3Frss%3Dyes This article seeks to provide the clinician with the clinical tools to achieve these goals by reviewing the anatomic and physiological basis of abdominal pain and key components of the history and the physical examination. In addition, this article discusses the approach to unstable patients with abdominal pain. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4748910 Tue, 26 Apr 2011 14:29:25 +0100 4748910 http://www.medworm.com/index.php?rid=4748909&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000162%2Fabstract%3Frss%3Dyes The abdomen is like a stageEnclosed within a fleshy cage,The symptoms are the actors whoAlthough they are a motley crewAct often with consummate artThe major or the minor part;Nor do they usually sayWho is the author of the play.That is for you to try and guess,A problem which, I must confessIs made less easy from the factYou seldom see the opening act,And by the time that you arriveThe victim may be just alive.(Cope Z. The Acute Abdomen in Rhyme. 5th edition. London: H.K. Lewis & Co Ltd; 1972.) (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4748909 Tue, 26 Apr 2011 14:29:25 +0100 4748909 http://www.medworm.com/index.php?rid=4748908&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000174%2Fabstract%3Frss%3Dyes Many physicians consider the brain to be the “black box” of the human body … that area of the body that may be difficult to understand and diagnose, one that harbors often occult but deadly pathologies. Personally, however, I consider the abdomen and gastrointestinal (GI) system to be the true “black box.” Within the abdomen lies myriad organs and vessels, each with multiple functions, and any one of which can produce death without fair warning symptoms or signs. Complicating matters further, abdominal pain and other GI symptoms are among the most common reasons that patients seek medical attention. Abdominal pain, nausea, vomiting, and diarrhea are presentations for an enormous number of diseases, from relatively mundane conditions to deadly conditions. These “typical” sympt... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4748908 Tue, 26 Apr 2011 14:29:25 +0100 4748908 http://www.medworm.com/index.php?rid=4748907&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000307%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=4748907 Tue, 26 Apr 2011 14:29:25 +0100 4748907 http://www.medworm.com/index.php?rid=4748906&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000241%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=4748906 Tue, 26 Apr 2011 14:29:25 +0100 4748906 http://www.medworm.com/index.php?rid=4748905&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS073386271100023X%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=4748905 Tue, 26 Apr 2011 14:29:25 +0100 4748905 http://www.medworm.com/index.php?rid=4748904&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862711000228%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=4748904 Tue, 26 Apr 2011 14:29:25 +0100 4748904 http://www.medworm.com/index.php?rid=4198101&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710001148%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=4198101 Thu, 25 Nov 2010 04:44:49 +0100 4198101 http://www.medworm.com/index.php?rid=4198100&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS073386271000088X%2Fabstract%3Frss%3Dyes During the past decade several new antiepileptic drugs (AEDs) have become available, including new formulations of some of the older medications. Understanding the pharmacokinetics of the new AEDs is important because they are primarily used for adjunctive therapy and interactions with other medications can result in significant toxicities. The new-generation AEDs do not cause serious morbidity in overdose, and treatment is primarily supportive. Specific medications should be chosen based on the patient's history and presentation. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4198100 Thu, 25 Nov 2010 04:44:49 +0100 4198100 http://www.medworm.com/index.php?rid=4198099&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000842%2Fabstract%3Frss%3Dyes Toxin-related seizures result from an imbalance in the brain's equilibrium of excitation-inhibition. Fortunately, most toxin-related seizures respond to standard therapy using benzodiazepines. However, a few alterations in the standard approach are recommended to ensure optimal care and expedient termination of seizure activity. If 2 doses of a benzodiazepine do not terminate the seizure activity, a therapeutic dose of pyridoxine (5 g intravenously in an adult and 70 mg/kg intravenously in a child) should be considered. Phenytoin should be avoided because it is ineffective for many toxin-induced seizures and is potentially harmful when used to treat seizures induced by theophylline or cyclic antidepressants. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4198099 Thu, 25 Nov 2010 04:44:49 +0100 4198099 http://www.medworm.com/index.php?rid=4198098&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000830%2Fabstract%3Frss%3Dyes The term alcohol-related seizures (ARS) is used to refer to all seizures in the aggregate associated with alcohol use, including the subset of alcohol withdrawal seizures (AWS). From 20% to 40% of patients with seizure who present to an emergency department have seizures related to alcohol abuse. However, it is critical to avoid prematurely labeling a seizure as being caused by alcohol withdrawal before performing a careful diagnostic evaluation. Benzodiazepines alone are sufficient to prevent AWS. The alcoholic patient with a documented history of ARS, who experiences a single seizure or a short burst of seizures should be treated with lorazepam, 2 mg intravenously. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4198098 Thu, 25 Nov 2010 04:44:49 +0100 4198098 http://www.medworm.com/index.php?rid=4198097&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000891%2Fabstract%3Frss%3Dyes The physical and emotional stress of pregnancy can precipitate new-onset seizures in a woman. In these cases, emergency department evaluations must rule out underlying pathology. Careful consideration of antiepileptic drug use must be considered in the first trimester as all antiepileptic drugs have been linked to some teratogenic effect. Eclampsia must always be considered in the pregnant woman who is more than 20 weeks gestation; 25% of eclamptic seizures occur in the postpartum period. Magnesium is the recommended treatment for eclamptic seizures when delivery is not possible. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4198097 Thu, 25 Nov 2010 04:44:49 +0100 4198097 http://www.medworm.com/index.php?rid=4198096&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000829%2Fabstract%3Frss%3Dyes Most well-appearing children who have had an afebrile seizure can be managed as outpatients with instructions for an outpatient electroencephalogram and primary care physician follow-up. Laboratory studies are needed only in children younger than 6 months, in patients with prolonged seizures or altered level of consciousness, or in those with history of a metabolic disorder or dehydration. Emergent neuroimaging is not recommended in children with a first unprovoked afebrile seizure, although studies should be considered in children with a predisposing condition or focal seizures if younger than 3 years. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4198096 Thu, 25 Nov 2010 04:44:48 +0100 4198096 http://www.medworm.com/index.php?rid=4198095&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000817%2Fabstract%3Frss%3Dyes Febrile seizures are common in children, who are often brought to the nearest emergency department (ED). Patients who meet the case definition of simple febrile seizure are not at higher risk for serious bacterial illness than clinically similar febrile children who have not experienced a convulsion. Children who have had complex febrile seizures must be evaluated on a case-by-case basis, and treated with diagnostic and therapeutic measures based on the differential diagnosis. Round-the-clock prophylactic administration of antipyretics has not been demonstrated to affect recurrence of simple febrile seizure. Parents should be informed that recurrence is common, and that these convulsions are benign with an excellent prognosis. Care-givers should be informed that the risk of developing epil... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4198095 Thu, 25 Nov 2010 04:44:47 +0100 4198095 http://www.medworm.com/index.php?rid=4198094&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000805%2Fabstract%3Frss%3Dyes Patients with psychogenic (nonepileptic) seizures (PS) are frequently encountered by clinicians in the emergency medicine setting. Despite the tendency for these patients to seek frequent medical attention, the time between onset of symptoms and diagnosis is often more than 7 years. The cause of PS is multifactorial, but most patients are thought to have an underlying dissociative condition. The diagnostic evaluation in the emergency department is challenging and relies heavily on clinical suspicion, based on historical and physical features. Laboratory testing and therapeutic maneuvers are of limited utility; prolonged video electroencephalography is the diagnostic gold standard. Once the diagnosis has been secured, the mainstay of treatment involves addressing the underlying psychologic... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4198094 Thu, 25 Nov 2010 04:44:47 +0100 4198094 http://www.medworm.com/index.php?rid=4198093&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000799%2Fabstract%3Frss%3Dyes Nonconvulsive status epilepticus (NCSE) refers to a prolonged seizure that manifests primarily as altered mental status as opposed to the dramatic convulsions seen in generalized tonic-clonic status epilepticus. There are 2 main types of NCSE, each of which has a different presentation, cause, and expected outcome. In the first type of NCSE, patients present with confusion or abnormal behavior, suggesting the diagnosis of absence status epilepticus (ASE) or complex partial status epilepticus (CPSE). The second type of NCSE (subtle status epilepticus [SSE]) must be considered in comatose patients who present after a prolonged generalized tonic-clonic seizure and who may have only subtle motor manifestations of a seizure, such as facial or hand twitchings. Whereas the morbidity and mortality... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4198093 Thu, 25 Nov 2010 04:44:47 +0100 4198093 http://www.medworm.com/index.php?rid=4198092&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000787%2Fabstract%3Frss%3Dyes Generalized convulsive status epilepticus (GCSE) has a high morbidity and mortality, such that the rapid delivery of anticonvulsant therapy should be initiated within minutes of seizure onset to prevent permanent neuronal damage. GCSE is not a specific disease but is a manifestation of either a primary central nervous system (CNS) insult or a systemic disorder with secondary CNS effects. It is mandatory to look for an underlying cause. First-line therapies for seizures and status epilepticus include the use of a benzodiazepine, followed by an infusion of a phenytoin with a possible role for intravenous valproate or phenobarbital. If these first-line medications fail to terminate the GCSE, treatment includes the continuous infusion of midazolam, pentobarbital, or propofol. (Source: Emergenc... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4198092 Thu, 25 Nov 2010 04:44:46 +0100 4198092 http://www.medworm.com/index.php?rid=4198091&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000775%2Fabstract%3Frss%3Dyes Up to 5% of the population will experience at least 1 nonfebrile seizure at some point during their lifetime. The management of a patient who has had a first-time seizure is driven by the history and physical examination. In almost one-half of these patients, the cause of their seizure is not identified. In general, patients with comorbidities, a focal neurologic examination, or who have not returned to a normal baseline mental status require an extensive diagnostic evaluation including a noncontrast head computed tomography (CT) scan in the emergency department (ED). Adults with a first-time seizure, with no comorbidities, and who have returned to a normal baseline require only serum glucose and electrolyte determination. Women of reproductive age also require a pregnancy test. Patients w... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4198091 Thu, 25 Nov 2010 04:44:46 +0100 4198091 http://www.medworm.com/index.php?rid=4198089&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000751%2Fabstract%3Frss%3Dyes Although only 3% of people in the United States are diagnosed with epilepsy, 11% will have at least one seizure during their lifetime. Seizures account for about 1% of all emergency department (ED) visits, and about 2% of visits to children's hospital EDs. Seizure accounts for about 3% of prehospital transports. In adult ED patients, common causes of seizure are alcoholism, stroke, tumor, trauma, and central nervous system infection. In children, febrile seizures are most common. In infants younger than 6 months, hyponatremia and infection are important considerations. Epilepsy is an uncommon cause of seizures in the ED, accounting for a minority of seizure-related visits. Of ED patients with seizure, about 7% have status epilepticus, which has an age-dependent mortality averaging 22%. (S... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4198089 Thu, 25 Nov 2010 04:44:45 +0100 4198089 http://www.medworm.com/index.php?rid=4198088&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS073386271000074X%2Fabstract%3Frss%3Dyes The pathophysiology of seizures is multifactorial and incompletely understood. Experimental work demonstrates that prolonged, abnormal, and excessive neuronal electrical activity in itself is injurious through several mechanisms independent of systemic acidosis and hypoxia. Population survival studies and laboratory investigations support the idea that brain injury and epileptogenesis result from status epilepticus. The basic distinction in seizure types is that of generalized and partial seizures. Correct classification of seizure types will aid in clinical communications and guide correct therapies. Revised definitions of generalized convulsive status epilepticus suggest making this diagnosis with as few as 5 minutes of continuous seizure activity. (Source: Emergency Medicine Clinics of ... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4198088 Thu, 25 Nov 2010 04:44:43 +0100 4198088 http://www.medworm.com/index.php?rid=4198087&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710001045%2Fabstract%3Frss%3Dyes Seizures and status epilepticus (SE) are neurologic emergencies that occur frequently in the prehospital and Emergency Department (ED) settings. The majority of patients who have had an acute seizure or who are in SE are treated in the ED; thus, emergency physicians play a critical role in their resuscitation. Patients who are actively seizing require prompt diagnosis, treatment, and seizure termination in order to minimize morbidity and maximize outcomes. Acute care providers, including paramedics, nurses, and physicians, must consider the etiology of the event, provide diagnostic testing, provide anti-epileptic drugs (AEDs) and other interventions when indicated, and determine the appropriate disposition for the patient. In order to do so, the epidemiology, differential diagnosis, and li... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4198087 Thu, 25 Nov 2010 04:44:43 +0100 4198087 http://www.medworm.com/index.php?rid=4198086&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710001057%2Fabstract%3Frss%3Dyes Seizures have been a source of mystery and intrigue to medical and laypeople alike for thousands of years. The first book on epilepsy, On the Sacred Disease, was written by Hippocrates in 400 BC, and since that time, medical writers and physicians have attempted to identify, understand, and treat the condition. Many famous historical figures have been suspected of having seizures, including Socrates, Julius Caesar, Napoleon, and Lenin. Many modern-day celebrities have suffered from seizures and epilepsy as well, such as Budd Abbott, Danny Glover, Lindsey Buckingham, Prince, and Florence Griffith Joyner, among many, many others. Seizures are a condition that almost every adult member of our society has heard of and would identify if they witnessed one … such is the prevalence and prominen... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4198086 Thu, 25 Nov 2010 04:44:42 +0100 4198086 http://www.medworm.com/index.php?rid=4198085&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710001136%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=4198085 Thu, 25 Nov 2010 04:44:42 +0100 4198085 http://www.medworm.com/index.php?rid=4198084&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710001124%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=4198084 Thu, 25 Nov 2010 04:44:42 +0100 4198084 http://www.medworm.com/index.php?rid=4198083&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710001112%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=4198083 Thu, 25 Nov 2010 04:44:42 +0100 4198083 http://www.medworm.com/index.php?rid=4198082&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710001100%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=4198082 Thu, 25 Nov 2010 04:44:42 +0100 4198082 http://www.medworm.com/index.php?rid=4101647&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000982%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=4101647 Tue, 26 Oct 2010 00:56:32 +0100 4101647 http://www.medworm.com/index.php?rid=4101644&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000507%2Fabstract%3Frss%3Dyes Multidisciplinary orthogeriatric care can enhance prompt ED diagnosis, optimal pre- and postoperative care, and functional recovery in older adults with bony injuries. Emergency care providers should be cognizant of prevalent geriatric syndromes including delirium and standing level falls to minimize fracture-related morbidity. Recognizing the implications of aging physiology, acute care physicians should be aware of effective alternatives to analgesia, procedural sedation, and definitive imaging to promote early surgical management and postoperative recovery. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4101644 Tue, 26 Oct 2010 00:56:32 +0100 4101644 http://www.medworm.com/index.php?rid=4101643&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000489%2Fabstract%3Frss%3Dyes Many well seasoned emergency physicians often find it challenging to assess and treat pediatric patients regardless of the complaint. Because of anatomic and physiologic differences, pediatric patients experience orthopedic injuries that are both unique and specific to this subset of the population. Emergency physicians must be aware of these nuances to properly diagnose and treat these injuries. An understanding of fractures unique to growing bone, such as buckle/torus and greenstick types, will provoke clinicians to have a keener eye when reviewing pediatric radiographs. The Salter-Harris classification provides a proven, generally accepted stratification of injury to describe and properly disposition pediatric fractures. Emergency physicians must also recognize a distal radial fracture,... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4101643 Tue, 26 Oct 2010 00:56:31 +0100 4101643 http://www.medworm.com/index.php?rid=4101642&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000854%2Fabstract%3Frss%3Dyes The emergency provider (EP) must be aware of the anatomy of the leg, ankle, and foot. The varied presentation of common injuries must be recognized as well as the unique presentations of uncommon injuries. The astute EP must rely on a focused history and a precise examination to avoid the pitfalls and missed injuries from an over-reliance on radiographic studies. In some cases, emergent orthopedic consultation is required. Potential complications associated with these injuries must be anticipated and avoided if possible. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4101642 Tue, 26 Oct 2010 00:56:31 +0100 4101642 http://www.medworm.com/index.php?rid=4101641&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000556%2Fabstract%3Frss%3Dyes The knee plays a significant role in ambulation and the activities of daily living. During the course of these activities and its role in weight bearing, the knee is susceptible to a variety of different forces and the emergency physician should be familiar with the diagnosis and treatment of the injuries that result. In addition to following basic trauma protocols, thorough neurovascular and musculoskeletal examinations should be performed and supplemented with appropriate imaging. Emergency physicians should also consider recent developments in knee anatomy and function when evaluating the patient with an acutely injured knee. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4101641 Tue, 26 Oct 2010 00:56:31 +0100 4101641 http://www.medworm.com/index.php?rid=4101640&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000568%2Fabstract%3Frss%3Dyes The management of pelvic fractures and hip injuries requires a multidisciplinary approach and begins in the prehospital setting. With the current advances in various investigative modalities along with the use of algorithms, the morbidity and mortality from these injuries has improved. This review discusses an outline of the current recommendations along with treatment strategies and options in the emergency department, which may vary from institution to institution based on the availability of expertise and resources and because no two trauma patients are alike with regard to the pathophysiology and injury patterns. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4101640 Tue, 26 Oct 2010 00:56:31 +0100 4101640 http://www.medworm.com/index.php?rid=4101637&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000738%2Fabstract%3Frss%3Dyes This article highlights the most frequent forearm and elbow injuries seen 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=4101637 Tue, 26 Oct 2010 00:56:30 +0100 4101637 http://www.medworm.com/index.php?rid=4101636&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000519%2Fabstract%3Frss%3Dyes This article provides a review of the evaluation and treatment of common injuries to the shoulder, humerus, and clavicle in the emergency department (ED) setting. In addition to a focused review of the shoulder's physical examination, topics include common emergent injuries such as glenohumeral dislocations, proximal humerus fractures, and acromioclavicular separations as well as less common, but important injuries including pectoralis and biceps tendon injuries and sternoclavicular dislocations. Accurate recognition and management of these injuries is essential in the optimal care of patients 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=4101636 Tue, 26 Oct 2010 00:56:30 +0100 4101636 http://www.medworm.com/index.php?rid=4101635&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000696%2Fabstract%3Frss%3Dyes This article focuses on evaluation and management of blunt cervical spine trauma by the emergency physician. Pertinent anatomy of the cervical spine and specific cervical spine fractures are discussed, with an emphasis on unstable injuries and associated spinal cord pathology. The association of vertebral artery injury with cervical spine fracture is addressed, followed by a review of the most recent literature on prehospital care. Initial considerations in the emergency department, including cervical spine stabilization and airway management, are reviewed. The most current recommendations for cervical spine imaging with regard to indications and modalities are covered. Finally, emergency department management and disposition of patients with spinal cord injuries are reviewed. (Source: Eme... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4101635 Tue, 26 Oct 2010 00:56:30 +0100 4101635 http://www.medworm.com/index.php?rid=4101634&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000866%2Fabstract%3Frss%3Dyes This edition of Emergency Medicine Clinics of North America is focused on the Emergency Department (ED) management of orthopedic injuries. The treatment of orthopedic patients is a growing part of our specialty with over 42.4 million injury-related visits to the ED in 2006. This fact along with the realization that immediate orthopedic consultation in the ED can often be difficult to impossible in some communities require that the emergency provider be comfortable and competent with the initial stabilization and management of orthopedic injuries. The American Association of Orthopaedic Surgeons also recognizes this and released a position statement in 2008 that acknowledges, “access to emergency orthopedic care in the United States is problematic and may get worse. At present, there is v... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4101634 Tue, 26 Oct 2010 00:56:30 +0100 4101634 http://www.medworm.com/index.php?rid=4101633&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000878%2Fabstract%3Frss%3Dyes In many other countries, the specialty of Emergency Medicine is referred to as “Accident and Emergency Medicine.” The addition of the word “Accident” provides appropriate recognition of the fact that many patients that present for emergency care are not suffering from a medical disorder but rather are victims of accidental trauma, having sustained orthopedic injuries. It is no surprise, therefore, that management of orthopedic injuries constitutes a significant part of the practice of emergency medicine. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4101633 Tue, 26 Oct 2010 00:56:30 +0100 4101633 http://www.medworm.com/index.php?rid=4101632&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710001033%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=4101632 Tue, 26 Oct 2010 00:56:30 +0100 4101632 http://www.medworm.com/index.php?rid=4101631&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000969%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=4101631 Tue, 26 Oct 2010 00:56:30 +0100 4101631 http://www.medworm.com/index.php?rid=4101630&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000957%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=4101630 Tue, 26 Oct 2010 00:56:30 +0100 4101630 http://www.medworm.com/index.php?rid=4101629&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000945%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=4101629 Tue, 26 Oct 2010 00:56:30 +0100 4101629 http://www.medworm.com/index.php?rid=4198090&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000763%2Fabstract%3Frss%3Dyes Seizure is one of the most common complaints encountered in the prehospital setting. In this review the authors discuss the prehospital management of seizures and review the evidence for specific treatment approaches. Specific attention is devoted to prehospital care of the pediatric seizure patient. Topics of interest to Emergency Medical Services directors such as patient refusal, resource allocation, and dispatch priority are also addressed. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4198090 Mon, 18 Oct 2010 00:00:00 +0100 4198090 http://www.medworm.com/index.php?rid=4101645&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000544%2Fabstract%3Frss%3Dyes The practice of wound care has greatly improved and evolved over the years. The emergency provider (EP) can choose from a wide variety of sutures, adhesives, strips, and surgical staples, and uses proven wound closure techniques to address this common Emergency Department (ED) patient complaint. All EPs should be comfortable and proficient in the management and care of wounds in the ED. Because wound care is responsible for a large number of malpractice claims, EPs need to be aware of practices that can limit bad outcomes and thus decrease their liability risk. EPs should follow a standard examination and ensure that there is no damage to underlying structures (ie, nerves, tendons, and vasculature), and that foreign bodies are meticulously looked for and removed if found. Discharge instruc... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4101645 Wed, 04 Aug 2010 23:00:00 +0100 4101645 http://www.medworm.com/index.php?rid=4101639&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000465%2Fabstract%3Frss%3Dyes This article focuses on the essential elements of an efficient and effective evaluation, management and treatment of patients with back pain in the ED, with special emphasis on epidural abscess, epidural compression syndrome, malignancy, spinal stenosis, and back pain in children. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4101639 Wed, 04 Aug 2010 23:00:00 +0100 4101639 http://www.medworm.com/index.php?rid=3870053&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000659%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=3870053 Sat, 31 Jul 2010 23:00:00 +0100 3870053 http://www.medworm.com/index.php?rid=3870052&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000350%2Fabstract%3Frss%3Dyes This article discusses the physiology and clinical syndromes involved in ethanol absorption, intoxication, and withdrawal, with special emphasis on the evidentiary backing for common treatments, as well as some discussion of the medicolegal sequelae of treatment of ethanol abusers 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=3870052 Sat, 31 Jul 2010 23:00:00 +0100 3870052 http://www.medworm.com/index.php?rid=3870050&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000428%2Fabstract%3Frss%3Dyes This article examines common endocrine and metabolic causes of altered mentation in the ED via sections dedicated to endocrine-, electrolyte-, metabolic acidosis-, and metabolism-related causes. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3870050 Sat, 31 Jul 2010 23:00:00 +0100 3870050 http://www.medworm.com/index.php?rid=3870049&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000349%2Fabstract%3Frss%3Dyes Delirium is defined as an acute change in cognition that cannot be better accounted for by a preexisting or evolving dementia. This form of organ dysfunction commonly occurs in older patients in the emergency department (ED) and is associated with a multitude of adverse patient outcomes. Consequently, delirium should be routinely screened for in older ED patients. Once delirium is diagnosed, the ED evaluation should focus on searching for the underlying cause. Infection is one of the most common precipitants of delirium, but multiple causes may exist concurrently. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3870049 Sat, 31 Jul 2010 23:00:00 +0100 3870049 http://www.medworm.com/index.php?rid=3870048&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000398%2Fabstract%3Frss%3Dyes When patients present to the emergency department with changes in behavior and levels of consciousness, psychiatric causes often move to the top of the list of diagnostic considerations. It is important to thoroughly assess such patients for medical causes. Although it is not common for primary psychiatric conditions to present with altered levels of consciousness, severe cases may present in this fashion. Altered mental states may also be caused by adverse reactions to psychiatric medications. In this article, the authors review some of the psychiatric causes of decreased levels of consciousness, as well as certain adverse drug reactions to psychotropic medications. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3870048 Sat, 31 Jul 2010 23:00:00 +0100 3870048 http://www.medworm.com/index.php?rid=3870047&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000325%2Fabstract%3Frss%3Dyes Mild traumatic brain injury (mTBI) refers to the clinical condition of transient alteration of consciousness as a result of traumatic injury to the brain. The priority of emergency care is to identify and facilitate the treatment of rare but potentially life-threatening intracranial injuries associated with mTBI through the judicious application of appropriate imaging studies and neurosurgical consultation. Although post-mTBI symptoms quickly and completely resolve in the vast majority of cases, a significant number of patients will complain of lasting problems that may cause significant disability. Simple and early interventions such as patient education and appropriate referral can reduce the likelihood of chronic symptoms. Although definitive evidence is lacking, mTBI is likely to be re... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3870047 Sat, 31 Jul 2010 23:00:00 +0100 3870047 http://www.medworm.com/index.php?rid=3870046&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000313%2Fabstract%3Frss%3Dyes There are several central nervous system (CNS) infections (meningitis, encephalitis, and brain abscess), any of which may present with an altered level of consciousness. Because CNS infections can have a devastating outcome, it is important to recognize the presence of a CNS infection and begin treatment as soon as possible because early appropriate therapy may, in some cases, limit morbidity and mortality. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3870046 Sat, 31 Jul 2010 23:00:00 +0100 3870046 http://www.medworm.com/index.php?rid=3870045&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000404%2Fabstract%3Frss%3Dyes This article provides an overview of the numerous causes of altered mental status and seizures: metabolic, toxic, malignant, infectious, and endocrine causes. The article focuses on those agents that should prompt the emergency physician to initiate unique therapy to abate the seizure and correct the underlying cause. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3870045 Sat, 31 Jul 2010 23:00:00 +0100 3870045 http://www.medworm.com/index.php?rid=3870044&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000386%2Fabstract%3Frss%3Dyes Pediatric syncope is a common presentation in the emergency department. Most causes are benign, but an evaluation must exclude rare life-threatening disorders. The lack of objective findings can pose a challenge. This case-based review emphasizes the importance of a detailed history and physical examination with electrocardiogram in determining high-risk patients. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3870044 Sat, 31 Jul 2010 23:00:00 +0100 3870044 http://www.medworm.com/index.php?rid=3870043&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS073386271000043X%2Fabstract%3Frss%3Dyes This article reviews the current status of syncope from the emergency department perspective, focusing on the current evidence behind the various clinical decision rules derived during the past decade. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3870043 Sat, 31 Jul 2010 23:00:00 +0100 3870043 http://www.medworm.com/index.php?rid=3870042&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000362%2Fabstract%3Frss%3Dyes This article reviews the diagnosis and ED work-up of syncope, the different classifications of syncope, and prognosis. The use of specific decision rules in risk stratification and syncope in the pediatric population are discussed in another article. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3870042 Sat, 31 Jul 2010 23:00:00 +0100 3870042 http://www.medworm.com/index.php?rid=3870041&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000337%2Fabstract%3Frss%3Dyes This article covers the general approach to patients who present to the emergency department with a complaint of dizziness or vertigo, and altered mentation. Patients' histories and physical examination findings are discussed first, then a pertinent differential diagnosis, ranging from neurological causes and poor perfusion states to toxicologic causes, is described along with the distinguishing features and potential diagnostic pitfalls of each problem. Case scenarios are presented and the treatment and disposition of patients from the emergency department are discussed. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3870041 Sat, 31 Jul 2010 23:00:00 +0100 3870041 http://www.medworm.com/index.php?rid=3870040&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000374%2Fabstract%3Frss%3Dyes This article offers an approach to allow better management of a patient with altered mental status. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3870040 Sat, 31 Jul 2010 23:00:00 +0100 3870040 http://www.medworm.com/index.php?rid=3870039&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000520%2Fabstract%3Frss%3Dyes You know that awesome feeling, the one you get when you walk up to the rack (now computer tracking board) to find out who your next patient is? What disease process are you up against next? How can you use your detective skills to solve the next mystery, whether you are Inspector Clouseau or Inspector Gadget? That investigation might be one of the best parts of emergency medicine, unless the patient happens to have altered mental status, perhaps the most dreaded chief complaint. Now I could be wrong, but I do not recall hearing any of my colleagues or residents screaming for joy when they pick up that chart. What I do know is that altered mental status is an all too common presenting complaint in emergency departments (EDs) across the globe and for an astounding 25% of patients more than 7... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3870039 Sat, 31 Jul 2010 23:00:00 +0100 3870039 http://www.medworm.com/index.php?rid=3870038&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000532%2Fabstract%3Frss%3Dyes Since the time of ancient civilizations, philosophers and scientists have tried to define and understand “consciousness.” A simple internet search using this term reveals more than 47 million sites, many of them various definitions or quotes by philosophers, from Aristotle to Freud, about this term. A consistent description of consciousness that emerged from a cursory review of those sites was the description of consciousness as a sense of one's own identity. It is therefore arguable that an altered or loss of consciousness represents one of the most heinous medical presentations we encounter in emergency medicine—a loss of one's identity. Not surprisingly, one of the most basic and also most vital components of any medical student or resident curriculum in emergency medicine and one... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3870038 Sat, 31 Jul 2010 23:00:00 +0100 3870038 http://www.medworm.com/index.php?rid=3870037&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000702%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=3870037 Sat, 31 Jul 2010 23:00:00 +0100 3870037 http://www.medworm.com/index.php?rid=3870036&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000635%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=3870036 Sat, 31 Jul 2010 23:00:00 +0100 3870036 http://www.medworm.com/index.php?rid=3870035&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000623%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=3870035 Sat, 31 Jul 2010 23:00:00 +0100 3870035 http://www.medworm.com/index.php?rid=3870034&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000611%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=3870034 Sat, 31 Jul 2010 23:00:00 +0100 3870034 http://www.medworm.com/index.php?rid=4101646&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000477%2Fabstract%3Frss%3Dyes Avoiding legal pitfalls of orthopedic injuries in the emergency department (ED) requires an understanding of certain high-risk injuries, their presentation, evaluation, and disposition. Various pitfalls pertaining to both upper and lower extremity injuries are discussed in detail, with recommendations regarding the history, physical examination, and radiographic techniques that minimize the risk inherent in these injuries. When approaching these injuries in the ED, a high level of suspicion coupled with appropriate evaluation and management will allow the practitioner to avoid mismanagement of these potential pitfall cases. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4101646 Thu, 29 Jul 2010 23:00:00 +0100 4101646 http://www.medworm.com/index.php?rid=4101638&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000490%2Fabstract%3Frss%3Dyes The anatomy of the hand is complex, which allows for the dexterity, strength, and adaptability of the most functional aspect of the musculoskeletal system. The evaluation and management of injuries to this area can be time consuming and pose a significant medicolegal risk to the emergency physician. Improperly diagnosed and managed injuries can lead to chronic pain, inability to perform activities of daily living, and even seemingly minor injuries can lead to missed work causing a significant cost to the individual and society. The purpose of this article is to review injuries to the hand and wrist and discuss diagnostic studies and treatment plans that the emergency physician can use to treat patients effectively and minimize their exposure to risk. (Source: Emergency Medicine Clinics of... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4101638 Thu, 29 Jul 2010 23:00:00 +0100 4101638 http://www.medworm.com/index.php?rid=3870051&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000416%2Fabstract%3Frss%3Dyes The diagnosis and management of poisoned patients presenting with alterations in mental status can be challenging, as patients are often unable (or unwilling) to provide an adequate history. Several toxidromes exist. Recognition hinges upon vital signs and the physical examination. Understanding these “toxic syndromes” may guide early therapy and management, providing insight into the patient's underlying medical problem. Despite toxidrome recognition guiding antidotal therapy, the fundamental aspect of managing these patients involves meticulous supportive care. The authors begin with a discussion of various toxidromes and then delve into the drugs responsible for each syndrome. They conclude with a discussion on drug-facilitated sexual assault (“date rape”), which is both an unde... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3870051 Wed, 23 Jun 2010 23:00:00 +0100 3870051 http://www.medworm.com/index.php?rid=3491936&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS073386271000026X%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=3491936 Thu, 22 Apr 2010 13:15:41 +0100 3491936 http://www.medworm.com/index.php?rid=3491935&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000143%2Fabstract%3Frss%3Dyes Health care workers are at risk for human immunodeficiency virus (HIV) and other infectious pathogens through exposure to blood and body fluids. Antiretroviral medications have been prescribed for postexposure prophylaxis following occupational exposure to the HIV since the early 1990s. This practice has since been extended to nonoccupational situations, such as sexual assaults. The efficacy of prophylactic therapy may be highly time-dependent and should be initiated as soon as possible. Wound care management and referral for social, medical, or advocacy services remain important for all cases. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3491935 Thu, 22 Apr 2010 13:15:41 +0100 3491935 http://www.medworm.com/index.php?rid=3491934&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS073386271000012X%2Fabstract%3Frss%3Dyes Although antiretroviral therapy (ART) for human immunodeficiency virus (HIV) has been in use since 1987, the initiation of highly active ART has produced an increase in adverse drug reactions. This is a new challenge as many of the adverse drug reactions attributable to ART may be indistinguishable from non–drug-related illnesses. The emergency physician must be aware of the potential complications of ART as affected patients may present with nonspecific symptoms. The focus of this article is the metabolic and hepatobiliary adverse effects of ART. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3491934 Thu, 22 Apr 2010 13:15:40 +0100 3491934 http://www.medworm.com/index.php?rid=3491933&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000052%2Fabstract%3Frss%3Dyes Immune reconstitution inflammatory syndrome (IRIS) must be considered in the differential diagnosis for any patient infected with HIV who has begun ART in the preceding months. Distinguishing between manifestations of IRIS and active infection is of paramount importance and poses a diagnostic challenge to the provider in the acute care setting. Presentations of IRIS are often atypical for the precipitating pathogen, and novel presentations are likely. Of the diseases associated with IRIS, mycobacteria and cryptococcal infections are commonly encountered, as are dermatologic symptoms in general. The most clinically significant complications of IRIS are those involving the central nervous system, lungs, and eye, and in many of these scenarios systemic steroids may be of benefit. Management s... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3491933 Thu, 22 Apr 2010 13:15:40 +0100 3491933 http://www.medworm.com/index.php?rid=3491932&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000039%2Fabstract%3Frss%3Dyes Acute human immunodeficiency virus (HIV) infection, also known as primary HIV infection, is the initial phase of infection, spanning from inoculation to the establishment of CD4 count and viral load set points. This phase is marked by dynamic changes in viral replication and host immune responses and contains 2 important clinical events: acute retroviral syndrome and seroconversion. Acute HIV infection is challenging to diagnose, but with recent improvements in diagnostic testing and a heightened awareness of acute HIV, the emergency physician is well positioned to make this diagnosis and initiate important interventions for the individual patient and public health. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3491932 Thu, 22 Apr 2010 13:15:40 +0100 3491932 http://www.medworm.com/index.php?rid=3491931&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS073386271000009X%2Fabstract%3Frss%3Dyes In 2001 and then again in 2006, the Centers for Disease Control and Prevention (CDC) published guidelines recommending universal HIV screening in acute care settings, including emergency departments (EDs). The value of early identification and treatment of HIV-infected patients is clear, but the most effective method for accomplishing this has yet to be determined. In this article, published experiences by ED-based HIV screening programs are reviewed to learn lessons from their mistakes and accomplishments. The goal of this article is to encourage thought regarding previous experiences with HIV screening and future ideas for improving efforts to this end. By examining the variety of HIV testing kits available, the debate regarding targeted testing versus screening, the consent and patient ... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3491931 Thu, 22 Apr 2010 13:15:40 +0100 3491931 http://www.medworm.com/index.php?rid=3491930&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000027%2Fabstract%3Frss%3Dyes Cutaneous diseases occur in most people infected with human immunodeficiency virus (HIV) and at a higher rate than people not infected with HIV. Common HIV-related rashes and rashes made unusual by HIV infection are reviewed. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3491930 Thu, 22 Apr 2010 13:15:40 +0100 3491930 http://www.medworm.com/index.php?rid=3491929&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000118%2Fabstract%3Frss%3Dyes Antiretroviral therapy has revolutionized the care of individuals infected with the human immunodeficiency virus (HIV) and has fundamentally altered the scope of the disease. Acute renal failure and chronic kidney disease from medication toxicity and comorbid noninfectious illnesses are just as likely today as end-organ injury from the virus itself. Chronic immunosuppression renders HIV-infected patients vulnerable to any of several unique urological infections not frequently seen in immunocompetent patients. A deeper understanding of renal and urological emergencies in the context of the HIV-infected patient will better prepare the emergency physician to render optimal care to this rapidly expanding and aging patient population. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3491929 Thu, 22 Apr 2010 13:15:40 +0100 3491929 http://www.medworm.com/index.php?rid=3491928&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000106%2Fabstract%3Frss%3Dyes There are several musculoskeletal conditions that are specific or unique to the patient infected with human immunodeficiency virus (HIV). These conditions affecting the patient with HIV can be divided into 4 categories: disseminated diseases, bone disorders, joint disease, and myopathies. This review focuses on the manifestations of HIV on musculoskeletal disease as they relate to the emergency physician. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3491928 Thu, 22 Apr 2010 13:15:40 +0100 3491928 http://www.medworm.com/index.php?rid=3491927&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000088%2Fabstract%3Frss%3Dyes This article discusses the various hematologic and oncologic diseases to consider when caring for a patient with HIV infection. These diseases are not only more common in this patient population, but they can often be more severe, leading to greater morbidity and mortality than would be expected for a patient without HIV infection. Among the hematologic conditions discussed are common blood dyscrasias such as anemia, leucopenia, and thrombocytopenia, as well as less common disease processes such as immune thrombocytopenic purpura, thrombotic thrombocytopenic purpura, and venous thromboses. The oncologic diseases discussed include AIDS-defining conditions, such as Kaposi sarcoma, invasive cervical carcinoma and non-Hodgkin lymphoma. The recognition of these conditions in patients infected w... Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3491927 Thu, 22 Apr 2010 13:15:40 +0100 3491927 http://www.medworm.com/index.php?rid=3491926&cid=s_33222_14_f&fid=33222&url=http%3A%2F%2Fwww.emed.theclinics.com%2Farticle%2FPIIS0733862710000131%2Fabstract%3Frss%3Dyes This article examines the epidemiology, diagnosis, and currently available treatment for patients with HIV-related AMS. (Source: Emergency Medicine Clinics of North America) Emergency Medicine Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3491926 Thu, 22 Apr 2010 13:15:40 +0100 3491926