Emergency medicine clinics of North America
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Few presentations to the emergency department are as critical or dramatic as the patient in shock. Cardiovascular disasters that commonly present with shock include massive pulmonary embolism, cardiac tamponade, aortic dissection and aneurysm, and cardiogenic shock associated with acute myocardial infarction. Because patients in "cardiovascular shock" have similar clinical presentations and a high degree of morbidity and mortality, they demand rapid, efficient, and aggressive evaluation and treatment. This article reviews the evaluation and treatment of patients presenting with cardiovascular shock.
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Narrow complex tachycardias are those cardiac rhythms with a ventricular rate of more than 100 beats per minute and a QRS complex width of less than 0.12 seconds. They originate either from the SA node, from atrial tissue itself, or from in or around the AV node. ⋯ Atrial and junctional rhythms can be treated with vagal maneuvers, drugs from classes I to IV and other antiarrythmic agents, magnesium, and cardioversion. Some patients may be candidates for surgical or catheter ablation.
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Echocardiography represents an important, accessible tool in the evaluation of the critically ill emergency department patient. Echocardiography provides anatomic and physiologic information about the cardiovascular system safely and at the bedside. This modality may permit early and more accurate diagnosis and management of a wide range of disease processes while avoiding the risks and costs associated with other diagnostic strategies. It is imperative that emergency department physicians have a working understanding of the applications and limitations of echocardiography to make best use of its considerable patient care potential.
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Emerg. Med. Clin. North Am. · Nov 1995
ReviewNonemergent hypertension. New perspectives for the emergency medicine physician.
The emergency medicine physician must evaluate and treat hypertensive patients in a variety of contexts, ranging from the compliant patient with well-controlled blood pressure who presents for an unrelated problem, to the patient with asymptomatic blood pressure elevation, to the patient with a true hypertensive urgency or emergency. Recently, the approach to the treatment of adult hypertension has been modified to take into account advances in the understanding of individual patient risk factors and relative risk of cardiovascular complications. ⋯ From this perspective, the authors define hypertensive urgency and make recommendations for more careful deliberation in management decisions. This article, along with the article on hypertensive emergencies in this issue, provides an approach to the patient presenting to the emergency department with hypertension, elevated blood pressure, or both.
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Research into the physiologic changes that occur during cardiac arrest and resuscitation have led to important changes in our approach to resuscitation of the cardiac arrest victim. Methods that improve coronary perfusion pressure, coupled with direct or indirect measures of coronary perfusion, are actively being sought to improve resuscitation rates and outcomes. ⋯ Although significant improvements in hospital discharge rates and neurologic outcome have not been realized as yet, a firm basis for future studies has been established. Overall, the most significant intervention that the clinician can presently perform is early and prompt defibrillation of the patient in ventricular fibrillation.