Emergency medicine clinics of North America
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Traumatic brain injury (TBI) contributes significantly to the mortality and morbidity rates of traumatized patients. This article presents current concepts in the pathophysiology of TBI, including mechanisms of injury, biomolecular mediators of injury, and the occurrence of secondary injury. Emergency management, monitoring, and imaging of TBI also are reviewed.
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Emerg. Med. Clin. North Am. · Feb 1996
ReviewTriage of critically ill patients: an overview of interventions.
The recognition of tissue hypoxia or cumulative oxygen debt is of fundamental importance for triage and resuscitation of critically ill patients during the ¿golden hour¿ in the emergency department (ED). The measurement of central venous blood oxygen saturation, plasma lactate concentration, cardiac output, systemic oxygen transport and use, and non-vital organ oxygenation and function can enhance the detection of systemic and regional hypoperfusion and tissue hypoxia. Systemic and organ-specific oxygenation indices may guide the choice of therapy to optimize resuscitation of the macrocirculation and microcirculation in critically ill ED patients.
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This article reviews the critical resuscitations necessary during prehospital and emergency department treatment of cardiac arrest. Standard therapy for cardiac arrest rhythms is presented. Novel pharmacologic agents, types of cardiopulmonary resuscitation, and circulatory-assist devices are discussed.
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Assessment and management of patients with blunt abdominal trauma remains a challenge for emergency physicians. The spectrum of injury ranges from the trivial to the catastrophic and the initial assessment, resuscitation, and investigation of patients with abdominal trauma must be individualized. This article covers the important aspects of patient history and physical examination and addresses the relevant investigative tools available. An approach to the assessment of patients with abdominal trauma is provided; the goal is to diagnose significant injuries as soon as possible and avoid the pitfall of a delayed or missed diagnosis.
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Recent evolution in the thinking of sepsis syndrome has provided a framework on which new clinical and basic research can be built. The separation of the inciting event and the cascade of subsequent physiologic changes has profound effects on how sepsis is thought of and ultimately how it will be treated. Early identification and treatment of infections and identifying patients at risk, to prevent SIRS, is the current role of Eps. ⋯ Modulation of the inflammatory response appears to be a prime prospect, but its practicality remains to be proved. Research and future roles of EPs include defining the population of ED patients at risk for SIRS and use of mediators of the inflammatory response. Emergency medicine is positioned in a critical point in the care of these patients.