Emergency medicine clinics of North America
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This article provides brief updates, pearls, and pitfalls on aspects of emergency practice that are dealt with routinely, including the application of diagnostic testing in the emergency department, ruling out subarachnoid hemorrhage, and the use of tympanic temperatures. Physician-patient and physician-physician communication skills are addressed. Finally, medicolegal and administrative topics, such as EMTALA, writing admitting orders, treating minors in the emergency department, and blood product therapy in Jehovah's Witnesses are also discussed.
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Emergency cardiac problems are a frequent and significant occurrence in the daily life of the emergency physician. The first part of this article discusses some of the pearls and pitfalls of caring for the cardiac patient ranging from treating wide-complex tachycardia and troubleshooting pacemaker malfunction to diagnosing acute myocardial infarction in the setting of bundle branch blocks. The second part of this article updates the reader on several of the newer technologies and treatments, such as transesophageal echocardiography and intravenous amiodarone, now in use in the emergency department setting.
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Patients present to the emergency department with a number of eye, ear, nose, and throat (ENT) problems. This article updates some very common problems; identifies a few pearls on nasal foreign body removal, ophthalmologic medication, and epistaxis; and reviews a few pitfalls in identifying malignancies and sore throats.
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A pediatric focus in the emergency department requires an understanding of age-specific parameters of assessment and management. Differential considerations are unique in the pediatric patient reflecting both congenital and acquired conditions. Respiratory problems, meningitis, seizures, and child abuse require careful assessment and aggressive intervention. When approaching the ill child, attention must be directed toward reducing anxiety and pain in the patient.
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Pearls and pitfalls learned from our practical experiences caring for poisoned patients are presented. Clinical pearls include the following: using diagnostic tests to detect end-organ toxicity, applying physiologic principles to the management of hemodynamically unstable poisoned patients, and dealing with psychologic injuries from hazardous materials incidents. ⋯ Therefore, updates on the evolving role of NAC as an antidote for acetaminophen poisoning, new psychotropic medications, and new antidotes were included in this article. These pearls, pitfalls, and updates are intended to provide practical information that is readily applicable to the clinical practice of emergency medicine.