Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Feb 2003
ReviewEvaluation and management of the high-risk orthopedic emergency.
Orthopedic injuries are frequently seen in the ED. Whereas the diagnosis and management of most of these injuries is straightforward, there are distinct pitfalls to avoid. The common theme among the high-risk "pitfall" injuries discussed in this article, besides a thorough patient history and careful physical examination with appropriate radiographs, is a high suspicion for the presence of these injuries. When the EP is knowledgeable about these orthopedic pitfalls, these injuries are much less likely to slip by in clinical practice.
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Emerg. Med. Clin. North Am. · Feb 2003
ReviewMedication errors in the emergency department: a systems approach to minimizing risk.
Adverse drug events caused by medication errors represent a common cause of patient injury in the practice of medicine. Many medication errors are preventable and hence particularly tragic when they occur, often with serious consequences. The enormous increase in the number of available drugs on the market makes it all but impossible for physicians, nurses, and pharmacists to possess the knowledge base necessary for fail-safe medication practice. ⋯ A systems approach to the complex problem of medication errors will help emergency clinicians eliminate preventable adverse drug events and achieve a goal of a zero-defects system, in which medication errors are a thing of the past. New developments in information technology and the advent of electronic medical records with computerized physician order entry, ward-based clinical pharmacists, and standardized bar codes promise substantial reductions in the incidence of medication errors and adverse drug events. ED patients expect and deserve nothing less than the safest possible emergency medicine service.
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Emerg. Med. Clin. North Am. · Feb 2003
ReviewDiagnosis of subarachnoid hemorrhage in the emergency department.
To decide which patients with headache ought to be evaluated for SAH, physicians should focus on specific elements of the patient history, such as onset, severity, and quality of the headache and associated symptoms. These questions should be asked and the responses documented for every patient with a headache. The physical examination should be compulsive with regard to vital signs, HEENT. and neurologic signs. ⋯ Physicians should understand the limitations of this diagnostic algorithm. In addition, the CSF should be carefully analyzed, including measuring the opening pressure. In patients whose CT scans and CSF analyses are normal, further testing is rarely indicated.
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Emerg. Med. Clin. North Am. · Feb 2003
ReviewPearls and pitfalls in the emergency department evaluation of abdominal pain.
Abdominal pain is a common complaint in the emergency department (ED), comprising approximately 5% of total visits. Although not typically serious, abdominal pain often presents many difficult situations for the clinician. ⋯ This article outlines the epidemiology of abdominal pain in patients who present to the ED, and provides guidelines pertinent to the evaluation of all patients. In addition, the article discusses the approach to abdominal pain of pelvic origin in women of reproductive age and abdominal pain in elderly individuals.
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Emerg. Med. Clin. North Am. · Feb 2003
ReviewManagement of lacerations in the emergency department.
The goals of wound management are simple: avoid infection and achieve a functional and aesthetically pleasing scar. This is achieved by reducing tissue contamination, debriding devitalized tissue, and restoring perfusion in poorly perfused wounds, in conjunction with a well-approximated skin closure.