Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Nov 2011
Review Case ReportsAcute coronary syndrome clinical presentations and diagnostic approaches in the emergency department.
This article discusses clinical presentations and diagnostic approaches to acute coronary syndrome in the emergency department.
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Emerg. Med. Clin. North Am. · Nov 2011
ReviewA phased approach to cardiac arrest resuscitation involving ventricular fibrillation and pulseless ventricular tachycardia.
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).
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Emerg. Med. Clin. North Am. · Nov 2011
ReviewApproach to the ED patient with "low-risk" chest pain.
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.
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Emerg. Med. Clin. North Am. · Nov 2011
ReviewEmergency department treatment of acute coronary syndromes.
Acute coronary syndrome (ACS) is a broad term encompassing a spectrum of acute myocardial ischemia and injury ranging from unstable angina and non-ST-segment elevation myocardial infarction to ST-segment elevation myocardial infarction. ACS accounts for approximately 1.2 million hospital admissions in the United States annually. The aging of the United States population, along with the national obesity epidemic and the associated increase in metabolic syndrome, means that the number of individuals at risk for ACS will continue to increase for the foreseeable future. This article reviews the current evidence and guidelines for the treatment of patients along the continuum of ACS.
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Pediatric congenital heart disease comprises a wide spectrum of structural defects. These lesions present in a limited number of ways. ⋯ 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 E(1) and early pediatric cardiology consultation is essential for positive outcomes.