Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · May 2012
Acute exacerbations of chronic obstructive pulmonary disease in the emergency department.
Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity and mortality worldwide. Acute exacerbations of COPD (AECOPDs) are a common presentation to emergency departments and are an important cause of respiratory failure. This article discusses the disease process and diagnosis of COPD and AECOPD. A further in-depth discussion is undertaken of evidence-based treatments, palliation, and disposition of patients who present to emergency departments with AECOPD.
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With the increasing prevalence of human immunodeficiency virus/AIDS patients and patients receiving chemotherapy for various malignancies, the numbers of immunosuppressed patients who present to the emergency department is on the increase. Thoracic-related emergencies in these vulnerable patients are serious and challenging to diagnose for the emergency physician, due mainly to atypical presentations, atypical pathogens, and to the often tenuous state of health of the patient. This article addresses a variety of cardiovascular, pulmonary, and esophageal emergencies that are seen specifically in immunocompromised patients presenting to the emergency department. Epidemiology, clinical presentation, investigations, prognosis, management, and evidence-based recommendations are discussed.
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Emerg. Med. Clin. North Am. · May 2012
Pneumonia in adults: the practical emergency department perspective.
In those patients who are hospitalized with pneumonia, mortality is 15%. Close to 90% of deaths attributed to pneumonia are in patients older than 65 years. This article provides the emergency physician with an understanding of how to make the diagnosis, initiate early and appropriate antibiotic therapy, risk stratify patients with respect to the severity of illness, and recognize indications for admission. The discussion is balanced with an emphasis on cost-effective management, an understanding of the changing spectrum of pathogenesis, and a cognizance toward variable and less common presentations.
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Dyspnea and hypotension often present a diagnostic challenge to the emergency physician. With limitations on traditional methods of evaluating these patients, lung ultrasound has become an essential assessment tool. With the sensitivity of lung ultrasound approaching that of CT scan for many indications, it is quickly becoming a fundamental technique in assessing patients with thoracic emergencies. This article reviews the principles of thoracic ultrasound; describes the important evidence-based sonographic features found in pneumothorax, pleural effusion, pneumonia, and pulmonary edema; and provides a framework of how to use thoracic ultrasound to aid in assessing a patient with severe dyspnea.
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Emerg. Med. Clin. North Am. · May 2012
ReviewDiagnosis and management of environmental thoracic emergencies.
Physiologic sequelae from increasing ambient pressure in underwater activities, decreasing ambient pressure while at altitude, or the consequences of drowning present a unique set of challenges to emergency physicians. In addition, several environmental toxins cause significant respiratory morbidity, whether they be pulmonary irritants, simple asphyxiants, or systemic toxins. It is important for emergency physicians to understand the pathophysiology of these illnesses as well as to apply this knowledge to the clinical arena either in the prehospital setting or in the emergency department. Current treatment paradigms and controversies within these regimens are discussed.