Emergency medicine clinics of North America
-
Neurocritical care aims to improve outcomes in patients with life-threatening neurologic illness. The scope of neurocritical care extends beyond the more commonly encountered and important field of cerebrovascular disease, as described previously. This article focuses on neuromuscular, neuroinfectious, and neuroimmunologic conditions that are significant causes of morbidity and mortality in the acutely neurologically ill patient. As understanding continues to increase regarding the physiology of these conditions and the best treatment, rapid identification, triage, and treatment of these patients in the emergency department is paramount.
-
Emerg. Med. Clin. North Am. · Nov 2014
ReviewEarly Identification and Management of Patients with Severe Sepsis and Septic Shock in the Emergency Department.
Severe sepsis and septic shock have great relevance to Emergency Medicine physicians because of their high prevalence, morbidity, and mortality. Treatment is time-sensitive, depends on early identification risk stratification, and has the potential to significantly improve patient outcomes. In this article, we review the pathophysiology of, and evidence basis for, the emergency department management of severe sepsis and septic shock.
-
Emerg. Med. Clin. North Am. · Nov 2014
ReviewLung-protective Ventilation Strategies and Adjunctive Treatments for the Emergency Medicine Patient with Acute Respiratory Failure.
Respiratory failure is a frequent disease process encountered in the emergency department. There is significant need for improvement in the care of patients on mechanical ventilation. If not contraindicated, lung-protective ventilation strategies should be used. It is important to consider pathophysiology (shunting, dead space ventilation, and low venous admixture) when formulating treatment strategies in patients who are difficult to oxygenate or ventilate or when Pao2, Paco2, and pH can only be maintained at unsafe ventilator settings.
-
Bleeding is the second leading cause of death after trauma. Initial care of the patient with hemorrhage focuses on restoring circulating blood volume and reversing coagulopathy. Trauma and injury can initiate the coagulation cascade. ⋯ Hemostatic resuscitation in conjunction with ratio-based transfusion and massive transfusion protocols should be utilized while awaiting hemorrhage control. The military initiated massive transfusion protocols in the battlefield. We discuss the coagulation cascade, recent recommendations of goal-directed therapy, massive transfusion protocols, fixed ratios, and the future of transfusion medicine.
-
Resuscitative ultrasonography provides rapid, repeatable, and multisystem assessment to guide diagnosis and management of critically ill patients in the emergency department (ED). Cardiac ultrasonography offers new anatomic and hemodynamic information, previously unavailable in an ED setting, whereas other applications match or exceed the speed and utility of existing tests such as chest radiograph (thoracic ultrasonography) or central venous pressure determination (inferior vena cava ultrasonography). Evolving areas of resuscitative ultrasonography include neurologic applications and transesophageal echocardiography, which promise to further enhance the role of ultrasonography in managing critical illness in the ED.