Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Nov 2016
ReviewDiagnosis of Acute Neurologic Emergencies in Pregnant and Postpartum Women.
Acute neurologic symptoms in pregnant and postpartum women may be caused by exacerbation of a preexisting neurologic condition, the initial presentation of a non-pregnancy-related problem, or a new neurologic problem. Pregnant and postpartum patients with headache and neurologic symptoms are often diagnosed with preeclampsia or eclampsia; however, other etiologies must also be considered. A team approach with close communication between emergency physicians, neurologists, maternal-fetal medicine specialists, and radiologists is the key to obtaining best outcomes. This article reviews the clinical features and differential diagnosis of acute serious neurologic conditions in pregnancy and the puerperium, focusing on diagnosis.
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Weakness is a common complaint in the emergency department, and a most challenging one, because before the emergency physician can proceed with an evaluation, the complaint of weakness must be fully clarified to determine about what the patient is actually complaining. This article will focus on causes of acute generalized nontraumatic bilateral weakness. Evaluation begins with the history and physical examination, followed by diagnostic testing in some cases.
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Emerg. Med. Clin. North Am. · Nov 2016
ReviewA New Approach to the Diagnosis of Acute Dizziness in Adult Patients.
Dizziness is a common chief complaint in emergency medicine. The differential diagnosis is broad and includes serious conditions, such as stroke, cardiac arrhythmia, hypovolemic states, and acute toxic and metabolic disturbances. ⋯ The traditional approach does not distinguish benign from dangerous causes and is not consistent with best current evidence. This article presents a new approach to the diagnosis of acutely dizzy patients that highly leverages the history and the physical examination.
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Emerg. Med. Clin. North Am. · Nov 2016
ReviewTransient Ischemic Attacks: Advances in Diagnosis and Management in the Emergency Department.
The definition of a transient ischemic attack (TIA) has evolved over the past decade from a clinical diagnosis to a tissue-based definition based on neuroimaging results. TIA shares the same pathophysiology as stroke, which occurs in up to 5% of patients within 48 hours of the TIA and 10% within 90 days. ⋯ Decision support scores have been developed to risk stratify patients, which include clinical and radiological elements. Antiplatelet and anticoagulant therapy, as well as carotid endarterectomy/stenting have been shown to reduce the stroke occurrence after TIA.
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Emerg. Med. Clin. North Am. · Nov 2016
ReviewDiagnosis and Management of Acute Intracerebral Hemorrhage.
Intracerebral hemorrhage (ICH) is the deadliest type of stroke and up to half of patients die in hospital. Blood pressure management, coagulopathy reversal, and intracranial pressure control are the mainstays of acute ICH treatment. Prevention of hematoma expansion and minimally invasive hematoma evacuation are promising therapeutic strategies under investigation. This article provides an updated review on ICH diagnosis and management in the emergency department.