Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Aug 2019
ReviewResuscitating the Critically Ill Geriatric Emergency Department Patient.
The emergency department resuscitation of the critically ill geriatric patient is challenging and can be fraught with peril. The anatomic and physiologic changes that occur with aging can significantly influence the recognition of critical illness and the logistics of resuscitation itself. This article discusses the relevant physiologic changes with aging, the effect of these changes on clinical manifestations of critical illness in older adults, and the core principles of resuscitation in this population, with specific attention to sepsis and trauma care. In addition, end-of-life care is also discussed.
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Emerg. Med. Clin. North Am. · Aug 2019
ReviewBeyond Mean Arterial Pressure and Lactate: Perfusion End Points for Managing the Shocked Patient.
Patients in shock present frequently to the emergency department. The emergency physician must be skilled in the resuscitation of both differentiated and undifferentiated shock. ⋯ Therapy should focus on the restoration of oxygen delivery to match tissue demand. This article reviews the evidence supporting common end points of resuscitation for common etiologies of shock and limitations to their use.
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Emerg. Med. Clin. North Am. · Aug 2019
ReviewIntracranial Hemorrhage and Intracranial Hypertension.
Central nervous system hemorrhage has multiple pathophysiologic etiologies, including intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and traumatic brain injury (TBI). Given the nuances intrinsic to each of these etiologies and pathophysiologic processes, optimal blood pressure varies significantly and depends on type of hemorrhage and individual characteristics. This article reviews the most current evidence regarding blood pressure targets and provides guidance on reversal of anticoagulation for TBI, ICH, and SAH. It also describes the assessment, optimal therapeutic targets, and interventions to treat intracranial hypertension that can result from TBI, ICH, or SAH.
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Emerg. Med. Clin. North Am. · Aug 2019
ReviewSedation and Analgesia for Mechanically Ventilated Patients in the Emergency Department.
Mechanically ventilated patients can experience significant pain and anxiety associated with their care. These symptoms should be aggressively treated, but can be challenging to manage without a systematic approach. This article reviews recent literature, current guidelines, and best practices in managing pain, agitation, and anxiety in mechanically ventilated patients in the emergency department.
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Emerg. Med. Clin. North Am. · Aug 2019
ReviewMechanical Ventilation in Hypoxemic Respiratory Failure.
Acute hypoxemic respiratory failure (AHRF) is a common challenge in emergency medicine. Patient outcomes depend on interventions performed during preintubation, intubation, and postintubation. The article presents recommendations for evidence-based practice to optimally manage patients with AHRF and the acute respiratory distress syndrome.