Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Nov 2022
ReviewPacemaker Malfunction-Review of Permanent Pacemakers and Malfunctions Encountered in the Emergency Department.
Pacemaker malfunction refers to a failure of the pacemaker to perform the desired cardiac pacemaking function. These malfunctions can occur anywhere within the system from the pulse generator and leads to the electrode-myocardium interface. These failures of sensing, capture, and inadequate pacing can have severe hemodynamic consequences, so rapid identification of specific dysfunction is critical to intervention and stabilization. Emergency providers should be aware of pacemaker components, function, basic programming, and types of malfunctions to adequately assess, stabilize, and disposition patients.
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Wide complex tachycardias (WCT) are frequently encountered in the emergency department. Causes of WCT vary from benign (eg, supraventricular with rate-related aberrancy) to life threatening (eg, atrial fibrillation with WPW, or ventricular tachycardia). ⋯ Treatment of WCT depends on patient stability, regularity of the rhythm, and QRS morphology. When in doubt, monomorphic WCT should be presumed to be ventricular tachycardia and treated as such.
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High-sensitivity cardiac troponin (hs-cTn) assays are highly specific to cardiac tissue and can detect small amounts of myocardial injury rapidly. Hs-cTn assays are the recommended cardiac biomarkers in the major US and European guidelines. ⋯ This can have significant downstream impacts on the percentage of patients discharged from the emergency department (ED), ED lengths of stay, cardiac testing, and hospitalizations. There are many proposed diagnostic protocols and experts recommend institutions implement a single validated protocol.
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Pharmacologic therapy is an integral component in the management of most cardiovascular emergencies. This article reviews the pharmacotherapy involved in the treatment of acute coronary syndromes, acute heart failure, and various arrhythmias. The focus will be to provide practical pearls that can be applied at the bedside in the Emergency Department.