Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · May 2023
ReviewEmergency Medicine Considerations in the Transgender Patient.
Transgender patients are at high risk for poor health outcomes and many harbor fear of healthcare settings secondary to prior discrimination, perceived sensationalism, clinician unfamiliarity, and unwanted exams. It is essential to approach transgender patients without judgement and with empathy. Asking open ended questions with explanation as to why your questions are pertinent to their specific care will help create rapport and trust. Through a basic working knowledge of terminology, types of hormone therapy, non-surgical techniques, garments, and surgical procedures typically encountered by such patients, and their respective potential side effects and complications, clinicians can provide quality care to transgender patients.
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Despite the majority of US births occurring in hospitals and under the direct care of obstetricians, there is a subset of patients who will deliver imminently in the emergency department (ED). ED physicians must be skillfully trained to manage both uncomplicated and complicated delivery scenarios. An ED delivery may require resuscitation of both mother and infant, so supplies should be readily available and all necessary consultants and support staff should be involved to ensure the best outcome. Most births are uncomplicated and require no significant additional interventions but ED staff must be prepared for these more complicated scenarios.
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In this article, we discuss the major nonobstetric surgical complications that may occur in pregnancy. We highlight specific diagnostic challenges particularly with imaging modalities and radiation considerations for the fetus. Topics covered in this article include appendicitis, intestinal obstruction, gallstone disease, hepatic rupture, perforated peptic ulcer, mesenteric venous thrombosis, splenic artery aneurysm rupture, and aortic dissection.
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Intimate partner violence and sexual violence represent significant public health challenges that carry many individual and societal costs. More than 1 in 3 women (35.6%) and more than 1 in 4 men (28.5%) in the United States have experienced rape, physical violence, and/or stalking by an intimate partner in their lifetime. Clinicians play an integral role on the screening, identification, and management of these sensitive issues.