Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Aug 2015
ReviewCardiotoxicodynamics: Toxicity of Cardiovascular Xenobiotics.
Maintaining adequate tissue perfusion depends on a variety of factors, all of which can be influenced by xenobiotics (substances foreign to the body, including pharmaceuticals, chemicals, and natural compounds). Volume status, systemic vascular resistance, myocardial contractility, and cardiac rhythm all play a significant role in ensuring hemodynamic stability and proper cardiovascular function. Direct effects on the nervous system, the vasculature, or the heart itself as well as indirect metabolic effects may play a significant role in the development of cardiotoxicity. This article is dedicated to discussion of the disruption of cardiovascular physiology by xenobiotics.
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Atrial fibrillation (AF) is a supraventricular tachyarrhythmia that results from the chaotic depolarization of atrial tissue. AF is the most common sustained cardiac dysrhythmia and the most common dysrhythmia diagnosed in US emergency departments. All patients with AF must have their cardioembolic risk assessed, even if sinus rhythm is restored. Novel oral anticoagulants may be considered instead of vitamin K antagonists for anticoagulation in patients with nonvalvular AF.
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Cardiac arrest afflicts more than 300,000 persons annually in North America alone. Advances in systematic, regimented postresuscitation care have lowered mortality and improved neurologic outcomes in select cohorts of patients over the last decade. ⋯ For most patients, high-quality postcardiac arrest care begins in the Emergency Department. This article reviews the evidence and offers treatment strategies for the key components of postcardiac arrest care.
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Emerg. Med. Clin. North Am. · Aug 2015
ReviewEmergency Care of Patients with Pacemakers and Defibrillators.
Devices such as pacemakers and implantable cardioverter-defibrillators (ICDs) are commonly inserted to treat unstable cardiac rhythm disturbances. Despite the benefits of these devices on mortality and morbidity rates, patients often present to the emergency department with complaints related to device insertion or malfunction. Emergency physicians must be able to rapidly identify potential life threats caused by pacemaker malfunction, ICD firing, and complications associated with implantation of the devices.
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Emerg. Med. Clin. North Am. · Aug 2015
ReviewManagement of Crashing Patients with Pulmonary Hypertension.
Critically ill patients with pulmonary hypertension (PH) often seem well, but they can decompensate dramatically in a short time. PH has several causes, classes, and complications; but the natural progression eventually leads to right ventricular failure, which can be extraordinarily difficult to manage. The purpose of this review is to discuss the causes, signs, and symptoms of PH as well as its management strategies and emergent complications. Treatment options are often limited, so it is imperative that the emergency department physician can recognize and manage these patients in a timely fashion.