Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Aug 2015
ReviewCardiovascular Catastrophes in the Obstetric Population.
Pregnancy is a complex and dynamic physiologic state, in which the needs of the mother and fetus must achieve a fine balance with one another. Some of the most dreaded and deadly complications that can arise during this period affect the cardiovascular system are hypertensive emergencies (including preeclampsia and eclampsia), acute coronary syndrome, peripartum cardiomyopathy, dysrhythmias, dissection, thromboembolism, and cardiac arrest. This review provides emergency physicians, obstetricians, intensivists, and other health care providers with the most recent information on the diagnosis and management of these deadly cardiovascular complications of pregnancy.
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Patients with acute decompensated heart failure are usually critically ill and require immediate treatment. However, most are not volume overloaded. ⋯ A diuretic should not be administered before optimal preload and afterload reduction has been achieved. Short-term inotropic therapy can be considered in select patients with cardiogenic shock and acute decompensated heart failure (ADHF) who fail to respond to standard therapy.
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Emerg. Med. Clin. North Am. · Aug 2015
ReviewThe Critically Ill Infant with Congenital Heart Disease.
This article presents an approach for identification of infants with congenital heart disorders. These disorders are difficult to diagnose because of the complexity and variety of cardiac malformations; additionally presentation can be complicated by age-dependent physiology. ⋯ Critical congenital cardiac lesions can be classified as left-sided obstructive ductal dependent, right-sided obstructive ductal dependent, and shunting or mixing. The simplified approach categorizes infants with these lesions respectively as "pink," "blue," or "gray." The emergency provider can provide life-saving stabilization until specialized care can be obtained.
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Hypertension affects approximately one-third of Americans. An additional 30% are unaware that they harbor the disease. ⋯ Several pharmacologic options are available for treatment, with intravenous antihypertensive therapy being the cornerstone, but there is no standard of care. Careful consideration of each patient's specific complaint, history, and physical examination guides the emergency physician through the treatment algorithm.